It was the classic image from places with inadequate health services (which is to say, far too many places) -- a central hospital overflowing with desperate people, hundreds more lined up and waiting, anxious families surrounding beds that were jammed in the hallways and along the walls outside the building, hugging the tiny bit of shade. It was the early 1990s in Lusaka, Zambia, where I was working on increasing women's political opportunities, even as it was rapidly becoming clear that inadequate health care was among the many things holding women back.
|Inequities in status, education, nutrition, public participation and mobility result in illness for people everywhere, and these same inequities determine who among the sick will be cared for and treated.
It worked in reverse as well: discrimination against women was holding back improvements in health care. I had interned earlier with the World Health Organization's Global Program on AIDS, appalled at the abuses of women's human rights that were being reported from all over the world and the ways in which these both contributed to women's risk of being infected with HIV, and once infected of receiving needed care and support. Women were being blamed for any HIV infection in their communities, forced to marry the brothers of their deceased husbands, deprived of property rights, and subjected to stigma and discrimination in increasingly new and different ways. How could countries ever get HIV under control when so many people was terrified of the stigma and ostracism that could result if it was known they were seen seeking testing let alone care?
Inequities in status, education, nutrition, public participation and mobility result in illness for people everywhere, and these same inequities determine who among the sick will be cared for and treated. Ever since I began to understand this, I have dedicated myself to fighting the misguided laws and policies that damage public health, usually because they discriminate against women. The most marginalized people – sex workers, drug users, adolescents – suffer the worst abuses.
More than 220 million women have no access to the contraceptive information and services they need to plan their families and determine their reproductive lives, for example. Some laws deny adolescents contraceptives without parental consent. Other laws require AIDS treatment centers to turn over the names of sex workers to government authorities, or to denounce prostitution even as they are trying to support the inclusion of sex workers in AIDS education efforts.
People living with HIV were until recently barred from entering the United States and are still not allowed into many other countries. Women with the virus are often still condemned for wanting to have sexual and reproductive lives. And in many places, people cannot accompany loved ones when they are sick or in hospitals because their relationships are not officially recognized.
Such outdated laws constrain the ability of even a good health service to do what it wants and needs to do. The Program on Global Health and Human Rights that I direct at the University of Southern California works against these laws, pointing out the links between public health and human rights abuses, including gender-based violence. But our approach does not rely on making speeches or organizing protests. As principal investigator for several projects sponsored by WHO, UNAIDS, the United Nations Population Fund, and others, I don't call myself an advocate. I am a researcher, providing the evidence and bringing up the facts of each situation using scientific research to highlight the harms caused by bad law.
If what my colleagues and I show is based in evidence and grounded in international human rights law, it can speak to the people who are skeptical, showing the value of comprehensive sexual and reproductive health care and what is needed to achieve it. Our academic research must be and is rigorous in order to be respected. We don't use a lot of adjectives. We want people to see for themselves the facts on the ground, and how the lives of real people are affected by the laws that govern them and their health care providers.
Achieving public health and equity for women in this way is neither easy nor fast. Individuals in decision-making positions need to be persuaded, one by one, to change laws and regulations and local customs that are harmful to women. They need time to grasp the ramifications as they go – not only health care and education but poverty, inequality and the issues of sanitation, transportation, trained personnel, medical equipment, delivery logistics, social reaction and so on.
This process yields very few quick wins or immediate success stories to decorate the quantitative reports so many agencies and funders now expect, and which often dictate their investments. That is why change on behalf of women is so difficult. And that is also why it is so important.
Sofia Gruskin directs the Program on Global Health & Human Rights at the University of Southern California Institute for Global Health, and holds appointments as Professor of Preventive Medicine at the Keck School of Medicine and as Professor of Law and Preventive Medicine at the Gould School of Law. A pioneer in global health and human rights, Professor Gruskin was previously at the Harvard School of Public Health's Department of Global Health and Population, where she was an Associate Professor, Director of the Program on International Health and Human Rights, and Co-Director of the Interdepartmental Program on Women, Gender and Health.