Reproductive rights

Reproductive Rights are legal rights and freedoms relating to reproduction and reproductive health. The World Health Organisation defines reproductive rights as follows: Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.

Reproductive rights began to develop a subset of human rights at the United Nation's 1968 International Conference on Human Rights. The resulting non binding Proclamation of Teheran was the first international document to recognize one of these rights when it stated that: "Parents have a basic human right to determine freely and responsibly the number and the spacing of their children." States, though, have been slow in incorporating these rights in internationally legally binding instruments. Thus, while some of these rights have already been recognized in hard law, that is, in legally binding international human rights instruments, others have been mentioned only in non binding recommendations and, therefore, have at best the status of soft law in international law, while a further group is yet to be accepted by the international community and therefore remains at the level of advocacy. Center for Reproductive Rights, International Legal Program, Establishing International Reproductive Rights Norms: Theory for Change, US CONG. REC. 108th CONG. 1 Sess. E2534 E2547 (Rep. Smith) (Dec. 8, 2003): "We have been leaders in bringing arguments for a woman's right to choose abortion within the rubric of international human rights. However, there is no binding hard norm that recognizes women's right to terminate a pregnancy. (...) While there are hard norms prohibiting sex discrimination that apply to girl adolescents, these are problematic since they must be applied to a substantive right (i.e., the right to health) and the substantive reproductive rights of adolescents are not `hard' (yet!). There are no hard norms on age discrimination that would protect adolescents' ability to exercise their rights to reproductive health, sexual education, or reproductive decisionmaking. In addition, there are no hard norms prohibiting discrimination based on marital status, which is often an issue with respect to unmarried adolescents' access to reproductive health services and information. The soft norms support the idea that the hard norms apply to adolescents under 18. They also fill in the substantive gaps in the hard norms with respect to reproductive health services and information as well as adolescents' reproductive autonomy. (...) There are no hard norms in international human rights law that directly address HIV/AIDS directly. At the same time, a number of human rights bodies have developed soft norms to secure rights that are rendered vulnerable by the HIV/AIDS epidemic. (...) Practices with implications for women's reproductive rights in relation to HIV/AIDS are still not fully covered under existing international law, although soft norms have addressed them to some extent. (...) There is a lack of explicit prohibition of mandatory testing of HIV-positive pregnant women under international law. (...) None of the global human rights treaties explicitly prohibit child marriage and no treaty prescribes an appropriate minimum age for marriage. The onus of specifying a minimum age at marriage rests with the states' parties to these treaties. (...) We have to rely extensively on soft norms that have evolved from the TMBs and that are contained in conference documents to assert that child marriage is a violation of fundamental human rights."

According to Knudsen, issues related to reproductive rights are some of the most vigorously contested rights' issues worldwide, regardless of the population's socioeconomic level, religion or culture. Reproductive rights may include some or all of the following: the right to legal or safe abortion, the right to birth control, the right to access quality reproductive healthcare, and the right to education and access in order to make reproductive choices free from coercion, discrimination, and violence. Reproductive rights may also include the right to receive education about contraception and sexually transmitted infections, and freedom from coerced sterilization, abortion, and contraception, and protection from gender-based practices such as female genital cutting (FGC) and male genital mutilation (MGM).

Proclamation of Teheran
In 1945, the UN Charter included the obligation "to promote... universal respect for, and observance of, human rights and fundamental freedoms for all without discrimination as to race, sex, language, or religion". However, the Charter did not define these rights. Three years later, the UN adopted the Universal Declaration of Human Rights (UDHR), the first international legal document to delineate human rights; the UDHR does not mention reproductive rights. Reproductive rights began to appear as a subset of human rights in the 1968 Proclamation of Teheran, which states: "Parents have a basic right to decide freely and responsibly on the number and spacing of their children and a right to adequate education and information in this respect".

This right was affirmed by the UN General Assembly in the 1974 Declaration on Social Progress and Development which states "The family as a basic unit of society and the natural environment for the growth and well-being of all its members, particularly children and youth, should be assisted and protected so that it may fully assume its responsibilities within the community. Parents have the exclusive right to determine freely and responsibly the number and spacing of their children." The 1975 UN International Women's Year Conference echoed the Proclamation of Teheran.

Cairo Programme of Action
The twenty year "Cairo Programme of Action" was adopted in 1994 at the International Conference on Population and Development (ICPD) in Cairo. The non binding Programme of Action asserted that governments have a responsibility to meet individuals' reproductive needs, rather than demographic targets. It recommended that Family planning services be provided in the context of other reproductive health services, including services for healthy and safe childbirth, care for sexually transmitted infections, and post-abortion care. The ICPD also addressed issues such as violence against women, sex trafficking, and adolescent health. The Cairo Program is the first international policy document to define reproductive health, stating: "Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed [about] and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant [para. 72]."

Unlike previous population conferences, a wide range of interests from grassroots to government level were represented in Cairo. 179 nations attended the ICPD and overall eleven thousand representatives from governments, NGOs, international agencies and citizen activists participated. The ICPD did not address the far-reaching implications of the HIV/AIDS epidemic. In 1999, recommendations at the ICPD+5 were expanded to include commitment to AIDS education, research, and prevention of mother-to-child transmission, as well as to the development of vaccines and microbicides.

The Cairo Programme of Action was adopted by 184 UN member states. Nevertheless, many Latin American and Islamic States made formal reservations to the programme, in particular, to its concept of reproductive rights and sexual freedom, to its treatment of abortion, and to its potential incompatibility with Islamic Law. .

Beijing Platform
The 1995 Fourth World Conference on Women in Beijing, in its non binding Declaration and Platform for Action, supported the Cairo Programme's definition of reproductive health, but established a broader context of reproductive rights: "The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behavior and its consequences [para. 96]." The Beijing Platform demarcated twelve interrelated critical areas of the human rights of women that require advocacy. The Platform framed women's reproductive rights as "indivisible, universal and inalienable human rights."

Reproductive rights and human rights
Since most existing legally binding international human rights instruments do not explicitly mention sexual and reproductive rights, a broad coalition of NGOs, civil servants, and experts working in international organizations has been promoting successfully a reinterpretation of those instruments to link the realization of the already internationally recognized human rights with the realization of reproductive rights. Amnesty International, Defenders of Sexual and Reproductive Rights; International Women’s Health Coalition and the United Nations, Campaign for an Inter-American Convention on Sexual and Reproductive Rights, Women's Health Collection, [http://www.thefreelibrary.com/_/print/PrintArticle.aspx?id=105915323 Abortion as a human right: possible strategies in unexplored territory. (Sexual Rights and Reproductive Rights),] (2003); and Shanthi Dairiam, Applying the CEDAW Convention for the recognition of women's health rights, Arrows For Change, (2002). In this regard, the Center for Reproductive Rights has noted that: "Our goal is to ensure that governments worldwide guarantee women's reproductive rights out of an understanding that they are bound to do so. The two principal prerequisites for achieving this goal are: (1) the strengthening of international legal norms protecting reproductive rights; and (2) consistent and effective action on the part of civil society and the international community to enforce these norms. Each of these conditions, in turn, depends upon profound social change at the local, national and international (including regional) levels. (...) Ultimately, we must persuade governments to accept reproductive rights as binding norms. Again, our approach can move forward on several fronts, with interventions both at the national and international levels. Governments' recognition of reproductive rights norms may be indicated by their support for progressive language in international conference documents or by their adoption and implementation of appropriate national-level legislative and policy instruments. In order to counter opposition to an expansion of recognized reproductive rights norms, we have questioned the credibility of such reactionary yet influential international actors as the United States and the Holy See. Our activities to garner support for international protections of reproductive rights include: Lobbying government delegations at UN conferences and producing supporting analyses/materials; fostering alliances with members of civil society who may become influential on their national delegations to the UN; and preparing briefing papers and factsheets exposing the broad anti-woman agenda of our opposition." Center for Reproductive Rights, International Legal Program, Establishing International Reproductive Rights Norms: Theory for Change, US CONG. REC. 108th CONG. 1 Sess. E2534 E2547 (Rep. Smith) (Dec. 8, 2003) An example of this linkage is provided by the 1994 Cairo Programme of Action: "reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other relevant United Nations consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes the right of all to make decisions concerning reproduction free of discrimination, coercion and violence as expressed in human rights documents. In the exercise of this right, they should take into account the needs of their living and future children and their responsibilities towards the community." Similarly, Amnesty International has argued that the realisation of reproductive rights is linked with the realisation of a series of recognised human rights, including the right to health, the right to freedom from discrimination, the right to privacy, and the right not to be subjected to torture or ill-treatment. However, not all states have accepted the inclusion of reproductive rights in the body of internationally recognized human rights. At the Cairo Conference, several states made formal reservations either to the concept of reproductive rights or to its specific content. Ecuador, for instance, stated that: "With regard to the Programme of Action of the Cairo International Conference on Population and Development and in accordance with the provisions of the Constitution and laws of Ecuador and the norms of international law, the delegation of Ecuador reaffirms, inter alia, the following principles embodied in its Constitution:  the inviolability of life, the protection of children from the moment of conception, freedom of conscience and religion, the protection of the family as the fundamental unit of society, responsible paternity, the right of parents to bring up their children and the formulation of population and development plans by the Government in accordance with the principles of respect for sovereignty. Accordingly, the delegation of Ecuador enters a reservation with respect to all terms such as "regulation of fertility", "interruption of pregnancy", "reproductive health", "reproductive rights" and "unwanted children", which in one way or another, within the context of the Programme of Action, could involve abortion." Similar reservations were made by Argentina, Dominican Republic, El Salvador, Honduras, Malta, Nicaragua, Paraguay, Peru and the Holy See. Islamic Countries, such as Brunei Darussalam, Djibouti, Iran, Jordan, Kuwait, Libya, Syria, United Arab Emirates, and Yemen made broad reservations against any element of the programme that could be interpreted as contrary to the Sharia. Guatemala even questioned whether the conference could legally proclaim new human rights.

Reproductive rights as women's rights
The United Nations Population Fund (UNFPA) and the World Health Organization (WHO) advocate for reproductive rights with a primary emphasis on women's rights. In this respect the UN and WHO focus on a range of issues, including access to family planning services, sex education, menopause, and the reduction of obstetric fistula, to the relationship between reproductive health and economic status.

The reproductive rights of women are advanced in the context of the right to freedom from discrimination and the social and economic status of women. The group Development Alternatives with Women for a New Era (DAWN) explained the link in the following statement: "Control over reproduction is a basic need and a basic right for all women. Linked as it is to women's health and social status, as well as the powerful social structures of religion, state control and administrative inertia, and private profit, it is from the perspective of poor women that this right can best be understood and affirmed. Women know that childbearing is a social, not a purely personal, phenomenon; nor do we deny that world population trends are likely to exert considerable pressure on resources and institutions by the end of this century. But our bodies have become a pawn in the struggles among states, religions, male heads of households, and private corporations. Programs that do not take the interests of women into account are unlikely to succeed..."

Attempts have been made to analyse the socioeconomic conditions that affect the realisation of a woman's reproductive rights. The term reproductive justice has been used to describe these broader social and economic issues. Proponents of reproductive justice argue that while the right to legalized abortion and contraception applies to everyone, these choices are only meaningful to those with resources, and that there is a growing gap between access and affordability.

Reproductive rights as men's rights
Men's reproductive rights have been claimed by various organizations, both for issues of reproductive health, and other rights related to sexual reproduction.

Three international issues in men's reproductive health are sexually transmitted diseases, cancer and exposure to toxins.

Recently men's reproductive right with regards to paternity have become subject of debate in the U.S. The term "male abortion" was coined by Melanie McCulley, a South Carolina attorney, in a 1998 article. The theory begins with the premise that when a woman becomes pregnant she has the option of abortion, adoption, or parenthood; it argues, in the context of legally recognized gender equality, that in the earliest stages of pregnancy the putative (alleged) father should have the right to relinquish all future parental rights and financial responsibility, leaving the informed mother with the same three options. See child support.

In 2006, the National Center for Men brought a case in the US, Dubay v. Wells (dubbed by some "Roe v. Wade for men"), that argued that in the event of an unplanned pregnancy, when an unmarried woman informs a man that she is pregnant by him, he should have an opportunity to give up all paternity rights and responsibilities. Supporters argue that this would allow the woman time to make an informed decision and give men the same reproductive rights as women. In its dismissal of the case, the U.S. Court of Appeals (Sixth Circuit) stated that "the Fourteenth Amendment does not deny to [the] State the power to treat different classes of persons in different ways."

Cairo Programme of Action implementation
Implementation of the Cairo Programme of Action varies considerably from country to country. In many countries, post-ICPD tensions emerged as the human rights-based approach was implemented. Since the ICPD, many countries have broadened their reproductive health programs and attempted to integrate maternal and child health services with family planning. More attention is paid to adolescent health and the consequences of unsafe abortion. Lara Knudsen observes that the ICPD succeeded in getting feminist language into governments' and population agencies' literature, but in many countries the underlying concepts are not widely put into practice. In two preparatory meetings for the ICPD+10 in Asia and Latin America, the United States, under the George W. Bush Administration, was the only nation opposing the ICPD's Programme of Action.

Abortion
Pro-choice activists argue that "twenty percent of all pregnancies worldwide end in abortion, and nearly half of those abortions are unsafe and often illegal." There are, however, more reliable facts: According to the WHO, more than 45 million (legal and illegal) abortions take place annually. At the same time, approximately 66,500 women die from the complications of unsafe abortion every year (according to data repeatedly published by Ipas).

An article from the World Health Organization calls safe, legal abortion a "fundamental right of women, irrespective of where they live" and unsafe abortion a "silent pandemic". The article states "ending the silent pandemic of unsafe abortion is an urgent public-health and human-rights imperative." It also states "access to safe abortion improves women’s health, and vice versa, as documented in Romania during the regime of President Nicolae Ceausescu" and "legalisation of abortion on request is a necessary but insufficient step toward improving women’s health" citing that in some countries, such as India where abortion has been legal for decades, access to competent care remains restricted because of other barriers. WHO’s Global Strategy on Reproductive Health, adopted by the World Health Assembly in May 2004, noted: “As a preventable cause of maternal mortality and morbidity, unsafe abortion must be dealt with as part of the MDG on improving maternal health and other international development goals and targets." The WHO's Development and Research Training in Human Reproduction (HRP), who's research concerns people's sexual and reproductive health and lives, has an overall strategy to combat unsafe abortion that comprises four inter-related activities :
 * to collate, synthesize and generate scientifically sound evidence on unsafe abortion prevalence and practices;
 * to develop improved technologies and implement interventions to make abortion safer;
 * to translate evidence into norms, tools and guidelines;
 * and to assist in the development of programmes and policies that reduce unsafe abortion and improve access to safe abortion and highquality postabortion care

When negotiating the Cairo Programme of Action at the 1994 International Conference on Population and Development (ICPD), the issue was so contentious that delegates eventually decided to omit any recommendation to legalize abortion, instead advising governments to provide proper post-abortion care and to invest in programs that will decrease the number of unwanted pregnancies.

On April 18, 2008 the Parliamentary Assembly of the Council of Europe, a group comprising members from 47 European countries, has adopted a resolution calling for the decriminalization of abortion within reasonable gestational limits and guaranteed access to safe abortion procedures. The nonbinding resolution was passed on April 16 by a vote of 102 to 69.

During and after the ICPD, some interested parties attempted to interpret the term ‘reproductive health’ in the sense that it implies abortion as a means of family planning or, indeed, a right to abortion. These interpretations, however, do not reflect the consensus reached at the Conference. For the European Union, where legislation on abortion is certainly less restrictive than elsewhere, the Council Presidency has clearly stated that the Council’s commitment to promote ‘reproductive health’ did not include the promotion of abortion. Likewise, the European Commission, in response to a question from a Member of the European Parliament, clarified:

''“The term ‘reproductive health’ was defined by the United Nations (UN) in 1994 at the Cairo International Conference on Population and Development. All Member States of the Union endorsed the Programme of Action adopted at Cairo. The Union has never adopted an alternative definition of ‘reproductive health’ to that given in the Programme of Action, which makes no reference to abortion.”'' With regard to the US, it should be noted that, only a few days prior to the Cairo Conference, the head of the US delegation, Vice President Al Gore, had stated for the record: “Let us get a false issue off the table: the US does not seek to establish a new international right to abortion, and we do not believe that abortion should be encouraged as a method of family planning.” Some years later, the position of the US Administration in this debate was reconfirmed by US Ambassador to the UN, Ellen Sauerbrey, when she stated at a meeting of the UN Commission on the Status of Women that: “nongovernmental organizations are attempting to assert that Beijing in some way creates or contributes to the creation of an internationally recognized fundamental right to abortion”. She added: ''“There is no fundamental right to abortion. And yet it keeps coming up largely driven by NGOs trying to hijack the term and trying to make it into a definition”''.

Collaborative research from the Institute of Development Studies states that "access to safe abortion is a matter of human rights, democracy and public health, and the denial of such access is a major cause of death and impairment, with significant costs to [international] development". The research highlights the inequities of access to safe abortion both globally and nationally and emphasises the importance of global and national movements for reform to address this. The shift by campaigners of reproductive rights from an issue-based agenda (the right to abortion), to safe, legal abortion not only as a human right, but bound up with democratic and citizenship rights, has been an important way of reframing the abortion debate and reproductive justice agenda.

Population control
Compulsory or forced sterilizations and abortions may also occur in the context of population control policies. From the 1970s to 1980s, tension grew between women's health activists who advance women's reproductive rights as part of a human rights-based approach and population control advocates. At the 1984 UN World Population Conference in Mexico City population control policies came under attack from women's health advocates who argued that the policies' narrow focus led to coercion and decreased quality of care and that these policies ignored the varied social and cultural contexts in which family planning was provided in developing countries. In the 1980s the HIV/AIDS epidemic forced a broader discussion of sex into the public discourse in many countries, leading to more emphasis on reproductive health issues beyond reducing fertility. The growing opposition to the narrow population control focus led to a significant departure in the early 1990s from past population control policies.