Health Care for Women: Basic Right or Market Commodity?
Editor in Chief
Is health care a human right? Here in the United States the answer depends on your political persuasion. Article 25 of the Universal Declaration of Human Rights says it IS, and so does the Constitution of the World Health Organization. Article 25 goes on to say that motherhood and childhood are entitled to special care and protection.
Yet of the eight Millennium Development Goals adopted by the United Nations in 1990, #5, Maternal Health, had the most disappointing results when progress was assessed for the 2012 report. Secretary General Ban Ki-Moon noted in his foreword that “The goal of gender equality also remains unfulfilled, again with broad negative consequences, given that achieving the MDGs depends so much on women’s empowerment and equal access by women to education, work, health care and decision-making.”
In India, “A Most Awful Form of Gender-Based Violence”
Though those “broad negative consequences” are all around us, a recent Oxfam report highlights some particularly shocking outcomes in India. The government’s proactive promotion of private sector facilities has let the profit motive run amok. In the Guntur district of Andhra Pradesh, nearly 15% of 3,000 women surveyed had undergone hysterectomies, most of them at for-profit facilities. The average age at which the operation was performed: 24.
Some 85% of these women were illiterate. They went to a doctor, or sometimes a community health worker out to earn commissions, for a stomach ache and woke up after major surgery with the pain intact, compounded by a massive load of debt. The pattern has also been documented in the provinces of Rajasthan, Bihar, and Chattisgarh. A February 10 front page story in the Times of India quoted Aniruddha Malpani, medical director of the Health Education Library for People: “If some doctors in small towns are performing unnecessary hysterectomies, why should it be any different in cities like Mumbai?”
In 1949, 92% of India’s health care facilities were public. Today, 93% of hospitals and 85% of doctors are for profit. Providers perform unnecessary hysterectomies and also Caesareans because pay or government reimbursement comes at a high rate for these procedures.
In a blog on the Guardian’s website Dr. Narendra Gupta of Prayas, one of Oxfam India’s partner organizations, calls this a “most awful form of gender-based violence.” Women are penalized for being women, and families and communities suffer with them. Worldwide, about 800 women die every day, according to the World Health Organization (WHO), from preventable causes related to pregnancy and childbirth. Add those who die or see their children die for lack of any medical care at all, or for lack of food or clean water, and we have massive structural violence on a global scale. WHO says 99% of these maternal deaths are in developing countries, but the “first world” has its own share of perpetrators, victims, and health champions too.
In the West: Mixed Results
US President Franklin Delano Roosevelt proclaimed the human right to health care in 1944, and his widow, Eleanor, was a major author of the Universal Declaration of Human Rights. In 1977, Jimmy Carter signed The International Covenant on Economic, Social and Cultural Rights, which commits parties to create “conditions which would assure to all medical service and medical attention in the event of sickness.” Three and a half decades later the U. S. Senate has still not ratified it.
President Obama told Tom Brokaw in 2008, “I think it [health care] should be a right for every American.” The Supreme Court has upheld his hotly contested Affordable Care Act, which stopped far short of universal health care but may help prevent the egregious abuses India has seen. According to Business Day (Jan. 8, 2013) private health care has only a slight edge here in the US. Some 9.1% of our GDP goes into private care and 8.5% to public―the two combining to make ours the world’s most expensive health care system, though not its most effective or most inclusive. A study published in the American Journal of Law and Medicine in 2010 found 16% of our population uninsured and noted that “physicians and other providers have tended to provide more healthcare than necessary to maximize reimbursement for services.”
The nations that rank highest in the Global Peace Index and various quality of life indicators (including Iceland, Denmark, New Zealand, and Canada) view their female and male citizens as their most important resources, and care for them accordingly. In those that view us as units of production and consumption, quality health care is a commodity beyond the reach of many.
For the Future: Building a Post-2015 Consensus
In mid-February, top officials from the health and finance ministries of 27 countries met for two days in Geneva with other high-level health and development stakeholders to discuss the world’s progress towards universal health coverage. The meeting was convened jointly by the World Health Organization (WHO) and the World Bank, and took place just weeks after the United Nations General Assembly adopted a resolution supporting universal health coverage.
Delegates at that Geneva meeting expressed strong support for the premise of universal health coverage: that societies function best when everyone can obtain the health services they need without putting their families at financial risk. As 2015 draws near, the Post-MDGs development agenda is a trending topic. A monitoring framework for tracking progress country by country is already underway.
To learn more about the scandal in India, read my interview with Araddhya Mehtta, one of the main authors of the new Oxfam report.
Be sure to read Peace X Peace CEO Kim Weichel’s report on the 2013 meeting of the Commission on the Status of Women, where the priority theme is the Elimination and Prevention of All Forms of Violence against Women and Girls.
And tell us what you think. Is there a human right to health care? If you say yes, what can we do to make it real?
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