Reproductive Rights (WHO)
Reproductive rights comprise a constellation of rights, established by international human rights documents, and related to people’s ability to make decisions that affect their sexual and reproductive health (Sundari Ravindran, 2001). Reproductive rights include the basic rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, to have the information and means to do so, and to attain the highest possible standard of sexual and reproductive health. They also include their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents (UNFPA, 1994 (para 7.3)).
Adding a gender and rights perspective helps to move away from a stereotyped conceptualization of reproductive health problems as “women’s troubles”. A gender and rights perspective moves beyond biological explanations of women’s vulnerability to mental disorder to consider their vulnerability to a range of human rights violations. This vulnerability has little to do with biology and much to do with gender-based inequalities in power and resources. From a gender and rights perspective, improvements in women’s reproductive mental health are contingent on the promotion and protection of women’s human rights rather than the paternalistic protection of women as the “weaker sex”. This perspective does not deny the role of biology; rather it considers how biological vulnerability interacts with, and is affected by, other sources of vulnerability including gender power imbalances, and how these can be remedied (WHO, 2001).
Although human rights violations are recognized as having a negative impact on mental health (Tarantola, 2001), there have been surprisingly few investigations of women’s mental health, including reproductive mental health, in relation to their human rights (Astbury, 2001). Nevertheless, the higher risk of depression among women clearly underlines the importance of using a gender and rights perspective.
Gender, Rights and Reproductive Mental Health
There is evidence that depression is the most important mental health condition for women worldwide and makes a significant contribution to the global burden of disease. Women suffer more often than men from the common disorders of depression and anxiety, both singly and as co-morbidities.
Sundari Ravindran, 2001, has described in the work by the WHO on Women’s mental health about the various Reproductive rights of the female partner. The rights that are being described by her have its basis in the various reviews of literature and extensive reading that has gone into from her side, and the team from the WHO that has been working in the current area for a while now. She has been able to identify the various areas that can be classified or those that can be introduced as the first step towards identifying the Reproductive Rights of Women.
These are: –
(i)the right to life;
(ii)rights to bodily integrity and security of the person (against sexual violence, assault, compelled sterilization or abortion, denial of family planning services);
(iii)the right to privacy (in relation to sexuality);
(iv)the right to the benefits of scientific progress (e.g. control of reproduction);
(v)the right to seek, receive and impart information (informed choices);
(vi)the right to education (to allow full development of sexuality and the self);
(vii)the right to health (occupational, environmental);
(viii) the right to equality in marriage and divorce;
(ix) the right to non-discrimination (recognition of gender biases).
The Role of Mental Health in Reproduction and Women’s Mental Health
Mental health as a component of reproductive health has generally been – and still is – inconspicuous, peripheral and marginal. The lack of attention it has received is unfortunate, given the significant contributions of both mental health and reproductive health to the global burden of disease and disability.
Of the ten leading causes of disability worldwide, five are neuropsychiatric disorders. Of these, depression is the most common, accounting for more than one in ten disability-adjusted life-years (DALYs) lost (Murray ; Lopez, 1996). Depression occurs approximately twice as often in women as in men, and commonly presents with unexplained physical symptoms, such as tiredness, aches and pains, dizziness, palpitations and sleep problems (Katon ; Walker, 1998; Hotopf et al., 1998). It is the most frequently encountered women’s mental health problem and the leading women’s health problem overall. Rates of depression in women of reproductive age are expected to increase in developing countries, and it is predicted that, by 2020, unipolar major depression will be the leading cause of DALYs lost by women (Murray ; Lopez, 1996). More than 150 million people experience depression each year worldwide.
Reproductive health programmes need to acknowledge the importance of mental health problems for women, and incorporate activities to address them in their services. Reproductive health conditions also make a major contribution to the global burden of disability, particularly for women, accounting for 21.9% of DALYs lost for women annually compared with only 3.1% for men (Murray ; Lopez, 1998).
The evidence base everywhere – in both high- and low-income countries – has significant gaps. Thus, the true impact on women’s mental health of the multiple reproductive health conditions experienced over the course of their life cannot currently be ascertained.