A Podcast on All Things Sexual and Reproductive Health and Rights

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SRHR, or sexual and reproductive health and rights, is the sum of rights and health issues that are related to human reproduction. Sexual health, sexual rights, reproductive health and reproductive rights are a complex and intersecting set of issues that address full control over individual’s sexual and reproductive lives and maintenance of a state of physical, mental and social well being. Nina Besser-Doorley from the International Women’s Health Coalition (IWHC) explains the components of SRHR and how it is currently faring in the domestic and global arena.

Often, SRHR is seen as a women’s issue. While these issues are closely linked to women’s empowerment, they can’t be seen solely as a women’s issue. SRHR impacts all of us. SRHR doesn’t just refer to abortion and contraception, either. While these are important issues under the umbrella, they don’t make up the entire story.

The WHO defines reproductive health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” This definition implies that all people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Therefore, access to safe, effective, affordable contraception and access to appropriate maternity care and prenatal health services is a MUST. Reproductive health includes accurate information about the reproductive system, menstruation and menstruation management, contraception methods and what works best for individuals, abortion methods, and information on pregnancy, delivery and fertility. It also includes access to different methods of contraception, abortion, pregnancy and delivery services, and fertility services. Reproductive health also means prevention, treatment, and care of reproductive illnesses and cancers

The 1994 International Conference on Population and Development (IDPC) defines reproductive rights as“…the basic right of all couples and individuals 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.” Access to affordable contraception is the key to reproductive rights, but reproductive rights also include issues of privacy, confidentiality, and informed consent. Reproductive rights are about the ability to make decisions about reproduction, free from discrimination, violence, and coercion.

According to the WHO, “sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” Examples of sexual health issues include prevention and control of HIV and other STIs, physical and mental health issues around sexual function, and issues of gender-based violence. Sexual health also includes access to education and information about sex, sexuality, safe sex practices. While sexual health and reproductive health intersect, it’s important to recognize the differences. In women’s health, it distinguishes women as more than reproductive vessels. Not all issues of sex are issues of reproduction- and that’s true for all people of all genders.

The WHO ‘s definition of sexual rights include critical components such as the right to be free from torture or to cruel, inhumane or degrading treatment or punishment, the right to privacy, the right to marry and to found a family and enter into a marriage with the free and full consent of the intending spouses, and to equality in the dissolution of marriage, the right to decide the number and spacing of one’s children, and more. In sexual rights, there is an emphasis on the human rights of all people to make decisions about their sexuality and their sexual life to the highest attainable standard of sexual health, and to the services, information and education they need to do so.

The 1994 International Conference on Population and Development (ICPD) defined reproductive health and reproductive rights, and linked reproductive rights to established human rights and international law. A year later, the Beijing Conference added a level of recognition to what we understand to be sexual rights, although that term wasn’t explicitly used. These actions shifted the way SRHR was represented in the global sphere.

SRHR was included in the Sustainable Development Goals 2030 Agenda, which hopes to, by 2030, “ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” The SDGs also include references to other SRHR issues, like ending early, child and forced marriage, reducing the global maternal mortality rate, and ending the HIV/AIDS epidemic. Despite this progress, some areas have been made particularly challenging by right-wing opposition. Abortion is one of them; women around the world die when they don’t have access to safe, legal abortion. According to the WHO, 13% of maternal deaths are attributable to unsafe abortion. Other issues include the use of ‘sexual rights’ as a term, and the lack of inclusive language prohibiting discrimination on the basis of sexual orientation and gender identity.

Under the Obama administration, the U.S. was an active proponent of many SRHR issues, and played a critical role in ensuring SRHR’s place in the 2030 SDGs. Unfortunately, the Trump administration has taken an unrelenting aim at SRHR on the global scale through foreign policy measures, attacks on funding for reproductive health programs, and assaults on the UN and global agreements on reproductive and sexual health and rights. At the annual Commission on the Status of Women, the administration has included delegates on the official delegation that are attempting to walk back commitments on these issues. The U.S. has become one of the most regressive countries in terms of SRHR.

How does this affect you personally? Every person has sexual and reproductive health needs and rights. 1 in 4 women in the U.S. has had or will get an abortion at some point in their lifetime. 99% of women between 15-44 who have had sexual intercourse has used at least one contraceptive method. Every day, people decide if they want to have sex and who with; they will choose if they will get married, who they will marry, and when they will marry; they will elect if, when, and how many kids they’ll have or how to prevent having children; they will seek medical intervention to prevent and treat reproductive health diseases or STIs. There are also people who are denied their SRHR, including people who are forced into sex, people who don’t have accurate SRHR information, people who are not able to marry (or are forced into marrying) a partner. Ready to take action?

Links from this episode

International Women’s Health Coalition
IWHC Twitter
IWHC Facebook
Sustainable Development Goals 2030 information

Transcript

Jennie: Welcome to rePROs Fight Back a podcast on all things repro. I'm your host Jennie Wetter. In each episode, I'll be taking you to the front lines of the escalating fight over our sexual and reproductive health and rights at home and abroad. Each episode, I will be speaking with leaders who are fighting to protect our reproductive health and rights to ensure that no one's reproductive health depends on where they live. It's time for repros to fight back.

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Jennie: Welcome to this week's episode of rePROs Fight Back. Today we're going to talk about what is SRHR. In our podcast, we use the tagline, a podcast about all things repro. And that's not exactly true about what we talk about. We talk about all things sexual and reproductive health and rights. But what exactly is that and what does it mean? Today, I am extra excited about our guest. Um, when we started talking, thinking about doing this podcast and even before I was sure, I have never had a bigger cheerleader or someone who was more excited about the idea of this podcast than today's guest. So I'm super excited to have her on today helping me talk about SRHR. I'm really happy to have Nina Besser-Doorley from the International Women's Health Coalition with me today. Hey Nina and thanks so much for being here.

Nina: Hey, thanks for having me.

Jennie: Before we do a deep dive into what the component parts are of sexual and reproductive health and rights or what we'll probably say SRHR for short because it's kind of a mouthful, do you want to do a quick overview of what we're talking about when we say SRHR?

Nina: Just speak very broadly, SRHR is the sort of sum of rights and health issues that are related to human sexuality and reproduction. So you can either see this as a combination of four specific elements, um, sexual health, sexual rights, reproductive health, and reproductive rights, um, or youi can sort of look at it as a, as a complex and often intersecting set of issues that affect whether people can fully control their sexual and reproductive lives and whether they can maintain a state of physical and mental and social wellbeing. I'll also point out a couple of things upfront. And the first is that these are often seen as women's issues. Reproductive rights is, is seen as something that affects women. And obviously that's true in part, but I really want to convey that everyone has sexual and reproductive health needs and reproductive rights and sexual rights and SRHR is closely linked to women's empowerment. And the lack of SRHR is a massive barrier towards gender equality, but it can't just be seen as a women's issue. These are, these are issues that do impact all of us. And I think the, the sort of other thing that I'll point out up front is that a lot of times when we hear reproductive health or reproductive rights, we immediately think of abortion and contraception and these are important issues within this sort of overall heading of SRHR. But again, it's really far from the entire story. And I'm really excited to talk to you today about sort of the full range of issues that fall under this very broad heading of SRHR and what are all the pieces we're talking about when we start diving into these issues.

Jennie: So we'll start at the four parts that are included. Let's start with reproductive health.

Nina: A lot of these terms, there are some places where they overlap. There's some overlap between reproductive health and sexual health, for example, but they all do mean distinct things. So what, what, what do we mean by reproductive health? We can start with the WHO definition. The World Health Organization offers a definition of health that defines health as a state of complete physical, mental and social wellbeing and not merely the absence of disease and or infirmity. And within this framework, um, the WHO defines reproductive health as, as the set of issues address, that address the reproductive processes, functions and systems at all stages of life. What does that mean? So according to the WHO, reproductive health implies that all people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how to do so. So this means they have access to, to safe and effective and affordable means of contraception if they want to delay reproduction or avoid reproduction. It means they have access to appropriate maternity care, prenatal health services if they choose to reproduce.

Nina: And so within this, there, there are a number of components beyond just contraception or maternity care. There's information about the reproductive system so people understand what it is that goes on with their bodies, what the range of choices that they have, um, and how to, how to, um, maintain control over their reproductive system. It means access to a variety of methods of contraception so that people can choose the method that is best for them. Do they want something that's long acting and they only have to use once in a blue moon or do they, are they okay with a method that they have to take everyday and continually monitor? Do they, are they aware of the side effects that that can come with certain forms of contraception? And are they able to make the decision that is very much right for them? It includes access to safe abortion and post abortion care and those critical services. It also includes issues of menstruation, um, the ability to manage menstruation in a hygienic and dignified way. Again, the understanding for, particularly for women of what's going on with their bodies when they do mensturate and how that plays into their, their, um, reproductive lives. And they're, they're also, it's, it's the ability to postpone having children, but it's also the ability to have, so this includes appropriate health care services for pregnancy and childbirth, but also access to services, information and treatments surrounding fertility and infertility for, for, um, people who, who do choose to go that route. And I guess the last thing that I'll flag that reproductive health often encompasses is the prevention, treatment and care of reproductive health diseases and cancers and, and a whole set of, of, you know, what we would we classically see as health care, um, the, the, the disease portion, um, the, the, the ability to manage these diseases of the reproductive health system. So in short, like that was long. But the short is summation is that reproductive health is that we're talking about the entire set of health care services and information and the resources that enable people to lead healthy reproductive lives.

Jennie: And one of the things I saw in there, and I think it comes up in a couple of the other definitions too, that always tends to get buried, but it's great to see there, is satisfying. Like that often isn't something that's talked about it so often, you know, as a health need or a preventative or you don't often talk about having satisfaction from having sex. That's like the thing that doesn't get talked about.

Nina: Yeah, absolutely. And I think there are several, several, particularly when we get to sexual health, there are several components where sexual health really goes beyond some of the pieces that are included in reproductive health to really hone in on, on some of those, those, uh, sexual needs that are different from, from just being about reproduction.

Jennie: Right. When you...so next after reproductive health comes reproductive rights, um, do you wanna talk about what's included in reproductive rights?

Nina: So moving away from the World Health Organization for a minute. The reproductive rights have an international definition that comes from the program of action from the 1994 International Conference for po on Population and Development. We also often referred to just as ICPD this, this definition has had stood up for the last, what, 20-30 years it is. The definition offered by ICPD is these rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so in the right to attain the highest standard of sexual and reproductive health. So this is really important because ICPD was a negotiated agreement between, between countries around the world. And it's, it's really been sort of the accepted definition of what, what we mean when we say reproductive rights and what's included.

Nina: So what are we talking about? Right? Then a kind of a wonky way of saying this, but we're talking about the ability to make decisions about reproduction. So if you want to have kids when you're going to do it, who you're gonna do it with. If you don't want to do it, if you don't want to reproduce. Um, and, and to do that without being coerced or forced in any way to do so. Our reproductive rights as individuals, they, they include these pieces of to try to, to try to have kids if I want to, to not, to um, not be bullied or forced into getting pregnant by a partner or family member, to decide I might want to have children with one person but not with another, or I might want to do it on my own without a partner. Um, I might want not want to do it when I'm 20 years old and doing something else, completing a college degree, but I might want to do it when I'm in my thirties or I might not. I might go my entire reproductive life and choose not to have kids. Those def, those decisions are going to look really different for each person. But the concept of reproductive rights is that each person gets to make those decisions and gets to figure this out for themselves. So we've talked about contraception a little bit under reproductive health. And this is a really key component. Access to contraception to effective and to, to effective methods and to a variety of methods is a really important part of reproductive rights as well. Because if women in particular do not have the ability to, um, avoid pregnancy at times that they don't want to, they don't have full control over their reproductive rights. Um, so this is something that's, that's been actively debated in this country in recent months and years, um, around the, the contraceptive mandate under Obamacare and the importance of providing that option for everyone regardless of their income or where they live. And the same thing is true globally. The, you know, the, the idea that where you live shouldn't dictate, or what resources you have, shouldn't dictate whether or not you're able to, to access, um, access the means of controlling your, your reproduction.

Jennie: Or the kind of a method you can use.

Nina: Exactly, exactly. And in too many cases, women are presented with only one option or you know, they don't have a full range of, of, of methods available to them. And, and that makes a big difference because some women have strong preferences or some women's bodies do way better on one, one method than another. Or some women may have issues where they can't talk to their partner about it or they, um, they need the ability to, to have discrete methods of contraception. So these issues are really important.

Jennie: So that's reproductive health and reproductive rights. So let's move on to sexual health.

Nina: We'll go back to the World Health Organization for a definition for sexual health, sexual health. And the WHO describe sexual health as a state of physical, emotional, mental and social wellbeing in relation to sexuality. It's not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. So there's, again, there's going to be a lot of overlap here between sexual health and reproductive health because sex is a key component of reproduction, right? But sexual health recognizes that reproduction isn't the only reason that people have sex. And it's not...reproductive health needs aren't the only set of needs that are associated with this. So some examples of sexual health issues, so prevention and control of HIV and other sexually transmitted infections, um, physical and mental health issues around sexual functions. So that could include treatment and counseling for sexual dysfunction and disorders. Sexual health can include issues of gender based violence and ensuring that individuals are safe from sexual violence. And it also includes education and information. So access to accurate and comprehensive information about sex, sexuality, safe sex practices and related issues so that people do understand, particularly young people, understand what's associated with sex and all of these different components that go along with it.

Nina: I mentioned this already, but I'll, I, I think it's really important and I'll go back to it, that it's really critical to recognize that there are distinctions between sexual health and reproductive health. And this is really important in women's health in particular because it recognizes that women aren't just reproductive vessels. There are lots of women, reasons that women choose to have sex and reproduction is part of the equation for women. It, it has to be part of the consideration, but it's not the whole story. There are also there plenty of people for whom reproduction is not an option for, for whatever reason. It's not even part of their decision making around sex, whether it's because of the relationship they're in, issues of gender nonconformity, issues of infertility. There's a whole set of of reasons why people aren't... Maybe having sex and not even thinking about reproduction and they still have sexual health needs. Um, so this, this, having, having these pieces fit together is able to encompass the, a much broader set of, of issues.

Jennie: So the last bit is sexual rights.

Nina: Yeah. So sexual rights. So of the four component parts, sexual rights is the place where there are still some active, active discussion around what the best definition is. Um, I think we have a firm understanding of what we're talking about, but there, there is not one accepted definition for it. The maybe the, the easiest and the simplest is a found in the 1995 Beijing Platform for Action, so this is a year after the ICPD defined reproductive rights. Beijing refers to the right to control, to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. And the WHO has gone on from that, they have a fairly lengthy working definition of sexual rights that highlights a number of components around privacy around the right to be free from torture and cruel, inhuman or degrading treatment, the right to marry and to find, found a family and enter into marriage at the free and full consent of the intending spouse, the right to decide the number and spacing of one's children. And a number of other components around this. And the who goes on to state that sexual rights protect all people's rights to fulfill and express their sexuality and enjoy sexual health with due regard to the rights of others and within a framework of protection against discrimination. And there are other international agreements that have gone farther, particularly at the regional level. Oh, a definition that I really like, uh, comes from the Montevideo Consensus on Population and Development in 2013, which is a Latin American regional negotiation between governments in that region. And they defined sexual rights to embrace the right to a safe and full sex life as well as the right to take free, informed, voluntary and responsible decisions on their sexuality, sexual orientation and gender identity without coercion, discrimination or violence. And they guarantee the right to information and the means necessary for their sexual health and reproductive health. So these are a lot of international agreement definitions. And, and in terms of what they really mean and what they all have in common is that sexual rights is about the human rights of all people to make decisions about their sexuality, about their sexual life, and to achieve the highest attainable both standard of sexual health.

Nina: So practically speaking, this can mean a number of things. Do you have the right to decide if, when, who you're going to have sex with, are you going to do it? Who are you going to do it with? Who, who do you want to have sex with? Um, you can't be coerced into having sex. You have a right to not face violence surrounding sexual activity and to, to be forced into be forced into sexual sexual assault. It can mean you can't be forced into a marriage or told who to marry your, your parents shouldn't be able to dictate your spouse. Um, you can't be coerced into, into forming a marriage. And this has big implications. You know, we're seeing this in our society on sort of a constant basis these days with the #MeToo movement and women who have come forward and really shown us how prevalent some of these coersion and discrimination aspects remain in the United States today. And these are, these are violations of people's sexual rights, right? If you're forced at work or if you're putting a is in a situation by your supervisor, where you know, you're being asked to do something sexual at work, that's a form of, of coersion or discrimination and falls very much under this category. And the other thing, which I think we can talk a little bit more about, cause it's really important is the implications for LGBTQ individuals. So this is where a lot of the, internationally, a lot of where the, a lot of the debate remains around sexual rights, but it's not the right to the right to have sex with whoever you want as long as it's the right person as dictated by society and the government or whoever, it's, it's to decide on all matters related to your sexuality. Right? So it does, it does enshrine the right of people to form relationships with who they want. And that has very, very important implications for, for LGBTQ equality and, and those, those related issues.

Jennie: Good. And I know, um, we've talked on our, touched on some of the international agreements that shows kind of how those definitions were crafted. So, um, maybe we want to talk a little bit about the history of the SRHR movement in a more straight line.

Nina: These issues, SRHR issues have a significant history of recognition at the United Nations and in international agreements between countries. And that, I think you can, you can trace back to, to seeing some of these concepts in the 1960s but 1994 and that and the International Conference on Population and Development, ICPD, is really sort of the breakthrough moment, um, where reproductive health is defined and elements are listed that of what reproductive health care entails. Reproductive rights are defined and linked to established human rights and international law and linked into the system. Cairo was really sort of, I think, a, a critical moment for the, for the movement because it moved sort of beyond just a population controller, demographically focused approach to all of these issues and started instead looking at human rights, the rights of individuals centering the agreement on women's human rights. And this is a really major shift in one that has been echoed then through in the, in the intervening years since then. And sort of similarly the Cairo agreement really rooted policy on on population and development issues in gender equality and women's empowerment. And that's been built on since, um, in a couple of really critical ways, but it really sort of solidified this idea that these issues, SRHR issues, are critical to successful development policy. Um, and, and that they have this sort of range of repercussions across women's lives. And that's a really important acknowledgement. And, and this was really, this was due to some really sustained long-term and strategic advocacy from women's rights groups, feminist groups who turned out, enforced and Cairo and, and really were instrumental in making this happen. And then they came again and the following year to Beijing. And you know, I think in the women's rights community we sort of all remember the, the women's rights or human rights moment in Beijing with, with, um, then first lady Hillary Clinton and the, that sort of being a moment, uh, for a lot of, of gender issues and women's rights issues. And, and for this, for the SRHR, Beijing, as we talked about previously, um, Beijing really took SRHR a step forward by introducing this component of sexual rights. And so it doesn't use the term sexual rights, but it uses the, the, it encompasses the idea of the right to control sexuality. And this was, again, it's a major win and it's, it's something that came about through sustained and strategic advocacy from the women's movement and feminist groups, who were both active within the negotiation spaces in Beijing and also in the, the very vibrant civil society spaces that, um, that, that were part of that conference.

Jennie: So now that we know a little bit of the history behind the SRHR movement, let's talk a little bit about what has been happening at the United Nations in the last several years. Nina: Since these sort of landmark agreements of the mid 1990s sexual and reproductive health and reproductive rights have been repeatedly reaffirmed, um, through international negotiations. And yet, despite over 20 years of agreement and consensus around these issues, we've still seen regressive governments continue to repeatedly try to undermine commitments and walk back some of this language. What we've seen in practice is that the basic concepts agreed to at ICPD and Beijing have been repeatedly reiterated in documents negotiated at the UN and there have been some additional and very hard fought advances. And one of the most significant, um, of those, those ways we, we have been able to move the conversation forward, came in 2015 with the adoption of the Sustainable Development Goals or the 2030 agenda. So this is the global development framework that was negotiated over several years and agreed to by the global community in 2015 at the UN to replace the Millennium Development Goals, and really sort of lay out a shared development vision for the next 15 years, going, looking ahead to 2030. And in this agreement, governments made a number of specific commitments really sort of around ensuring universal access to sexual and reproductive health care services and, and universal access to reproductive rights in accordance with these, um, these agreements laid out in the 90s. Um, and the, and the SDGs went a little bit farther because they really linked linked SRHR and these issues to the broader development agenda. So the ways that, that these issues, um, feed into both the achievement of health outcomes for entire societies and also to, to goals around women's equality and gender equality and women's empowerment. The SDGs also refer specifically to a number of, of issues that fall under an SDG or an STD SRHR sort of umbrella. Um, so commitments around any child early enforced marriage, for example, um, specific commitments around reducing global mortality rate, ending the HIV epidemic and achieving universal health coverage, all of which are critical to this conversation.

Nina: So, so there, so we have seen some real advancements since the 90s and I, and that that has been through really sustained advocacy through a lot of engagement with, with um, member states at the UN who do support these issues and, and pushing back against some of these efforts to roll back commitments. Um, there are a handful of areas where progress has been really hard though and we haven't seen a lot of progress since the 90s and one of these is abortion. ICPD um, includes language around co language calling for abortion to be safe where abortion is not against the law and that's a quote. Um, Beijing goes a little bit farther and calls on countries to review laws that criminalize abortion. But despite sort of overwhelming evidence documenting that women die when they lack access to safe and legal abortion, the international community has been really unable to come to consensus around protecting access to abortion services, which is, it's a huge problem obviously. Like the WHO says that up to 13% of all maternal deaths are attributable to unsafe abortion and says that almost every abortion, death and disability could be prevented through sexuality education, use of effective contraception, provision of safe legal induced abortion and timely care for con complications. So it's really quite, it's, it's one piece but it's a huge problem that the international community hasn't been able to, to really take this one on.

Nina: And a second place where some progress has been, progress has been slow and, and really hard to try to reach this this international consensus is around sexual rights. Sexual rights were admitted from the 2030 agenda and the SDGs there, we talk about sexual and reproductive health and reproductive rights. And so if you're looking at SRHR, the piece that's missing is the SR the sexual rights. In sort of repeated negotiations, the international community has baulked at using the term sexual rights and international consensus documents and regressive governments have taken aim at this term, both over the issues of women's and girl's bodily autonomy and their control over their sexuality as well as over the recognition of diverse sexual orientations and gender identities. So this has become, uh, a sort of a loaded conversation, um, in UN spaces and one that it has made progress forward difficult. And I will say, you know, the, the lack of inclusion of language on sexual orientation and gender identity back in Beijing in 1995 was a source of disappointment for, for my organization and for, for a number of the other groups that were there. And this has, has really, uh, really continued because again, this is a huge issue. Individuals in this country and around the world continue to face violence, harassment and discrimination because of their sexual orientation or gender identity. And many governments pursue policies that make this worse, right? That not only fail to recognize the human rights of all people, but actively criminalize them based on, on these grounds. So again, this is a place, one specific place within SRHR where it's been difficult to advance international consensus and the repercussions of that are significant around the world.

Jennie: Absolutely. I mean you've definitely seen places like Uganda where it's criminalized and people were being killed. Like it's really an area that we need progress on.

Nina: Yeah, absolutely.

Jennie: We have talked about the UN. Um, and one other thing that we haven't touched on yet is the Trump/Pence administration and how they have affected these things. So over the course of this podcast, we've talked about, you know, their impact on global policies and domestic policies, but we've not really spent time talking about their impact at the UN. So maybe we want to talk about what has changed since the Trump/Pence administration took office.

Nina: Since President Trump took office, I think we've really seen two things, which taken together having an, uh, a really massive impact globally, and that's what the US is doing both domestically and in terms of its foreign policy in attacking SRHR. Uh, many of these, these issues you've talked about on your, on your podcasts, but things like reimplementing the global gag rule, defunding UNFP, the UN's reproductive health entity agency, and these sort of attempts to cut funding for bilateral programs. These are, these are sort of US foreign policy pieces. And then that's been coupled with really persistent attacks on the UN, on the fabric of multi-lateralism, the international system and the idea of US leadership in these spaces, it's having a, a sort of a snowballing effect. I think the US is the largest funder of global health and reproductive health, so what the US says on these issues really matters and the US has a big voice on these issues. And in the past we, under the Obama administration, we really saw at the UN, the US in many cases being being a champion for, for particularly for reproductive rights and reproductive health and really actively leading the charge on this. And under this administration, it's really quite the opposite. So they've taken sort of every opportunity to, to, uh, to, to undermine language on sexual and reproductive health and rights, as well as to undermine the UN system itself and the processes of multi-lateralism, which I think is sort of a separate issue, but it's important to recognize the sort of, the ways that they're deleglitimizing the system and not, not working within the established framework.

Nina: I'll throw out a couple of examples of what we've seen since this administration has taken office. Um, every year countries meet for the Commission on the Status of Women. This is an annual UN space where countries, it's the major international space where countries are able to review progress on gender equality and women's empowerment. And they negotiate an agreement , at the space. And the Trump administration, both years since being in office, um, has included delegates on the official US delegation who have been committed to walking back commitments on SRHR. So in 2017, it was a delegate from an organization called C-Fam, which is designated as a hate group by the Southern Poverty Law Center and known for its extremest opposition to both women's health and rights and LGBTQ rights. And then in 2018, it was, uh, a political appointee from USAID, um, who cause had caused outcry when she was appointed to that position because of her history of aggressively crusading against transgender rights and including her as, as part of the negotiating team this year. So, and, and you know, we, we saw US negotiators stating the US is a pro-life country, disregarding the fact that both US law and public opinion support the right to, um, access safe abortion. Uh, we've repeatedly seen, uh, we've seen US diplomats pushing for changes to some of these longstanding agreed language pieces that, that we've, we've discussed already, um, on SRHR and calling for, for example, deleting references to modern contraceptives, really sort of pushing, pushing some of these places where there has been longstanding agreement pushing against that. Um, and in practice this, this has made the US sort of one of the most progressive countries in terms of sexual and reproductive health and rates in the UN space and has threatened longstanding international consensus on these issues. This is, this is a huge change. You know, we saw during the SDG process, um, leading up to 2015 we saw the Obama administration really playing a critical role in ensuring that in the end, end stages of those negotiations, that these issues were included. And now to see the Trump administration taking the opposite approach really sort of emboldens and empowers other regressive governments to also really dig in their heels on this. So it makes, it makes the whole process of, of, of these, um, of consensus on these issues really much more challenging.

Jennie: Yeah. It's particularly horrifying to see them arguing against modern contraceptive. Like that seems such a basic thing that women need, to hear that our government at the UN is fighting against that is pretty atrocious.

Nina: Yeah, absolutely. And, and there's just, there's so much evidence around it. There's so much evidence on, on what works for women and what, women need to control their, their reproductive lives and to see this really, this push back that that goes back decades is really, really disturbing.

Jennie: So some of this conversation has been pretty, you know, a little Wonky, a little, uh, policy-focused. So maybe we should bring it back to how does SRHR affect individuals?

Nina: Ah, that's, that's a great question cause I, you know, in, in DC we, we sort of get caught up in the wonky and the, the definitions and the, all of these various policy pieces. But I think we'll go back to where we started, which is that everybody has sexual and reproductive health needs, and everybody has sexual and reproductive rights. And so what does that look like in your life? You know, sort of everyday people are deciding whether or not they want to have sex, right? They're deciding if they want to get married, who they want to get married to, if they want to have kids. And if they do, how are they gonna make it happen? If they don't, how are they going to prevent it from happening? What are, what are the options available to them? Every day people are seeking medical intervention to treat reproductive cancer, to prevent it and, and to deal with, with a huge range of other, other health complications. And whenever you can make these decisions freely and you have access to these critical forms of health care, you're exercising, your sexual and reproductive health and rights. And I think it's probably more often than most people realize. But it is, it's really a key component of people's every day lives. And I, and I think we, we sort of, we get derailed sometimes because people hear SRHR and think abortion or they hear, they hear reproductive rights and think abortion or reproductive health. And abortion is a critical issue, I don't want to downplay it. I love those shirts from the um, National Network of Abortion Funds that say, uh, everyone loves someone who's had an abortion. Like the statistics really bear that out. Abortion is a big issue. In, in the US one in four women will get an abortion sometime in her lifetime. So I'm not trying to downplay that. Right? But what I'm trying to sort of up up play, the opposite of downplay. Um, you know, I think what's important to recognize is, is that there's also this huge range of other issues that that really do impact us all. Sort of to take it a step further, abortion rights can often be seen as a bellwether for where this is all going. So you know, when these issues come up in policy debates, particularly abortion, it's generally, it's, I think it's a huge mistake to see it as an attack on one specific service that some people need and some people don't. Right? It's an effort to control women's bodies and an effort to limit women's options. Abortion really is a, a piece of only a piece of this, but it's an indicative piece of, of policy. So I really sort of urge people in terms of how this affects me to look at, look at where the conversations are, abort on abortion are as an indication of um, the government's approach to sexual and reproductive health and rights writ large. And where we're heading in all of these conversations.

Jennie: You're talking about that as a bellweather, you know, a lot of these attacks are specifically targeted at abortion but fully well knowing they're going to have a much broader impact. Right? Like so closing Planned Parenthood... I mean it's not just about abortion, right? Like people are going there for their reproductive and sexual health needs and abortion is just part of that. But if Planned Parenthood stopped doing abortion tomorrow, conservative still wouldn't be happy. Right? Like they would still be mad that there's this group making sure that people have access to their sexual and reproductive health needs.

Nina: Right. And I mean this is, we come back to that. We talked about the, the attack on modern contraception. Like we just see these things escalated. It doesn't, it doesn't stay. Even if, if we see conservatives in power attack abortion specifically, it then also, well, but we're also sort of attacking tech contraception. We see it in the, in the challenges to the Obamacare contraceptive mandate. Again, like the, these things, it's a, these things are intrinsically linked, right? And can't really be seen as, oh well this is one service, so it's okay to not address that one because it's too controversial.

Jennie: Okay. So I always love to end my podcast with a really important question and that is, what can people do? What actions can people take if they care about SRHR globally?

Nina: Yeah, I think there's a number of things. The first day I'll say is just be informed. I think global SRHR is in the headlines more now than it usually is and there are more really good reporters who are covering these issues. Even even the sort of mundane ins and outs of UN negotiations, but you still have to look for it and it's, it's often not the sort of above the fold New York Times headline. And so I really think, I think the more that people can, can seek out information on this, listening to your podcast is a great way to do that because you've done a really great job of digging into some of the specific issues under this very broad heading, but really, really being informed about these issues and the ways that the impacts that a lot of these policies are having around the world is sort of, to me is step one.

Nina: In terms of what to do though, how to push back. I really encourage people to look to Congress. I used to work for Congress, or work for a member of Congress, so I'm a little bit biased here, but I do think that that Congress has a lot of power here to be the check on the administration that they're intended to be. And they can do this in a number of ways and they've shown some indication already, even under this Republican controlled Congress of playing that role. So funding is a key one. The administration has proposed the first year of the administration, they oppose, they proposed zeroing out the reproductive global reproductive health budget. This past year, they tempered that proposal slightly and only just massively gutted their, their funding requests. Um, and, and both times congress has sort of approached that as an a thanks but no thanks and has and has continued to fund these programs. So Congress does have that ability to set the final budget and to, to, to really to to push back against some of these most extreme proposals. And, and sort of similarly we saw, we've seen real intent, some real interest in the Senate in, in ending the global gag rule. Um, you know, while it wasn't finalized into law, we, we did see senators actively of both parties actively pushed back against this policy. So there, there are places that, that Congress has shown some interest and willingness to, to not just go along with some of these terrible proposals, but to really provide roadblocks. And a sort of a critical place that's ongoing is nominations, and sort of at all levels from, from there's a bunch of really critical and still empty State Department positions that the Senate will have to confirm eventually, to all the way up to, obviously we're seeing in the headlines every day the Kavanaugh nomination to the Supreme Court. And each of these nominations is an opportunity for the Senate to get a say in who's setting and executing US policy on these issues. So I really think it's, it's con that the Congress shouldn't be written off and that if people are looking for ways to take action, that the Congress is a great place to start. And I'll just, I'll throw out that I, I, having worked in a congressional office, members of Congress do listen to what their constituents say. They don't always act on it, but they listen. And it's important that members of Congress, both those who support SRHR and those who do not, it's important for them to hear that this is, this is an important issue. This is something that the people that their constituents care about and hear what their constituents, you know, want to see them doing.

Jennie: And that's really important and I think as particularly on these issues, there isn't, it's not like um, ACA repeal where you're getting thousands of people calling into your congress person's office about this particular issue and you're just another voice. You're going to be one of very few people calling in about this issue so you have a chance for your voice kind of make a bit of an outsized impact.

Nina: Yeah, absolutely. Absolutely. And I think it's really important even even if you know your member of Congress votes the right way on, on all of these things.

Jennie: Thank you helps.

Nina: Thank you helps. And and they are being asked to put out so many fires right now and their attention is pulled in so many different directions that the more they can be told this is an issue, that's important to me. This is something I want to hear you speak out on this is something that is of of interest to me as one of your constituents. I think that that is really important. I, you know, I think calling your, your member of Congress is important. There are a lot of other ways to make your voice heard. And you know, here in, in DC it seems like there's a protest every week and an opportunity to make signs and take to the streets. And I think those are all all really important. And one of the things that I people can do as they're standing up for women's reproductive, sexual reproductive health and rights here in this country is also understand that this administration is pursuing the same policies globally. And in some cases they're sort of using it as a trial balloon. And I'll go back to the global gag rule. Like we saw the imposition of this policy in the, globally in the first week of the Obama or the Obama, the Trump, whew the Trump Administration.

Jennie: Wishful thinking.

Nina: We saw the uh, the, yeah, the imposition of this policy and the first week of the Trump administration, and now a year and a half in, they're trying to apply it to organizations in this country, a very similar version of this policy. And so understanding that these, these global policies which affect women around the world but may not affect women here are going to come home. And, and the, the, you know, that's all part of the same ideology, that same approach to controlling women's bodies and, and to, to really undermining sexual and reproductive health and rights for all people. That is, is ends up in these policies overseas but also in the domestic space. So keeping that link in mind and, and really sort of speaking out on attacks on SRHR sort of wherever they occur.

Jennie: Well, Nina, thank you so much for being here. I had a lot of fun talking to you. Uh, so thank you.

Nina: Thanks so much.

Jennie: Thanks everybody. For more information including show notes from this episode and previous episodes, please visit our website reprosfightback.com. You can also find us on Facebook and Twitter at rePROs Fight Back. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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