Reproductive Health and

UNIT 9 REPRODUCTIVE HEALTH AND Rights

RIGHTS
Structure
9.1 Introduction
9.2 Objectives
9.3 What is Reproductive Health and Rights?
9.3.1 What is Reproductive Health?
9.3.2 What is Programme of Action for India under RCH Approach?
9.4 Indicators of Reproductive Health
9.5 Reproductive and Child Health policy: A Critiques
9.6 Summing Up
9.7 Key Words
9.8 References
9.9 Unit End Questions

9.1 INTRODUCTION
Reproductive health and rights of every individual are fundamental to the well-
being of the family, community, society and development of a country. The
Programme of Action of the International Conference on Population and
Development at Cairo in the year 1994 defined reproductive health and included
the perspective of individual rights under its definition. The Cairo programme
laid down the purpose of reproductive health is “enhancement of life and personal
relations and not merely to counseling and care related to reproduction and
sexually transmitted disease (WHO, 2015, p. 4). Reproductive and maternal health
are major issues of concern in both developing and the developed worlds and it
impacts women and men differently. For instance, reproductive health and rights
deal with issues of pregnancy, childbirth and individual access to contraception
and safe abortion. These issues become complicated for women when it intersects
with other cultural and social practices. With this background, you will learn
about reproductive health and rights from a gender perspective.

9.2 OBJECTIVES
After studying this Unit, you would be able to:
Know the meaning of Reproductive Health and Rights;
Comprehend the indicators of Reproductive Health and Rights;
Explore about various international conventions and their role in
implementing the Reproductive Rights Approach; and
Explain briefly about the Reproductive and Child Health Policy (RCH) in
India.
Let us begin with reading what is understood by reproductive health and
reproductive rights of an individual.

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Health and Gender
9.3 WHAT IS REPRODUCTIVE HEALTH AND
RIGHTS?
Reproductive rights are also legal rights that give freedom to individual/couple
to take decision with regard to reproduction and reproductive health (Jaiswal
2012). The conceptualization of reproductive health and right can be linked to
the early women’s struggle to demand their right to legal and safe abortion in the
industrialized countries. Later, the concept of women’s reproductive health was
reformulated in the year 1994 at International Conference on Population and
Development (ICPD) popularly known as the Cairo conference. Cairo conference
emphasized that women’s health is socially constructed therefore it is important
to understand reproductive health in the context of individual or couple’s right to
reproductive health. Reproductive health is recognized as human right issues
also.
What is the difference between Reproductive Rights and Reproductive
Health?
The ICPD defines Reproductive Rights in its Chapter 7 as follows:
These rights rest on the recognition of the basic right of all couples and individu-
als 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 their
right to make decisions concerning reproduction free of discrimination, coer-
cion and violence. UN Population Fund, para. 7.3.; original emphasis, cited in
Jaiswal 2012, p.14)
Reproductive right is a broader framework under which reproductive health was
included and clearly defined. The definition of reproductive health was recognized
by the Fourth World Conference on Women in 1995 known as the Beijing
Declaration and Platform for Action as a human right issue for women.
Reproductive rights may include the following rights for women;
right to legal or safe abortion;
right to birth control;
the right of access quality reproductive health care; and
right to education in order to make reproductive choices (emphasis added,
Amnesty International 2007, in Jaiswal 2012).
9.3.1 What is Reproductive Health?
Reproductive health is defined by the Cairo Program of Action as follows:
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 to its functions and processes. (cited in Jaiswal 2012)
Reproductive health is defined by the Cairo Program of Action as follows:
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 to its functions and processes. (cited in Jaiswal 2012)

The definition of reproductive health has implications for both women and men.
The Programme of Action (POA) in ICPD placed reproductive health and rights
110 as follows:
 The right of couple and individuals to decide the number, timing and space Reproductive Health and
Rights
of their children; and to have information and means to do so;
Regulate her fertility through access to information and good health services;
Have access to safe, effective, affordable and acceptable methods of family
planning of their choice for regulation of fertility;
Identification and treatment of Reproductive Tract Infections (RTIs) and
Sexually transmitted diseases among women, prevention and treatment of
RTIs/HIVs:
Remain free of reproductive morbidity (death); and
Bear and raise healthy children.
(Source: Qadeer 1998; Srinivasan et.al 2007; Jaiswal 2012)

During the post-Cairo period specific recommendations were made by various

international conventions to ensure reproductive rights and health of every woman.
Let us list some of the major international conventions which outlined different
measures to ensure reproductive health and rights at the country level.

Box 2

Article 10(2) of the International Covenant on Economic, Social and

Cultural Rights (ICESCR) writes “special protection should be accorded
to mothers during a reasonable period before and after childbirth” (United
Nations 1996).
Article 12(2) of Convention on the Elimination of Discrimination against
Women (CEDAW) outlines, “State Parties shall ensure to women
appropriate services in connection with pregnancy, confinement and the
post-natal period, granting free services where necessary, as well as
adequate nutrition during pregnancy and lactation” (United Nations, 2979).
General Recommendation No. 24 on Article 12 of CEDAW directs states
to take up the responsibility towards preventing maternal mortality. Article
14(1) of CEWAD recommends the states to take account of the problems
faced by rural women and take appropriate measures to address these
problems.
Millennium Development Goal (MDG) Goal-5- Improving Maternal
Health and Mortality specifies universal access to reproductive health
services by 2015. (cited by Jaiswal 2012, p. 15)

These are international forums in which women’s reproductive rights are specified
and demanded action at the state level to improve the condition of reproductive
and child health in every country. In India, the still majority of women don’t
have access to reproductive health services. We will understand the situation of
maternal health in India when we will read the section on the indicators of
reproductive health and rights.

9.3.2 What is Programme of Action for India under the RCH

approach?
Further, the POA also recommended a set of development goals for bringing a
sustainable and equitable society to implement the Reproductive and Child Health
Policy in India. The development goals include: 111
Health and Gender Sustainable economic development;
Education for girl child;
Promoting gender equity, equality and women’s empowerment;
Reduction in the infant, child and maternal mortality; and
Universal access to reproductive and sexual health services (Source:
Srinivasan et.al 2007).
These POA aims towards building a sustainable society in which the reproductive
health and rights of every individual can be realized in the policy in India which
was formulated on the basis of the POA of ICPD. In the year 1997, government
of India officially adopted the RCH approach and recognized the RCH programme
as the national policy of the government of India. The RCH programme introduced
the target-free approach to family planning and framed the POA for India
accordingly:
Immunization of children and access to contraceptive services by the couples;
Identification, prevention and treatment of RTIs and STDs;
Reproductive health education and services to the adolescent girls and boys;
Identification, prevention and treatment of cervical and uterine cancer for
women who are in the stage of menopause; and
Family planning is an integral part of the RCH programme
These are some of the indicators which were clearly stated in the RCH programme
under the government of India. In rural areas of India, Primary Healthcare Centres
(PHCs) are identified as the core unit to integrate the RCH approach into the
National Health Policies of India. Auxiliary Nurse Midwife (ANM) became the
core agent to provide basic reproductive and child health services in rural areas.
Therefore, the role of ANM was further expanded as counselor, educator, service
provider and coordinators of various other health programmes (Srinivasan et al.
2007, pp. 2931-2932). These are some of the basic concepts of reproductive
health and rights in India. You will be reading more about the reproductive health
indicators in the next section of this Unit.
Check Your Progress Exercise 1
Note: i) Use the space given below to answer the questions.
ii) Compare your answer with the Course material of this unit.
1) Define Reproductive Health.
......................................................................................................................
......................................................................................................................
......................................................................................................................

2) What are the important points on reproductive health placed before IPCD
with regard to Programme of Action (POA)?
......................................................................................................................
......................................................................................................................

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 Reproductive Health and
9.4 INDICATORS OF REPRODUCTIVE HEALTH Rights

The following are the indicators of reproductive health.

Quality of Care: Reproductive rights aim at ensuring universal access to
reproductive health services. The approach of providing care to the clients
became an integral part of the POA. For example, the type of care is provided
to the clients by the service-delivery systems. Continuous counseling, inter-
personal communication and information sharing between the clients and
the service providers became the centre of the quality of care. Imparting
training for the skill development is also emphasized within the POA of
ICPD. According to Sadik (2000) the UNFPA field study of different
countries revealed that there were about 45 countries which imparted training
programme to the service providers to implement the reproductive health
and right approach in their countries.

Gender Relations and Women’s Empowerment: It is one of the indicators

of reproductive health and rights. Many countries took initiative to eliminate
all forms of discrimination against women and efforts were made at the
country level to create a space for gender equality. According to UNFPA
report, out of 114 countries, 98 countries took positive initiative to ensure
gender equality. The positive initiatives include: establishing institutions
and ministry to look into the rights of women and child, facilitating right to
education and health, bringing legal ratification to protect the rights of
women and girl child, protecting women and girl child from harmful
practices of the community. In India, to name a few constructive initiatives
include: laws against sex-selective abortion, Beti Bachao Beti Padhao,
2005 Succession Act, Domestic Violence Act, Sexual Harassment Act 2013,
Verma Committee Report, Right to Education and so on.

Contraception and abortion: This is an important area of feminist enquiry

within the domain of reproductive health and rights. In the year 2010, the
development of pills completed its fiftieth years, hence many experts viewed
that the contraceptive pills have impacted gender relations in significant
way. For instance, the development of pills and better contraceptive methods
has increased women’s reproductive choice to avoid unwanted pregnancies
which in turn transforming the maternal health indicators. Unintended
pregnancies may result into abortion that is illegal in many countries. In
developing countries, abortion related complications amount to maternal
deaths when abortions are carried out under illegal and unsafe conditions.
Globally, 13 percent of maternal deaths occur due to unsafe abortion (World
Health Organisation Regional Office for Africa 2010, cited by Lips, 2014).
In case of India, an estimated 1.7 percent of pregnancies end with induced
abortion, between four million and 6 million abortions are done illegally
and around 9 to 16 percent of maternal deaths are due to unsafe abortions
(Centre for reproductive Rights and ARROW 2005, cited in Whittaker 2013).
Therefore, we can say that the development of pills and other contraceptive
methods in some ways has expanded women’s reproductive decision-making
and access to safe contraception. On the contrary, there is not much
development has happened towards men’s access to contraception. Use of
condom and sterilization through vasectomy are the most developed
contraceptive methods for men. However, the effort and approach of the
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Health and Gender family and the government lack towards involving more men to accept
major responsibility for contraception (Lips 2014). When we talk about
reproductive health and rights, the focus is more towards targeting women
rather involving the men in this process of decision-making. Reproductive
health approach emphasizes the involvement of men in reproductive
decision-making can bring down the gender-based discrimination and
violence against women in family and society. Therefore, Ministry of Health
and Family Welfare, Government of India in its National Population Policy
(2000) emphasized the involvement of men for making contraceptive choices
and make the efforts for utilizing the reproductive and child health services
in India (Singh et.al 2006).

Maternal Health: Maternal health is a significant dimension of reproductive

health. Maternal health risks often increase due to pregnancy, childbirth,
poverty and social practices of early marriage and motherhood. Lips (2014)
lists some of the pregnancy related complications as sever bleeding during
and after childbirth, infections, hypertensions, heart disease, diabetic,
abortion and so on. These complications combined with sever poverty
increases the risks of maternal mortality in developing countries. In
developed countries, the pregnancy related deaths are high among women
who have less access to economic resources and modern medical care. In
both develop and developing countries, maternal mortality is common
among the women belonging to underprivileged groups. Let us read a case
study to understand how women are denied reproductive services in India.

SreejaJaiswal (2012) cites this case study in her article Commercial

Surrogacy in India: An Ethical Assessment of Existing Legal Scenario from
the Perspective of Women’s Autonomy and Reproductive Rights. The case
study is about Shanti Devi’s right to life and reproductive health. She was a BPL
cardholder and belonged to the Scheduled Caste community. In 2008, she carried
a dead foetus in her womb for five days because she was demand medical
treatment from various hospitals and she didn’t have the money to pay the hospital
fees. Finally, the foetus was removed in a government hospital and she was
discharged immediately from the hospital without realizing the condition of her
physical health. She got pregnant again in less than two years and gave birth to a
baby in January 2010 without the assistance of any skilled birth attendant and
died immediately (p. 17). The court asked the State of Haryana to pay the
compensation of INR 2,40,000 to the family of Shanti Devi because it is a form
of violation of her human rights.

The 11th Five Year Plan of India specified its own of the goals as inclusive and
faster growth. This is possible by bringing women and the marginalized sections
of the society to mainstream development in which significant attention is on
reducing the maternal mortality rate in India for which government is committed
to allocate adequate resources for improving maternal health and address obstetric
emergency. In the year 2004-2005, Ministry of Women and Child Development
(MWCD) outlined the mission statement, i.e., “budgeting for gender equity”
(Mahapatro, 2014, p. 313). In India, various institutional mechanisms and policies
are formulated to realize the goal of women’s empowerment. Some significant
policies include: National Health Policy, Common Minimum Programme,
National Rural Health Mission (NRHM) and RCH programme are focused on
women and child health by reducing maternal, infant and child mortality, providing
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antenatal and post-partum care, making accessible, affordable and appropriate Reproductive Health and
Rights
health services to all with specific emphasis on women and children from
marginalized sections of the society (Mohapatra 2014). In spite of states’ proactive
action and positive discrimination towards women, many poor women in India
still deprive of their basic health rights. There are many stories which tells that
many hardly have any access to family planning and other reproductive services
in India. Let us now read a story.

This is a case about Jaitun vs. Maternity Home, MCD, Jangpura & Ors. In
which the High Court of Delhi directed the Municipal Corporation of Delhi
(MCD) and Government of National Capital Territory of Delhi to INR 50,000
compensation to Fatima. She is a 24 old woman suffering from epilepsy and
was forced to give birth under a tree on a crowded street of New Delhi. She
was denied delivery of her baby by the maternity home in Delhi. The Court
said it is a case of complete failure of the public health system to implement
the programmes and schemes formulated for reducing maternity and neonatal
mortality in India. The Court said: “…...the complete failure of the
implementation of the schemes. With the women not receiving attention and
care in the critical weeks preceding the expected dates of delivery, they were
deprived of accessing minimum health care at either home or at the public
health institutions. ….. It points to the failure of the referral system where a
poor person who is sent to a private hospital cannot be assured of quality and
timely health services. (para. 40). (Refer SreejaJaiswal, p.17-18).
Let us read about the reproductive rights of adolescents.
Reproductive Rights of Adolescent: ICPD clearly states the importance
of reproductive and sexual health of adolescent girls and boys. In many
countries, the discussion on reproductive and sexual health of young
individuals is still considered to be a grey area. Therefore, ICPD put much
emphasis on enabling the young people to make decisions related to
reproduction and their role as parents. The UNFPA field report suggests
that around 55 countries have included adolescent reproductive health in
their National Health Plan and Non-Governmental Organizations (NGOs)
are working in alliance with the various government to provide information
and services related to reproductive health to the young people. The UN
Special Session calls for the following Programme of Action that includes:

“The governments to provide confidential services to address effectively

their reproductive and sexual health needs, respecting their cultural values
and religious beliefs, emphasizing the identity and rights of the young people
themselves. Furthermore, the governments are urged to include at all levels,
as appropriate, of formal and non-formal schooling, education about
population and health issues, including reproductive health issues” (Sadik,
2000, p. 10-11).

9.5 REPRODUCTIVE AND CHILD HEALTH

POLICY: A CRITIQUE
One of the major challenges posed by the international organizations and
advocates of women’s health movements is towards integrating public health
and human rights principles under the comprehensive RCH policy. The main
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Health and Gender focus of this programme was to transform the conventional family planning
programme into a rights-based approach in which equity and empowerment of
women can be ensured within the public health programme. However, there is a
wider gap between the public health perspective and ensuring rights and equity
of women. Many health programmes often failed to deal with the socio-cultural
and economic condition of the society in which both health care providers and
clients are located. Therefore, in many cases the implementation of reproductive
health and rights agenda became a complex issue.

As Datta and Mishra rightly argued, after six years of India’s commitment to
reproductive and child health policy, still the policy faces a lot of challenges in
terms of understanding the concept of reproductive right. There is a lack of public
understanding in viewing reproductive health in terms of women’s rights. In
India, advocating for reproductive health actually faces challenges for the
following reasons;

Advocating for reproductive health and rights needs a pro-active approach

for implementation.
The concept of reproductive health continues to evoke discomfort among
the women’s group, policy makers, and health practitioners.
Despite the RCH policy promise towards women’s health rights, still the
government remains committed towards the demographic goals.
Concepts like ‘rights’ and ‘health’ have been seen as complex subjects by
policy makers and the programme managers while implementing the RCH
policy in the field.
The concept of bringing child health along with reproductive health to some
extent has been unable to address the issues women as independent of their
maternal role and responsibility.
RCH programme to some extent has the principle of target-driven family
planning approach, as it continues to exclude the single women from the
range of services.
RCH programme is largely an expansion of the existing MCH/FP package
with additional services like termination of pregnancy and, towards
prevention and treatment of reproductive tract infections and sexually
transmitted diseases.
ICPD has limited women’s health to the issues of safe abortion and the
women’s reproductive rights to the extent of making choice over
contraception.
Central concepts like a comprehensive and integrated reproductive and child
health policy remain will define in the programme. For example, at the
level of implementation, the health care providers feel that they are unclear
about how to provide a rights-based health care facility to all the clients
simultaneously (this section is adapted from MA in Gender and Development
Studies).

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 Reproductive Health and
9.6 SUMMING UP Rights

This Unit speaks about the reproductive health and rights of individuals. It
discusses the origin of the concept of reproductive rights in international
conventions. The Units tells us that women’s right to reproductive health is a
matter of human right issue which cannot be ignored in the context of inclusive
development and women’s empowerment. In the last, the unit also provides a
critic of reproductive and child health policy from gender perspective. It aims at
understanding reproductive health in relation to decision-making, choice and
universal access to health services in India.

9.7 KEY WORDS

Human Rights Based Approach: The human rights-based approach focuses on
those who are most marginalized, excluded or discriminated against. This often
requires an analysis of gender norms, different forms of discrimination and power
imbalances to ensure that interventions reach the most marginalized segments of
the population.

Elements of good practices under a human rights-based approach

Programmes identify the realization of human rights as ultimate goals of
development
People are recognized as key actors in their own development, rather than
passive recipients of commodities and services.
Participation is both a means and a goal.
Strategies are empowering, not disempowering.
Both outcomes and processes are monitored and evaluated.
Programmes focus on marginalized and excluded groups.
The development process is locally owned.
Programmes aim to reduce disparities and empower those left behind.
Situation analysis is used to identify immediate, underlying and root causes
of development problems.
Analysis includes all stakeholders, including the capacities of the state as
the main duty-bearer and the role of other non-state actors.
Human Rights standards guide the formulation of measurable goals, targets
and indicators in programming.
National accountability systems need to be strengthened with a view to
ensure independent review of government performance and access to
remedies for aggrieved individuals. 
Strategic partnerships are developed and sustained. 
(http://www.unfpa.org/human-rights-based-approach#sthash.rDiXNHhC.dpuf)

9.8 REFERENCES
Wang, G. and V.K. Pillai (2001). Measurement of Women’s Reproductive Health
and Reproductive Rights: An Analysis of Developing Countries, Social Indicators
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Health and Gender Research, Vol. 54, No. 1 (Apr., 2001), pp. 17-35, Accessed: 16-03-2016 09:34
UTC.

Qadeer, Imrana (1998). Reproductive Health: A Public Health Perspective,

Economic and Political Weekly, Vol. 33, No. 41 (Oct. 10-16, 1998), pp. 2675-
2684, URL: http://www.jstor.org/

Srinivasan, K. ChanderShekhar and P. Arokiasamy (2007). Reviewing

Reproductive and Child Health Programmes in India. Economic and Political
Weekly, Vol. 42, No. 27/28 (Jul. 14-20, 2007), pp. 2931-2935+2937-2939.

Jaiswal, S (2012) Commercial Surrogacy in India: An Ethical Assessment of

Existing Legal Scenario from the Perspective of Women’s Autonomy and
Reproductive Rights. Gender, Technology and Development, 16(1), 1-28.

Sadik, Nafis, (2000). Health and Human Rights, Vol. 4 (2), Reproductive and
Sexual Rights pp. 7-15

Singh, A. Ram, F and Ranjan, R. (2006). Couples’ reproductive goals in India

and their policy relevance, Social Change, Vol 36 (2).

Mahapatro, M. (2014). Mainstreaming Gender: Shift from Advocacy to Policy,

Vision, 18(4) 309–315

SAGE Publications, Los Angeles, London, New Delhi, Singapore, Washington

DC, DOI: 10.1177/0972262914551663

9.9 UNIT END QUESTIONS

1) Explain indicators of reproductive health.
2) Explain the criticism of reproductive and child health policy

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