SRHR NGOs have always been intrigued by the possibility of incorporating SRHR issues more comprehensively within the CEDAW reporting process. This week, we thought it would be helpful if we sent you the latest government country reports on CEDAW as well as the Shadow Reports, with a brief analysis on how these reports cover and report on achievements in sexual and reproductive health and rights.
The sexual and reproductive health and rights issues covered by the 12 government reports are:
Bangladesh (www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Bangladesh.pdf)
The Bangladesh government identifies maternal mortality as a serious issue and talks about nutritional deficiency and anemia, access to health services including antenatal care, access to skilled attendance at birth and access to emergency obstetric care services (pp.32)
The report goes on to say that “Significant efforts are being made for promoting women’s health and in generating employment opportunities for women in the health sector.”(pp. 32) But this report fails to elaborate on what these ‘significant efforts’ are and how effective they have been.
Cambodia (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Cambodia.pdf)
Cambodia also identifies maternal mortality as a key SRHR issue, with unsafe abortions and access to health services especially skilled attendance at birth and antenatal care as key factors. (pp. 7)
Unsafe abortions occur in Cambodia because while abortion is legal, it is only legal under certain circumstances – under 12 weeks of gestational age, more than 12 weeks in fetal abnormalities, in cases of rape and incest, and decisions subject to approval of a panel of 2-3 doctors. (pp. 65)
The report also talks about the prevalence of HIV/AIDS in the country. (pp. 66)
China (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/China.pdf)
In China, the government report concentrates on maternal and infant health-care, as well as reproductive health rights, namely access to contraception and abortions. “In June 2001, the State Council promulgated the Regulations on the Administration of Family Planning Technical Services, which stipulates that citizens have the right to make informed choices concerning contraceptive methods…The project emphasizes the use of contraception, observes the principle of free choice and safety in induced abortions, opposes the use of forced induced abortions, prohibits illegal induced abortions and the sex-specific termination of pregnancy while stressing the importance of the informed choice of contraceptive methods.” (pp. 47)
The Government has also formulated policies that should increase inputs into rural health care, as there is a relatively high maternal and infant mortality in the rural areas. (pp. 48)
India (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/India.pdf)
The Indian country report focused on maternal health; a holistic health policy for women, maternal mortality rates, infant mortality rates, sex ratio, sex selective abortion and family planning targeted at women. “Maternal deaths due to complications in pregnancy and childbirth are among theleading causes of death among women in the country…The causes for maternal deaths include haemorrhage (both ante and post partum), sepsis, obstructed/prolonged labour, puerperal sepsis, unsafe abortion, anemia, etc. The factors responsible are poor health care facilities, lack of access to health care units, limited access to Family Planning services and safe abortion services, poor nutrition, early marriage, frequent and closely spaced pregnancies.” (pp. 80)
Indonesia (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Indonesia.pdf)
According to the Indonesian country report, “In health, nutrition, and family planning: there are at least five major gender issues namely the low involvement and responsibility of men in family health; high maternal mortality rate; high prevalence of iron anemia among women in their reproductive years along with chronic energy and vitamin A deficiencies among women and girls; low participation of men in family planning; and women’s lack of control over their reproductive health, particularly family planning.”( pp.17)
Lao PDR (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/LaoPDR.pdf)
In Laos PDR, the major causes for maternal mortality have been identified as postpartum hemorrhage, complications of abortion, infectious diseases (malaria), postpartum sepsis, and cardiopathies. The absence of pre-natal, delivery and post-natal care that are accessible, available and acceptable. Considering that a majority of high-risk factors can be identified and managed during the first antenatal visit, even one visit could save mother’s life. “However, only one of every four women visits a pre-natal care facility. Attitudes and accessibility are constant deterrents. An average rural family lives 11-15 km from the nearest public health facility. Rural pregnant women often lack transport and money for the travel and services.” (pp. 51)
Another issue of concern in Laos PDR is the increase of sexually transmitted diseases/infections and HIV/AIDS. One of the reasons given for affecting the increase of these transmissions was the gender disparities in Laos PDR, which put women in particular at high risk due to their lack of knowledge, their overall position in the community and the family as well as their limited ability to negotiate safe sex practices with men. (pp. 45)
Malaysia (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Malaysia.pdf)
While maternal mortality in Malaysia has declined to less than 20 per 100 000 live births (2004), from 83 per 100 000 live births in 1975, the country report states that the strengthening of effective strategies is necessary to further reduce the rate. It points out that some of the main causes of mortality in the country is either caused by or related to conditions that are more difficult to manage such as pregnancy-induced hypertension, haemorrhaging before, during or after the birth and embolism (pp. 77). According to the report, the issue of abortion also plays a part in the country’s maternal mortality and morbidity. Abortion in Malaysia is permitted only on certain grounds:
if the pregnancy is likely to result in danger to the mother’s physical or mental health. However, the patient must obtain the approval of two government medical specialists before this can be done.
for the purpose of saving a woman’s life. (pp. 78)
The report also states that “Recognising that many illegal abortions take place, government policy requires that medical practitioners performing abortions – whether legal or not – must treat the patient humanely and do everything possible to save her life or restore her to health, just as for any other medical condition.”(pp. 78)
Both the government and Shadow report in this case are inaccurate on 2 counts: one is the ‘legal’ status of abortion (performed legally when a physician deems it is necessary for the physical or mental health of the woman), which the shadow report should refute but doesn’t. There is a periodic national confidential enquiry into maternal deaths. These enquiries found that only 3 to 5 maternal deaths over 2 years were caused by or related to abortions.
Nepal (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Nepal.pdf)
The Nepal country report states that Nepal is one of the countries in Asia that has a high maternal mortality rate. Son preference, women’s limited access to knowledge, food and care, risks of childbirth, early marriage and early pregnancy, poor family planning services, lack of reproductive health supplies, lack of male responsibility for contraception, low literacy and lack of ability to raise up reproductive health issues within the family are among the factors that were identified as contributing to the high rate. (7) The report also says that the increasing cases of sexually transmitted diseases and HIV/AIDS reflect on the poor health status of the women in the country. (pp. 7)
Pakistan (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Pakistan.pdf)
In 2005 (the year of the report), Pakistan estimated the maternal mortality to be around 340 per 100 000 live births or higher. Although the high rate is a cause for concern, the report does not give a definitive cause of this rate, instead it says: “Two out of five pregnant women are anaemic and four out of five deliveries are not assisted by trained health officials,” (pp. 82) and informs that abortion in Pakistan is illegal with one exception: to save the mother’s life. (pp. 128)
Philippines (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Philippines.pdf)
According to the government country report, while maternal deaths in the country came up to less than 1% of the total deaths in the country, they contribute 14% of all deaths in women aged 15 – 49. These deaths were mainly due to complications related to pregnancy occurring in the course of labour, delivery and puerperium (the 4-week period following childbirth), hypertension, complications, postpartum hemorrhage, abortive pregnancies, hemorrhages related to pregnancy. Another contributing factor is the failure to obtain pre-natal care as well as limited access to professional health care during pregnancy and childbirth.
The health department has incorporated some elements of the Reproductive Health Package in a reproductive health framework:
Men’s reproductive health;violence against women; and prevention and treatment of infertility and sexual disorders. (pp. 123)
Thailand (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Thailand.pdf)
The main issues the Thailand country report focuses on is domestic violence, marital rape, sexual violence against women and children in public places, sexual harrassment against women, pornography and abortion.
In Thailand, abortion is only allowed if the pregnancy endangers the mother’s health or in cases of rape. According to the report, a number of abortions are done in remote and rural areas and are often unsafe because of the lack of knowledge about the condition of the foetus or the mother’s health, or even when there is no time to get a doctor to perform a safe abortion. (pp. 74)
At the time of this report, the Thai government was revising the law to make abortion safer*. Progress was also cited in terms of prevention of violence against women and children, in improvements and revisions in the law as well as collaborative efforts between the government and private sector according to the report.
*the Thai government amended this law in 2005, providing a standard interpretation of the criminal law provision on abortion, clarifying that abortion is permitted not just in cases of rape or when the mother’s physical health is endangered, but also if following the course of the pregnancy will endanger her mental health as well.
Vietnam (http://www.arrow.org.my/home/images/publications/CEDAW/Country%20Reports/Vietnam.pdf)
According to the country report, trafficking in women and exploitation of prostitution of women remain pressing issues in Vietnam. (pp. 19)
Another pressing issue the report highlights is the issue of sexually transmitted diseases and the quality of healthcare services, which is poor and difficult to access, especially for women living in rural and mountainous areas. (pp. 39)
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