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Sexual and reproductive health rights and justice – tracking the relationship a
b
Maya Unnithan & Stacy Leigh Pigg a
Department of Anthropology, University of Sussex, Brighton, UK
b
Department of Sociology and Anthropology, Simon Fraser University, Burnaby, Canada Published online: 14 Oct 2014.
Click for updates To cite this article: Maya Unnithan & Stacy Leigh Pigg (2014) Sexual and reproductive health rights and justice – tracking the relationship, Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 16:10, 1181-1187, DOI: 10.1080/13691058.2014.945774 To link to this article: http://dx.doi.org/10.1080/13691058.2014.945774
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
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Culture, Health & Sexuality, 2014 Vol. 16, No. 10, 1181–1187, http://dx.doi.org/10.1080/13691058.2014.945774
Editorial Introduction Sexual and reproductive health rights and justice – tracking the relationship Maya Unnithana* and Stacy Leigh Piggb
Downloaded by [Flinders University of South Australia] at 03:59 02 February 2015
a
Department of Anthropology, University of Sussex, Brighton, UK; bDepartment of Sociology and Anthropology, Simon Fraser University, Burnaby, Canada
As human rights frameworks increasingly pervade health development policy, planning and programmes globally, and most markedly in countries of the South, there is a growing sense that rights have arrived but justice has not followed. This swell of opinion has emerged from the ground up, challenging and interrogating the meanings, use and limits of rights by those who are ill, vulnerable and who seek and expect treatment, and from the health-workers and development actors who work to facilitate processes that promote reproductive and sexual health and well-being. At the level of social theory, the disconnect between rights and justice finds resonance in the work of social scientists highly critical of the moralising, neo-colonial and neo-liberal tendencies implicit in international human rights frameworks (see, for example, Brown 2004; Zˇizˇek 2005). These voices underscore the need to closely examine the relationship between rights and justice in sexual and reproductive health and its implications for healthcare practice and policy. While notions of justice have underpinned and moved rights forward in terms of a global health policy agenda – of which the concept of Reproductive Health formulated at the Cairo International conference on Population and Development in 1994 is a dramatic example – the need for a more comprehensive understanding of how to theorise structural injustices that underlie women and men’s sexual and reproductive lives is only now emerging (Aggleton and Parker 2010; Bailey 2011; Correa, Petchesky, and Parker 2008). Such work also begs the question of what the dominance of a rights-based approach entails for social and reproductive justice (Hodgson 2011) and what the alternative approaches to justice would be. We use the idea of reproductive justice, following Bailey (2011) and Correa, Petchesky, and Parker (2008), to signify contexts that are sufficiently enabled for women and men to make reproductive choices and health decisions that are meaningful and fully informed. Reproductive justice goes beyond a focus on marginalised populations because ‘examining the reproductive disciplining of some groups’ experience also highlights the reproductive privileging of others’ (Luna and Luker 2013, 328; also Unnithan 2013). Whereas rights are salient in a legal domain, justice more broadly engages individuals and community moralities in a wider sense, speaking to and challenging power inequalities.1 Reproductive justice is thus distinct from rights in its function as a ‘moral indicator’.2
*Corresponding author. Email: [email protected] q 2014 Taylor & Francis
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The use, problem and limits of rights In the face of the simplistic Cairo-driven development rhetoric that invokes ‘rights’ as the answer to problems in the domain of sexual and reproductive health, there has also emerged a sense that the notion of rights itself is problematic. First, studies that have tracked ‘local’ responses to reproductive and sexual health rights have importantly shown there to be a complex interconnection (and often disjunction) between ideas of rights as lived, embodied, articulated and claimed, from more universal understandings of rights as they are situated within legal and international discourse and practice (Aggleton and Parker 2010; Cornwall and Welbourn 2001; Correa, Petchesky, and Parker 2008; Petchesky 1998; Pigg 2005; Standing, Oronje, and Hawkins 2011; Unnithan-Kumar 2003). Second, this work has shown how rights work can engender processes through which certain people and agendas become excluded and new forms of inequalities, marginalised subjectivities and ‘victimhood’ emerge (that is, the ‘dark side’ of rights, as discussed by Aggleton and Parker [2010]). Drawing on insights from this body of work, the papers in this special symposium issue move on to examine more closely the nature of the gap between rights and justice. Contributions underscore the need to interrogate ‘rights-talk’ in the domain of health, to understand how, when and by whom is rights-talk wielded and to what effects. As international organisations and national governments are working to promote a rightsbased approach to health as a means of bringing about positive transformations in health outcomes,3 there is a significant need to critically examine the unqualified application of rights, that is, to understand ‘rights-work’ itself. How are rights actively appropriated and re-worked in specific historical, ideological and material contexts? What is it that the invocation of rights achieves, and for whom? How do notions of rights work against, with, or in some combination with, local notions of justice? These are important issues to examine and it is no coincidence that they emerge in a context of an increasing neoliberalisation of health, whereby national governments veer to adopt rights-based approaches in the face of unmet Millennium Development Goals, giving rise in the process to new languages, registers (of safety, risk and responsibility) and forms of subjectivity. The criticism of rights discourse in its general form, while important, does not fully account for what actually occurs when human rights frameworks become local social facts, embodied within people’s experiences of health programmes and policies and in the everyday practices of developments actors, or how they engage with local struggles for justice. Equally invisible, though just as crucial, is knowledge of how development actors and institutions ‘translate’ between indigenous, historically specific notions of justice, dignity, entitlement, duty and so forth, and the universalised, legal frame of rights. What is the effect of these uneasy junctures in programmes addressing sexual and reproductive health inequalities? How do rights frameworks that resonate elegantly and beautifully at one level begin to disintegrate into contradictions in actual practice? How does the on-theground enactment of rights frameworks and notions of justice empower or otherwise alter the agency of various development actors, be they grassroots non-governmental organisation workers, the experts in international development agencies or policy makers themselves? Situating these concerns in the context of lived experience and in field-based ethnography enables us to see the social and cultural effects of work done in the name of human rights. As recent studies investigating sexual and reproductive health rights (SRHR) in terms of lived experience point out, such a perspective is important as it enables an identification of the bottlenecks in ‘mainstreaming’ rights-based programmes and the
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gaps in the understanding of policy makers (Standing, Oronje, and Hawkins 2011). While we are supportive of these important ways of going beyond the abstract policy and legal formulations, we suggest such scholarship is limited in that its focus is on operationalising the concept of SRHR in different local and national domains. Taking rights analysis into the messiness of everyday life, we suggest, also requires an examination of how rights are ‘framed’, not only operationalised. Framing is what positioned actors, organisations and institutions do when they take up, promote, evoke and apply the concept of rights or seek avenues for legal protection through rights. The investigation of framing therefore necessitates a more detailed look at both how the possibilities of a rights framework are appropriated and tailored to specific goals, as well as the limitations and possible harms of the promotion of rights. The gains made by human rights activism suggest that rights remain the ‘most viable rhetorical structure available to civil society groups for making social and erotic justice claims, seeking redress or accountability’ (Correa, Petchesky, and Parker 2008, 152). Of similar import are the opportunities that rights-based development frameworks have provided for re-framing the meaning of ‘participation’ in health programmes (Cornwall and Nyamu-Musembi 2004; Cornwall and Welbourn 2001; Unnithan and Heitmeyer 2012, 2014). At the same time, recent studies and contributions in this issue remind us that rights work can put further distance between the benefits of rights legislation and those subjects who cannot claim access to the discourse of rights. They point us to the political environments in which rights talk is embedded. For example, Latin American conservatives are seen to appropriate the rhetoric of rights to argue for the support of pro-life and anti-abortion policies (Morgan, this issue; Morgan and Roberts 2012). Here, the ‘right to life’ of the unborn child is pitted against the rights to abortion, reproductive control and choice of the mother. In countries such as El Salvador and Nicaragua, the recognition of the juridical rights of the foetus has led to a ban on abortion and, in turn, as Morgan and Roberts suggest, underlies the rise of maternal death due to unsafe abortions. Similarly, rights can be appropriated to exacerbate existing, multiple forms of oppression that women suffer, at the same time as they seek to open up spaces and processes whereby these women can claim familial and institutional accountability (Macgregor and Mills 2011; Madhok, Unnithan and Heitmeyer, this issue). Or they can tell us how sexual subjectivities come into being through a dynamic relationship to a social discourse of rights (Boyce, this issue). A focus on the selective and strategic utilisation of rights by state and non-state health and legal aid organisations gives insight into which dimensions of rights are promoted and which particular concepts and legal tools become activated. We also see how such ‘translations’ engage the subjectivities of those who seek treatment as well as those who provide it, and are dynamically shaped in the moments of their enactment (Madhok, Unnithan and Heitmeyer, this issue; Ram, this issue). Overall, papers in the issue write from the position, as Hodgson (2011, 11) has observed, that realises the very sources of power of human rights discourses are also sources of its limitations. So while rights-based protocols are powerful as they promote and reinforce autonomy and self-determination of individuals, they are limited precisely in that they obscure other modes of being, belonging, connections, obligations and affiliations generated by overlapping collectivities. Another illustration of the simultaneous power and limitation of rights, according to Hodgson, is their secular foundation, which conflicts with ‘alternative modalities of morals and justice grounded in religious teaching’ (Hodgson 2011, 11). Wider structural inequalities that underpin poverty and economic exploitation become difficult to address through a rights paradigm that focuses on the individual alone.
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Aggleton and Parker (2010) make a similar point when they suggest that the darker, oppressive and discriminating forms associated with rights have their origins in deeper structures of violence, which necessitate wider struggles of justice. As tropes, sex and sexuality hold out the possibilities of both empowerment and destruction wherein ‘so much of sex ties not to autonomy, reciprocity and mutuality but to the expression of power and control’ (5). The negative sides to the competition over rights emerge precisely around issues of power and control and the ways in which, for example, new ‘victims’ are installed (e.g. through the prevention of domestic violence legislation discussed in Madhok, Unnithan, Heitmeyer, this issue), new kinds of responsibility are defined, which are unjust (such as in increasing the care burdens of women already entrusted with major responsibilities in the household and family (Campbell, Nair and Maimane this issue; Macgregor and Mills 2011), and long-standing essentialisms are reinforced (as in the rights of ‘indigenous’ and minority groups including women [Morgan, this issue]). Focusing on institutional and community engagement with sexual and reproductive health rights frameworks across the global South, the papers in this special edition offer new and critical insights on the relationship between justice and rights as locally mediated; on emergent forms of gendered politics of rights; on re-configured frameworks of citizenstate relations; on the collaboration and contestation between voluntary and civil society organisations and the state, as well as in relation to the communities they serve; and the place of health-related rights in the ‘deepening’ of justice and democracy in countries of the global South. Overview of papers Kalpana Ram’s paper sets the conceptual tone for this symposium with a focus on the connections between the capacities of the body (at once discursive and material in their scope), health and justice. Her paper weaves together empirical material from activists working in health in Tamil Nadu in order to show that in India, the framework of social justice has come to encompass the discourse of rights, particularly in the area of health. This is the result, she argues, of a much longer history going back to the interaction between colonialism and nationalism. She traces this history as an ongoing tradition that can be concretely and empirically tracked to demonstrate how a framework of social justice has transformed the invocation of rights in the area of health activism. Through ethnographic methods, she shows how a tradition such as this is both transmitted and renewed afresh by individuals, organisations and generations. In each case, the re-framing of rights by a discourse of securing justice allows an expansive response to varying political contexts by different groups of women situated quite differently in terms of caste, religion and cultural capital. The claims of the paper, and in particular its methodological arguments, extend well beyond India. Discourses of justice are able to encompass discourses of rights, she argues, ultimately because experiences of injustice are more primordially related to certain features of human embodiment. Through sensory modes of perception and movement, our bodies effect a synthesis with the world around us, its people and its places. Any sharp break or rupture in that synthesis may be experienced in certain moods as injustice. Injustice, and its corollary the need for justice, is thus more basic to experience than rights. It also means that discourses of justice will necessarily be more varied than those of rights, since they will emerge from very different kinds of human syntheses between body and world. Activist and other kinds of political traditions are active ingredients in such syntheses, integrating past and present in constituting embodied notions of justice.
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The generative relation between body and world is further explored by Paul Boyce through an examination of the multifaceted implications of same-sex sexual rights movements in India. Boyce’s paper challenges the notion that the global extension of sexual rights discourses will be welcomed by all queer sexual subjects as unambiguously emancipatory. Globalised frameworks for articulating sexual rights presume a linear, individuated advance toward greater public expression of and recognition for preordained, but heretofore subjugated, sexual identities. Whilst such policies may be progressive, they also do violence to subtle, multiple formations of sexualness and self-identification in everyday experience. Research in West Bengal shows that such understandings of subjectivity emerge within a matrix of both economic and cultural possibilities, with ambivalent effects. Neoliberal market liberalisation supports social formations in which the possibility of recognition for individuated sexual identities can be desirable, but these socio-economic conditions can also lead some people to reject identification as a claimant of sexual rights. Insomuch as rights discourse operates in a political economy of free market capital, it should be understood as but one aspect of the contextual possibilities that marginalised and gendered subjects might look to for justice and social legitimacy. Focusing on the relationship between political economy and the realisation of HIVrelevant rights in practice, Campbell, Nair and Maimane examine the limits to rights from the ‘ground-upwards’. Drawing on the experiences of the foreign funded Entabeni Project in South Africa, they problematise the value of rights-claims in responses to HIV beyond the rhetoric of the international. Marginalised women in a rural community sought to use their role as volunteer HIV carers in the Entabeni Project to leverage access to material resources and enhanced social status, through accessing government stipends and increasing recognition of their work. The programme generated enthusiastic activity and significant short-term successes in local HIV-related care. It failed to secure the stipend, or build effective alliances with significant others within and outside the community. After three years it collapsed, leaving women despondent and disappointed. Efforts to translate rights talk into practice in impoverished settings are more complex than is often acknowledged in HIV circles. The authors argue that especially gender equality-related rights (in which HIV- and AIDS-related rights are anchored) are impossible to realise, primarily because they are seldom ‘given away’ in contexts where power hierarchies allocate rights in an unequal manner. They highlight the fundamental significance of building social environments that enable marginalised collectives to assert rights and in which powerful members lend their support to such claims. Unless material entitlements are at the heart of rights struggles, and powerful groups incentivised to support the claims of the excluded, rights may be a blunt tool in communities lying beyond the reach of international treaties or urban-based activist movements In their paper, Madhok, Unnithan and Heitmeyer examine the critical role of legal activism in the domain of reproductive health. They draw attention to the difficulty of accessing reproductive health rights in the absence of effective state and legal guarantees for gender equity and citizenship, and argue that if reproductive rights are to be meaningful interventions on the ground, they must be legally and politically reframed in terms of reproductive justice. Drawing on multi-sited ethnographic fieldwork in Rajasthan, Northwest India, the authors track two dynamic legal aid interventions in India, namely to do with domestic violence and maternal mortality, that have sought to fill the existing gap between ineffective state legislation and state policy to ensure reproductive rights. Through an analysis of these interventions, they propose that requirements of reproductive justice cannot be met through discrete, albeit creative, legal initiatives pursued either by individuals or civil society organisations, but must involve comprehensive policies as well
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as strategic alliances between state, non-state, transnational organisations and progressive political groups. Lynn Morgan’s paper documents the appropriation of ‘human rights’ discourses by conservative Catholics in Argentina and throughout Latin America, where the recent success of reproductive and sexual rights social movements has generated a significant and vicious series of backlashes. When the Rosa Parks Prize was awarded to a conservative Argentine senator in 2009 for her outspoken opposition to contraception, sterilization and abortion, it was clear that something odd was happening. This paper documents the appropriation of human rights discourses by conservative Catholics in Argentina and throughout Latin America, where the recent success of reproductive and sexual rights social movements has generated a significant and vicious series of backlashes. The paper specifically traces an effort by Catholic legal scholars to justify what they term ‘a distinctively Latin American approach to human rights’, while ignoring decades of human rights activism by others, including the Madres of the Plaza de Mayo. Opponents of reproductive and sexual rights deploy rights-talk selectively and strategically, Morgan argues, using it as secular cover for theological agendas they hope will advance pro-life and pro-family policies.
Acknowledgements The majority of the contributions to this symposium issue were initially presented at a conference entitled Global Flows, Human Rights, Sexual and Reproductive Health: Ethnographies of Institutional Change in the South, organised by the first author at the University of Sussex, UK, in July 2011 (supported by an ESRC grant Res-062-23-1609 and a small grant from the Wellcome Trust). A subsequent panel discussion on Global Flows, Sexual and Reproductive Health and Rights: Ethnographies of Crossing and ‘Translation’ in the Global South was organised by both the authors at the American Anthropological Association meeting in San Francisco in November 2012. We thank Lynn Morgan for sharing her notes as discussant for the panel.
Notes 1.
2.
3.
In their work on reproductive justice, Luna and Luker (2013) highlight the dynamic yet tenuous relation between the law, social movements and academic scholarship. They suggest that while reproductive rights stem from a law-focused social movement, reproductive justice is predicated on notions of social justice, which emphasise intersectional social identities and community development solutions to structural inequalities. For Bailey (2011, 728), it is this ability to mobilise individuals and communities to create structural change through which notions of justice emerge as moral indicators. However, as she elaborates, the notion of reproductive justice cannot account for an independent moral theory until it accounts for why reproductive oppression is morally wrong or how reproductive goods and services ought to be fairly distributed. See UNFPA reports such as State of the World’s population, the WHO monograph on evaluating the impact of rights (Bustreo et al. 2013) and the proposed bill on Universal Health coverage in India, for example.
References Aggleton, P., and R. Parker. 2010. “Introduction.” In Routledge Handbook of Sexuality, Health and Rights, edited by P. Aggleton and R. Parker, 1– 9. London: Routledge. Bailey, A. 2011. “Reconceiving Surrogacy: Toward a Reproductive Justice Account of Indian Surrogacy.” Hypatia 26 (4): 715–741. doi:10.1111/j.1527-2001.2011.01168.x Brown, W. 2004. “‘The Most We Can Hope For . . . ’: Human Rights and the Politics of Fatalism.” The South Atlantic Quarterly 103 (2-3): 451– 463.
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Bustreo, F., P. Hunt, S. Gruskin, A. Eide, L. McGoey, S. Rao, F. Songane, et al. 2013. Women’s and Children’s Health: Evidence of Impact of Human Rights. World Health Organization: Geneva. http://www.who.int/maternal_child_adolescent/documents/women_children_human_rights/en/ Cornwall, A., and C. Nyamu-Musembi. 2004. “Putting The ‘Rights-Based Approach’ to Development Into Perspective.” Third World Quarterly 25 (8): 1415– 1437. doi:10.1080/ 0143659042000308447 Cornwall, A., and A. Welbourn. 2001. “Introduction.” In Realizing Rights: Transforming Approaches to Sexual and Reproductive Well-Being, edited by A. Cornwall and A. Wellbourn, 1 – 21. London: Zed Books. Correa, S., R. Petchesky, and R. Parker, eds. 2008. Sexuality, Health and Human Rights. London: Routledge. Hodgson, D. L. 2011. “Introduction: Gender and Culture at the Limit of Rights.” In Gender and Culture at the Limit of Rights, edited by D. Hodgson, 1 – 17. Philadelphia: University of Pennsylvania Press. Luna, Z., and K. Luker. 2013. “Reproductive Justice.” Annual Review of Law and Social Science. 9 (1): 327– 352. Macgregor, H., and E. Mills. 2011. “Framing Rights and Responsibilities: Accounts of Women with A History of AIDS Activism.” BMC International Health and Human Rights. 11 (Suppl 3): S7. doi:10.1186/1472-698X-11-S3-S7 Morgan, L., and E. Roberts. 2012. “Reproductive Governance in Latin America.” Anthropology & Medicine 19 (2): 241– 254. doi:10.1080/13648470.2012.675046 Petchesky, R. P. 1998. “Introduction.” In Negotiating Reproductive Rights: Women’s Perspectives across Countries and Cultures, edited by R. P. Petchesky and K. Judd, 1– 31. London: Zed Books. Pigg, S. L. 2005. “Globalising the Facts of Life.” In Sex in Development: Science, Sexuality and Morality in Global Perspective, edited by V. Adams and S. L. Pigg, 39 – 65. Durham: Duke University Press. Standing, H., R. N. Oronje, and K. Hawkins. 2011. “Contextualising rights: the lived experience of sexual and reproductive health rights.” BioMedCentral International Health and Human Rights 11 (Suppl 3). http://www.biomedcentral.com/bmcinthealthhumrights/supplements/11/S3 Unnithan, M. 2013. “Thinking through Surrogacy Legislation in India: Reflections on Relational Consent and the Rights of Infertile Women.” Journal of Legal Anthropology 1 (3): 287– 313. Unnithan, M., and C. Heitmeyer. 2012. “Global Rights and State Activism: Reflections on Civil Society-State Partnerships in Health in NW India.” Contributions to Indian Sociology 46 (3): 283– 310. doi:10.1177/006996671204600302 Unnithan, M., and C. Heitmeyer. 2014. “Challenges in ‘Translating’ Human Rights: Perceptions and Practices of Civil Society Actors in Western India.” Development and Change 45 (6): 1 –24. Unnithan-Kumar, M. 2003. Reproduction, Health, Rights: Connections and Disconnections. In Rights, Claims and Entitlements: Anthropological Perspectives, edited by R. A. Wilson and J. Mitchell, 183–208. London: Routledge. Zˇizˇek, S. 2005. “Against Human Rights.” New Left Review 34: 115– 131.
Culture, Health & Sexuality: An International Journal for Research, Intervention and Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/tchs20
Sexual and reproductive health rights and justice – tracking the relationship a
b
Maya Unnithan & Stacy Leigh Pigg a
Department of Anthropology, University of Sussex, Brighton, UK
b
Department of Sociology and Anthropology, Simon Fraser University, Burnaby, Canada Published online: 14 Oct 2014.
Click for updates To cite this article: Maya Unnithan & Stacy Leigh Pigg (2014) Sexual and reproductive health rights and justice – tracking the relationship, Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 16:10, 1181-1187, DOI: 10.1080/13691058.2014.945774 To link to this article: http://dx.doi.org/10.1080/13691058.2014.945774
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [Flinders University of South Australia] at 03:59 02 February 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Culture, Health & Sexuality, 2014 Vol. 16, No. 10, 1181–1187, http://dx.doi.org/10.1080/13691058.2014.945774
Editorial Introduction Sexual and reproductive health rights and justice – tracking the relationship Maya Unnithana* and Stacy Leigh Piggb
Downloaded by [Flinders University of South Australia] at 03:59 02 February 2015
a
Department of Anthropology, University of Sussex, Brighton, UK; bDepartment of Sociology and Anthropology, Simon Fraser University, Burnaby, Canada
As human rights frameworks increasingly pervade health development policy, planning and programmes globally, and most markedly in countries of the South, there is a growing sense that rights have arrived but justice has not followed. This swell of opinion has emerged from the ground up, challenging and interrogating the meanings, use and limits of rights by those who are ill, vulnerable and who seek and expect treatment, and from the health-workers and development actors who work to facilitate processes that promote reproductive and sexual health and well-being. At the level of social theory, the disconnect between rights and justice finds resonance in the work of social scientists highly critical of the moralising, neo-colonial and neo-liberal tendencies implicit in international human rights frameworks (see, for example, Brown 2004; Zˇizˇek 2005). These voices underscore the need to closely examine the relationship between rights and justice in sexual and reproductive health and its implications for healthcare practice and policy. While notions of justice have underpinned and moved rights forward in terms of a global health policy agenda – of which the concept of Reproductive Health formulated at the Cairo International conference on Population and Development in 1994 is a dramatic example – the need for a more comprehensive understanding of how to theorise structural injustices that underlie women and men’s sexual and reproductive lives is only now emerging (Aggleton and Parker 2010; Bailey 2011; Correa, Petchesky, and Parker 2008). Such work also begs the question of what the dominance of a rights-based approach entails for social and reproductive justice (Hodgson 2011) and what the alternative approaches to justice would be. We use the idea of reproductive justice, following Bailey (2011) and Correa, Petchesky, and Parker (2008), to signify contexts that are sufficiently enabled for women and men to make reproductive choices and health decisions that are meaningful and fully informed. Reproductive justice goes beyond a focus on marginalised populations because ‘examining the reproductive disciplining of some groups’ experience also highlights the reproductive privileging of others’ (Luna and Luker 2013, 328; also Unnithan 2013). Whereas rights are salient in a legal domain, justice more broadly engages individuals and community moralities in a wider sense, speaking to and challenging power inequalities.1 Reproductive justice is thus distinct from rights in its function as a ‘moral indicator’.2
*Corresponding author. Email: [email protected] q 2014 Taylor & Francis
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The use, problem and limits of rights In the face of the simplistic Cairo-driven development rhetoric that invokes ‘rights’ as the answer to problems in the domain of sexual and reproductive health, there has also emerged a sense that the notion of rights itself is problematic. First, studies that have tracked ‘local’ responses to reproductive and sexual health rights have importantly shown there to be a complex interconnection (and often disjunction) between ideas of rights as lived, embodied, articulated and claimed, from more universal understandings of rights as they are situated within legal and international discourse and practice (Aggleton and Parker 2010; Cornwall and Welbourn 2001; Correa, Petchesky, and Parker 2008; Petchesky 1998; Pigg 2005; Standing, Oronje, and Hawkins 2011; Unnithan-Kumar 2003). Second, this work has shown how rights work can engender processes through which certain people and agendas become excluded and new forms of inequalities, marginalised subjectivities and ‘victimhood’ emerge (that is, the ‘dark side’ of rights, as discussed by Aggleton and Parker [2010]). Drawing on insights from this body of work, the papers in this special symposium issue move on to examine more closely the nature of the gap between rights and justice. Contributions underscore the need to interrogate ‘rights-talk’ in the domain of health, to understand how, when and by whom is rights-talk wielded and to what effects. As international organisations and national governments are working to promote a rightsbased approach to health as a means of bringing about positive transformations in health outcomes,3 there is a significant need to critically examine the unqualified application of rights, that is, to understand ‘rights-work’ itself. How are rights actively appropriated and re-worked in specific historical, ideological and material contexts? What is it that the invocation of rights achieves, and for whom? How do notions of rights work against, with, or in some combination with, local notions of justice? These are important issues to examine and it is no coincidence that they emerge in a context of an increasing neoliberalisation of health, whereby national governments veer to adopt rights-based approaches in the face of unmet Millennium Development Goals, giving rise in the process to new languages, registers (of safety, risk and responsibility) and forms of subjectivity. The criticism of rights discourse in its general form, while important, does not fully account for what actually occurs when human rights frameworks become local social facts, embodied within people’s experiences of health programmes and policies and in the everyday practices of developments actors, or how they engage with local struggles for justice. Equally invisible, though just as crucial, is knowledge of how development actors and institutions ‘translate’ between indigenous, historically specific notions of justice, dignity, entitlement, duty and so forth, and the universalised, legal frame of rights. What is the effect of these uneasy junctures in programmes addressing sexual and reproductive health inequalities? How do rights frameworks that resonate elegantly and beautifully at one level begin to disintegrate into contradictions in actual practice? How does the on-theground enactment of rights frameworks and notions of justice empower or otherwise alter the agency of various development actors, be they grassroots non-governmental organisation workers, the experts in international development agencies or policy makers themselves? Situating these concerns in the context of lived experience and in field-based ethnography enables us to see the social and cultural effects of work done in the name of human rights. As recent studies investigating sexual and reproductive health rights (SRHR) in terms of lived experience point out, such a perspective is important as it enables an identification of the bottlenecks in ‘mainstreaming’ rights-based programmes and the
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gaps in the understanding of policy makers (Standing, Oronje, and Hawkins 2011). While we are supportive of these important ways of going beyond the abstract policy and legal formulations, we suggest such scholarship is limited in that its focus is on operationalising the concept of SRHR in different local and national domains. Taking rights analysis into the messiness of everyday life, we suggest, also requires an examination of how rights are ‘framed’, not only operationalised. Framing is what positioned actors, organisations and institutions do when they take up, promote, evoke and apply the concept of rights or seek avenues for legal protection through rights. The investigation of framing therefore necessitates a more detailed look at both how the possibilities of a rights framework are appropriated and tailored to specific goals, as well as the limitations and possible harms of the promotion of rights. The gains made by human rights activism suggest that rights remain the ‘most viable rhetorical structure available to civil society groups for making social and erotic justice claims, seeking redress or accountability’ (Correa, Petchesky, and Parker 2008, 152). Of similar import are the opportunities that rights-based development frameworks have provided for re-framing the meaning of ‘participation’ in health programmes (Cornwall and Nyamu-Musembi 2004; Cornwall and Welbourn 2001; Unnithan and Heitmeyer 2012, 2014). At the same time, recent studies and contributions in this issue remind us that rights work can put further distance between the benefits of rights legislation and those subjects who cannot claim access to the discourse of rights. They point us to the political environments in which rights talk is embedded. For example, Latin American conservatives are seen to appropriate the rhetoric of rights to argue for the support of pro-life and anti-abortion policies (Morgan, this issue; Morgan and Roberts 2012). Here, the ‘right to life’ of the unborn child is pitted against the rights to abortion, reproductive control and choice of the mother. In countries such as El Salvador and Nicaragua, the recognition of the juridical rights of the foetus has led to a ban on abortion and, in turn, as Morgan and Roberts suggest, underlies the rise of maternal death due to unsafe abortions. Similarly, rights can be appropriated to exacerbate existing, multiple forms of oppression that women suffer, at the same time as they seek to open up spaces and processes whereby these women can claim familial and institutional accountability (Macgregor and Mills 2011; Madhok, Unnithan and Heitmeyer, this issue). Or they can tell us how sexual subjectivities come into being through a dynamic relationship to a social discourse of rights (Boyce, this issue). A focus on the selective and strategic utilisation of rights by state and non-state health and legal aid organisations gives insight into which dimensions of rights are promoted and which particular concepts and legal tools become activated. We also see how such ‘translations’ engage the subjectivities of those who seek treatment as well as those who provide it, and are dynamically shaped in the moments of their enactment (Madhok, Unnithan and Heitmeyer, this issue; Ram, this issue). Overall, papers in the issue write from the position, as Hodgson (2011, 11) has observed, that realises the very sources of power of human rights discourses are also sources of its limitations. So while rights-based protocols are powerful as they promote and reinforce autonomy and self-determination of individuals, they are limited precisely in that they obscure other modes of being, belonging, connections, obligations and affiliations generated by overlapping collectivities. Another illustration of the simultaneous power and limitation of rights, according to Hodgson, is their secular foundation, which conflicts with ‘alternative modalities of morals and justice grounded in religious teaching’ (Hodgson 2011, 11). Wider structural inequalities that underpin poverty and economic exploitation become difficult to address through a rights paradigm that focuses on the individual alone.
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Aggleton and Parker (2010) make a similar point when they suggest that the darker, oppressive and discriminating forms associated with rights have their origins in deeper structures of violence, which necessitate wider struggles of justice. As tropes, sex and sexuality hold out the possibilities of both empowerment and destruction wherein ‘so much of sex ties not to autonomy, reciprocity and mutuality but to the expression of power and control’ (5). The negative sides to the competition over rights emerge precisely around issues of power and control and the ways in which, for example, new ‘victims’ are installed (e.g. through the prevention of domestic violence legislation discussed in Madhok, Unnithan, Heitmeyer, this issue), new kinds of responsibility are defined, which are unjust (such as in increasing the care burdens of women already entrusted with major responsibilities in the household and family (Campbell, Nair and Maimane this issue; Macgregor and Mills 2011), and long-standing essentialisms are reinforced (as in the rights of ‘indigenous’ and minority groups including women [Morgan, this issue]). Focusing on institutional and community engagement with sexual and reproductive health rights frameworks across the global South, the papers in this special edition offer new and critical insights on the relationship between justice and rights as locally mediated; on emergent forms of gendered politics of rights; on re-configured frameworks of citizenstate relations; on the collaboration and contestation between voluntary and civil society organisations and the state, as well as in relation to the communities they serve; and the place of health-related rights in the ‘deepening’ of justice and democracy in countries of the global South. Overview of papers Kalpana Ram’s paper sets the conceptual tone for this symposium with a focus on the connections between the capacities of the body (at once discursive and material in their scope), health and justice. Her paper weaves together empirical material from activists working in health in Tamil Nadu in order to show that in India, the framework of social justice has come to encompass the discourse of rights, particularly in the area of health. This is the result, she argues, of a much longer history going back to the interaction between colonialism and nationalism. She traces this history as an ongoing tradition that can be concretely and empirically tracked to demonstrate how a framework of social justice has transformed the invocation of rights in the area of health activism. Through ethnographic methods, she shows how a tradition such as this is both transmitted and renewed afresh by individuals, organisations and generations. In each case, the re-framing of rights by a discourse of securing justice allows an expansive response to varying political contexts by different groups of women situated quite differently in terms of caste, religion and cultural capital. The claims of the paper, and in particular its methodological arguments, extend well beyond India. Discourses of justice are able to encompass discourses of rights, she argues, ultimately because experiences of injustice are more primordially related to certain features of human embodiment. Through sensory modes of perception and movement, our bodies effect a synthesis with the world around us, its people and its places. Any sharp break or rupture in that synthesis may be experienced in certain moods as injustice. Injustice, and its corollary the need for justice, is thus more basic to experience than rights. It also means that discourses of justice will necessarily be more varied than those of rights, since they will emerge from very different kinds of human syntheses between body and world. Activist and other kinds of political traditions are active ingredients in such syntheses, integrating past and present in constituting embodied notions of justice.
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The generative relation between body and world is further explored by Paul Boyce through an examination of the multifaceted implications of same-sex sexual rights movements in India. Boyce’s paper challenges the notion that the global extension of sexual rights discourses will be welcomed by all queer sexual subjects as unambiguously emancipatory. Globalised frameworks for articulating sexual rights presume a linear, individuated advance toward greater public expression of and recognition for preordained, but heretofore subjugated, sexual identities. Whilst such policies may be progressive, they also do violence to subtle, multiple formations of sexualness and self-identification in everyday experience. Research in West Bengal shows that such understandings of subjectivity emerge within a matrix of both economic and cultural possibilities, with ambivalent effects. Neoliberal market liberalisation supports social formations in which the possibility of recognition for individuated sexual identities can be desirable, but these socio-economic conditions can also lead some people to reject identification as a claimant of sexual rights. Insomuch as rights discourse operates in a political economy of free market capital, it should be understood as but one aspect of the contextual possibilities that marginalised and gendered subjects might look to for justice and social legitimacy. Focusing on the relationship between political economy and the realisation of HIVrelevant rights in practice, Campbell, Nair and Maimane examine the limits to rights from the ‘ground-upwards’. Drawing on the experiences of the foreign funded Entabeni Project in South Africa, they problematise the value of rights-claims in responses to HIV beyond the rhetoric of the international. Marginalised women in a rural community sought to use their role as volunteer HIV carers in the Entabeni Project to leverage access to material resources and enhanced social status, through accessing government stipends and increasing recognition of their work. The programme generated enthusiastic activity and significant short-term successes in local HIV-related care. It failed to secure the stipend, or build effective alliances with significant others within and outside the community. After three years it collapsed, leaving women despondent and disappointed. Efforts to translate rights talk into practice in impoverished settings are more complex than is often acknowledged in HIV circles. The authors argue that especially gender equality-related rights (in which HIV- and AIDS-related rights are anchored) are impossible to realise, primarily because they are seldom ‘given away’ in contexts where power hierarchies allocate rights in an unequal manner. They highlight the fundamental significance of building social environments that enable marginalised collectives to assert rights and in which powerful members lend their support to such claims. Unless material entitlements are at the heart of rights struggles, and powerful groups incentivised to support the claims of the excluded, rights may be a blunt tool in communities lying beyond the reach of international treaties or urban-based activist movements In their paper, Madhok, Unnithan and Heitmeyer examine the critical role of legal activism in the domain of reproductive health. They draw attention to the difficulty of accessing reproductive health rights in the absence of effective state and legal guarantees for gender equity and citizenship, and argue that if reproductive rights are to be meaningful interventions on the ground, they must be legally and politically reframed in terms of reproductive justice. Drawing on multi-sited ethnographic fieldwork in Rajasthan, Northwest India, the authors track two dynamic legal aid interventions in India, namely to do with domestic violence and maternal mortality, that have sought to fill the existing gap between ineffective state legislation and state policy to ensure reproductive rights. Through an analysis of these interventions, they propose that requirements of reproductive justice cannot be met through discrete, albeit creative, legal initiatives pursued either by individuals or civil society organisations, but must involve comprehensive policies as well
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as strategic alliances between state, non-state, transnational organisations and progressive political groups. Lynn Morgan’s paper documents the appropriation of ‘human rights’ discourses by conservative Catholics in Argentina and throughout Latin America, where the recent success of reproductive and sexual rights social movements has generated a significant and vicious series of backlashes. When the Rosa Parks Prize was awarded to a conservative Argentine senator in 2009 for her outspoken opposition to contraception, sterilization and abortion, it was clear that something odd was happening. This paper documents the appropriation of human rights discourses by conservative Catholics in Argentina and throughout Latin America, where the recent success of reproductive and sexual rights social movements has generated a significant and vicious series of backlashes. The paper specifically traces an effort by Catholic legal scholars to justify what they term ‘a distinctively Latin American approach to human rights’, while ignoring decades of human rights activism by others, including the Madres of the Plaza de Mayo. Opponents of reproductive and sexual rights deploy rights-talk selectively and strategically, Morgan argues, using it as secular cover for theological agendas they hope will advance pro-life and pro-family policies.
Acknowledgements The majority of the contributions to this symposium issue were initially presented at a conference entitled Global Flows, Human Rights, Sexual and Reproductive Health: Ethnographies of Institutional Change in the South, organised by the first author at the University of Sussex, UK, in July 2011 (supported by an ESRC grant Res-062-23-1609 and a small grant from the Wellcome Trust). A subsequent panel discussion on Global Flows, Sexual and Reproductive Health and Rights: Ethnographies of Crossing and ‘Translation’ in the Global South was organised by both the authors at the American Anthropological Association meeting in San Francisco in November 2012. We thank Lynn Morgan for sharing her notes as discussant for the panel.
Notes 1.
2.
3.
In their work on reproductive justice, Luna and Luker (2013) highlight the dynamic yet tenuous relation between the law, social movements and academic scholarship. They suggest that while reproductive rights stem from a law-focused social movement, reproductive justice is predicated on notions of social justice, which emphasise intersectional social identities and community development solutions to structural inequalities. For Bailey (2011, 728), it is this ability to mobilise individuals and communities to create structural change through which notions of justice emerge as moral indicators. However, as she elaborates, the notion of reproductive justice cannot account for an independent moral theory until it accounts for why reproductive oppression is morally wrong or how reproductive goods and services ought to be fairly distributed. See UNFPA reports such as State of the World’s population, the WHO monograph on evaluating the impact of rights (Bustreo et al. 2013) and the proposed bill on Universal Health coverage in India, for example.
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