An survey reported by the Zimbabwean on the Constitution found that 40% of those interviewed were in favour of the Constitution preserving full rights for women to have an abortion, while fewer(39%) believed it should be preserved only in certain instances which must be clearly stated by law. Only 19% were completely opposed to the Constitution preserving any rights for a woman to have an abortion. More men than women were in favour of full rights for women to seek an abortion. The government, which says it is aware of the practice of illegal abortions, promotes safe sex as a solution, but a spokesman for the Ministry of Health and Child Welfare admitted this was a huge challenge due to the unavailability of – and cultural resistance to – contraceptives. A largely Christian society, abortion in Zimbabwe is condemned by both the church and the state. Women who do choose the abortion route say that although a safe, legal abortion is exorbitant – around US$350 – it’s still a lot cheaper than the cost of giving birth to a child in a city hospital. Pregnant women who cannot afford the legal option are reported to resort to taking herbal remedies from traditional healers.
Values, Policies and Rights
HIV/AIDS is a preventable disease, yet approximately 5 million people were newly infected with HIV in 2003, the majority of them through sex. Many of these cases could have been avoided, but for state-imposed restrictions on proven and effective HIV prevention strategies, such as latex condoms. Condoms provide an essentially impermeable barrier to HIV pathogens. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), scientific data "overwhelmingly confirm that male latex condoms are highly effective in preventing sexual HIV transmission." However, many governments around the world either fail to guarantee access to condoms or impose needless restrictions on access to condoms and related HIV/AIDS information. Such restrictions interfere with public health as well as set back internationally recognized human rights - the right to the highest attainable standard of health, the right to information, and the right to life.
"The fact that a very large part of the world’s population has inadequate access or none to essential and often life-saving medicines is of grave concern. It results in a vast loss of life and much suffering, more particularly among the poor and underprivileged. It is in blatant contradiction to the fundamental principles of human rights. And, even if one were to set humanitarian considerations side, it results in serious damage to the economy and to the functioning of society."
The right to health facilities, goods and services specifically includes the provision of essential medicines as defined by WHO. The Human Rights Approach should be incorporated in all national medicine policies and programmes, the selection of medicines for essential public health functions should be further refined, States parties’ international reporting obligations on access to essential medicines should be strengthened, and national NGOs should be empowered to put pressure on governments to fulfil their commitments and obligations under the international and national human rights instruments they have signed and ratified.
In 2008 WHO analysed 186 national constitutions and found that 135 (73%) include provisions on health or the right to health. Of these, 95 (51%) constitutions mention the right to access health facilities, goods and services, which includes medicines. Only four national constitutions (2%) specifically mention universal access to medicines. There are at least three different routes, the study argues, through which the right to health – and essential medicines – can be recognised in national legal frameworks. The strongest government commitment is created by including the right to essential goods and services in the national constitution. The second approach is constitutional recognition that international treaties ratified by the State override or acquire the status of national law. The third option, inclusion of health rights in other national legislation, is easier to create but also easier to change or cancel. The full range of strategies should be used to promote universal access to essential medicines through rational selection, affordable prices, sustainable financing and reliable health systems, the article argues. Constitutional recognition of the right to access essential medicines is an important sign of national values and commitment, but is neither a guarantee nor an essential step – as shown by those countries that have failing health systems despite good constitutional language, and those that have good access without it. Yet constitutional recognition creates an important supportive environment, especially in middle-income countries where health insurance systems are being created and patients are becoming more aware of their rights and are more vocal in demanding them.
Although the estimated 600 million people with disabilities have formally been recognized, in reality they are still often being overlooked and by no means enjoy the same rights as the rest of the world's population. The goal is to ensure that all people, disabled and able bodied alike, have the same access to all kinds of services in society, in particular health care.
This United Nations resolution recognises that access to medicines is one of the fundamental elements in achieving progressively the full realisation of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. It stresses the responsibility of States to ensure the highest attainable level of health for all, including through access, without discrimination, to medicines, in particular essential medicines, that are affordable, safe, efficacious and of quality. At the same time, the resolution emphasises the crucial role of prevention, the promotion of healthy lifestyles and the strengthening of health systems. The central element of the resolution urges States, as appropriate, to take 16 measures to fulfil their obligations on access to medicines within the right to health framework. The resolution also recognises the innovative funding mechanisms that contribute to the availability of vaccines and medicines in developing countries, such as the Global Fund and the GAVI Alliance. It calls upon all States, United Nations programmes and agencies, relevant intergovernmental organisations and pharmaceutical companies to help safeguard public health from conflict of interest, as well as to further collaborate to enable equitable access to quality, safe and efficacious medicines that are affordable to all.
In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long-term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights. In this paper, the authors explore the existing evidence related to global and country-specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa, as examples of three countries with different conditions regarding women's access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non-implementation of the law, and a rather liberal setting. Similarities and differences are discussed, and the authors outline global and country-specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.
In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology. For the first time in IDS Bulletin history, themes are explored not only in text but also through a selection of online multimedia content, including a workshop video, a photo story and a documentary. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards UHC and the linked agenda of accountability for health equity. The articles and multimedia in this IDS Bulletin reflect the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed.
Kenyan human rights activists have filed an appeal for the release of two men imprisoned for defaulting on their tuberculosis (TB) treatment, and are warning that the arrests could discourage other patients from seeking treatment. The appeal has been filed at Kapsabet court in Rift Valley Province. Arrested in August 2010, the two men have been held in police remand in Kapsabet for ‘posing a risk to the health of the wider community’. Under the Public Health Act, they can be held until the district medical officer who ordered their arrest decides they are no longer a public health threat. According to Nelson Otwoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya, the two men have not been isolated, posing a health risk to other inmates. He warned that the arrests could act as a deterrent to patients needing treatment. ‘This is a negative consequence of the government's action’, he added, denouncing criminalisation of the disease. ‘Counselling of those on treatment will have better outcomes,’ he noted.