Reproductive Rights Case Studies
By Penelope Xenou, Raiaab Ajmal and Oliver Polachini
Case Study 1: Malta
The standard definition of human rights is rights that every person inherently possesses. Food, shelter, education, workers’ rights and various other liberties instantly come to mind. Some individuals believe that reproductive rights are an intrinsic human right. However, governments often place the prioritization of these rights on the executive backburner. While in some progressive countries, those respective governments continue to enforce reproductive rights awareness programs and protective action. In other nations, the governmental officials remain conservative when considering reproductive liberties. A country perfectly exemplifying a total legislative stagnation on this domain is Malta. A Southern European island country with a population of 450,000 over an area of 316 km, Malta is the tenth smallest country in the world.
Despite being a member of the European Union since 2004, Malta has failed to align with her neighboring countries’ reproductive rights advancements on both a social and legal level.
Despite this failure to act, Malta’s unmoving stance can to some extent be justified given the slow-paced assertion of reproductive rights internationally. In 1945, the United Nations Charter included the obligation “to promote... universal respect for, and observance of, human rights and fundamental freedoms for all without discrimination as to race, sex, language, or religion". However, the charter did not define these rights. Three years later, the first international legal document to delineate human rights, the UDHR, made no mention of reproductive rights. It wasn’t until 1968, that the Proclamation of Tehran alluded to them, stating: "Parents have a basic human right to determine freely and responsibly the number and the spacing of their children". A milestone, however, in the rights’ progression proved to be the “Cairo Programme of Action” in 1994. Adopted by 184 UN member states, the CPA is the first international policy document to define reproductive health, stating, among other, the implicit right of women “to be informed and have access to safe, effective, affordable and acceptable methods of family planning of their choice, … and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.” One year later, in 1995, the Fourth World Conference on Women in Beijing established a broader context of reproductive rights:
“The human rights of women include their right 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.”
25 years has passed, and Maltese and individuals around the world alike ask themselves if the European island country achieved anything in the field of reproductive rights. Malta launched its first National Sexual Health Policy in 2010 and went on to set a National Sexual Health Strategy in 2011. The Maltese government created a sexual health website and conducted a national study on sexual behavior. In spite of the government’s good intentions, their enthusiasm gradually wore off. The government failed to develop a national plan beyond its initial stages. Their national plan lacked the indication of clear responsibilities, timelines and measures of monitoring, and evaluation of quality standards in corresponding health services. The introduction of Guidelines for Sexuality and Relationship education in Maltese Schools in 2013 shared the same failures as the National Sexual Health Strategy. Albeit a positive step, the measure did not ensure sufficient training for teachers. As a result, educational professionals did not teach the sessions. Specifically regarding the matter of abortion, the schools only invited pro-life organizations to present information about reproductive health.
The results of the 2011 National Survey showed that only 55.4% of respondents used modern contraceptive methods, with almost 40% of them preferring condoms. Meanwhile, other forms of long-acting reversible contraception are not available in Malta. At the same time, only 5% of girls answered positive when asked about whether they had been on the contraceptive pill during their last sexual intercourse. In 2012, the results disclosed that 30% of sexually active young people aged 16 -18 did not use any form of contraception.
These statistics, however, would not take a Maltese citizen by surprise since on the national government fails to address all sex- and relationship- related issues. To Maltese society and previous governmental administration, these are “taboo” issues. Even naming them would be considered an insult to society.
The situation, however, has gradually improved, with the 2010s being a milestone decade for the island country: a national campaign to end censorship in the arts, the legalization of divorce, same-sex marriage and gay adoption, gender identity rights and wider access to IVF. Thus, with the legalization of these rights, only one more issue remained absent from any political agendas and legislative committees: abortion. Malta is the only European country that outright bans abortion without the examination of special circumstances. A woman who terminates her pregnancy and the doctor who facilitates the procedure can each face up to three years in prison. Even in Poland and Northern Ireland, countries who also host notoriously restrictive reproductive rights laws, abortions are allowed in certain situations where the woman’s health is jeopardized.
The World Health Organization declares, “if the aim of a country is to make abortions rarer, zero tolerance achieves zero results and the only way to reduce the number of abortions is through investing in measures that increase the use of contraception.” Although reproductive health is considered a “non-issue” in Malta, backstreet abortions are on the rise; each year hundreds of women take short trips overseas, typically in the UK or Italy, to undergo abortion procedures that can cost more than $1,000. These backstreet abortion trips mean, unfortunately, that they receive no follow-up appointments. This notable lack of monitoring after a medical procedure puts their lives at risk, insomuch that Maltese doctors avoid advising them for fear of being accused as accessories in a criminal act. Women who do not have the means for these “abortion trips” resort to illegally ordering abortion pills online.
This dire situation mirrors, indeed, the public opinion on the matter; in 2018, MaltaToday polled the Maltese to find that 95% are against abortion in the first three months of pregnancy, while 78.5% oppose pregnancy termination in case of rape. It is evident that these beliefs are interwoven in the Maltese religious identity. The island is a stronghold for the Catholic Church. The social, cultural background is very firmly rooted in the Catholic doctrine, given that even the constitution implicitly names Malta a “Roman Catholic country”.
Yet, despite these issues, reproductive-rights activists remain optimistic; Malta will soon change its course. A wind of libertarianism -in terms of human rights freedom- appears to be blowing across many European countries, loosening reproductive rights restrictions even in traditional, conservative environments. The most prominent example is Ireland, which lifted its ban on divorce only in 1995, legalized same-sex marriage in 2015 and decriminalized abortion in 2019. Albeit belated, reproductive-rights movements seem to be, at last, gaining unprecedented momentum on the island country; Malta is to follow in Ireland’s footsteps.
The standard definition of human rights is rights that every person inherently possesses. Food, shelter, education, workers’ rights and various other liberties instantly come to mind. Some individuals believe that reproductive rights are an intrinsic human right. However, governments often place the prioritization of these rights on the executive backburner. While in some progressive countries, those respective governments continue to enforce reproductive rights awareness programs and protective action. In other nations, the governmental officials remain conservative when considering reproductive liberties. A country perfectly exemplifying a total legislative stagnation on this domain is Malta. A Southern European island country with a population of 450,000 over an area of 316 km, Malta is the tenth smallest country in the world.
Despite being a member of the European Union since 2004, Malta has failed to align with her neighboring countries’ reproductive rights advancements on both a social and legal level.
Despite this failure to act, Malta’s unmoving stance can to some extent be justified given the slow-paced assertion of reproductive rights internationally. In 1945, the United Nations Charter included the obligation “to promote... universal respect for, and observance of, human rights and fundamental freedoms for all without discrimination as to race, sex, language, or religion". However, the charter did not define these rights. Three years later, the first international legal document to delineate human rights, the UDHR, made no mention of reproductive rights. It wasn’t until 1968, that the Proclamation of Tehran alluded to them, stating: "Parents have a basic human right to determine freely and responsibly the number and the spacing of their children". A milestone, however, in the rights’ progression proved to be the “Cairo Programme of Action” in 1994. Adopted by 184 UN member states, the CPA is the first international policy document to define reproductive health, stating, among other, the implicit right of women “to be informed and have access to safe, effective, affordable and acceptable methods of family planning of their choice, … and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.” One year later, in 1995, the Fourth World Conference on Women in Beijing established a broader context of reproductive rights:
“The human rights of women include their right 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.”
25 years has passed, and Maltese and individuals around the world alike ask themselves if the European island country achieved anything in the field of reproductive rights. Malta launched its first National Sexual Health Policy in 2010 and went on to set a National Sexual Health Strategy in 2011. The Maltese government created a sexual health website and conducted a national study on sexual behavior. In spite of the government’s good intentions, their enthusiasm gradually wore off. The government failed to develop a national plan beyond its initial stages. Their national plan lacked the indication of clear responsibilities, timelines and measures of monitoring, and evaluation of quality standards in corresponding health services. The introduction of Guidelines for Sexuality and Relationship education in Maltese Schools in 2013 shared the same failures as the National Sexual Health Strategy. Albeit a positive step, the measure did not ensure sufficient training for teachers. As a result, educational professionals did not teach the sessions. Specifically regarding the matter of abortion, the schools only invited pro-life organizations to present information about reproductive health.
The results of the 2011 National Survey showed that only 55.4% of respondents used modern contraceptive methods, with almost 40% of them preferring condoms. Meanwhile, other forms of long-acting reversible contraception are not available in Malta. At the same time, only 5% of girls answered positive when asked about whether they had been on the contraceptive pill during their last sexual intercourse. In 2012, the results disclosed that 30% of sexually active young people aged 16 -18 did not use any form of contraception.
These statistics, however, would not take a Maltese citizen by surprise since on the national government fails to address all sex- and relationship- related issues. To Maltese society and previous governmental administration, these are “taboo” issues. Even naming them would be considered an insult to society.
The situation, however, has gradually improved, with the 2010s being a milestone decade for the island country: a national campaign to end censorship in the arts, the legalization of divorce, same-sex marriage and gay adoption, gender identity rights and wider access to IVF. Thus, with the legalization of these rights, only one more issue remained absent from any political agendas and legislative committees: abortion. Malta is the only European country that outright bans abortion without the examination of special circumstances. A woman who terminates her pregnancy and the doctor who facilitates the procedure can each face up to three years in prison. Even in Poland and Northern Ireland, countries who also host notoriously restrictive reproductive rights laws, abortions are allowed in certain situations where the woman’s health is jeopardized.
The World Health Organization declares, “if the aim of a country is to make abortions rarer, zero tolerance achieves zero results and the only way to reduce the number of abortions is through investing in measures that increase the use of contraception.” Although reproductive health is considered a “non-issue” in Malta, backstreet abortions are on the rise; each year hundreds of women take short trips overseas, typically in the UK or Italy, to undergo abortion procedures that can cost more than $1,000. These backstreet abortion trips mean, unfortunately, that they receive no follow-up appointments. This notable lack of monitoring after a medical procedure puts their lives at risk, insomuch that Maltese doctors avoid advising them for fear of being accused as accessories in a criminal act. Women who do not have the means for these “abortion trips” resort to illegally ordering abortion pills online.
This dire situation mirrors, indeed, the public opinion on the matter; in 2018, MaltaToday polled the Maltese to find that 95% are against abortion in the first three months of pregnancy, while 78.5% oppose pregnancy termination in case of rape. It is evident that these beliefs are interwoven in the Maltese religious identity. The island is a stronghold for the Catholic Church. The social, cultural background is very firmly rooted in the Catholic doctrine, given that even the constitution implicitly names Malta a “Roman Catholic country”.
Yet, despite these issues, reproductive-rights activists remain optimistic; Malta will soon change its course. A wind of libertarianism -in terms of human rights freedom- appears to be blowing across many European countries, loosening reproductive rights restrictions even in traditional, conservative environments. The most prominent example is Ireland, which lifted its ban on divorce only in 1995, legalized same-sex marriage in 2015 and decriminalized abortion in 2019. Albeit belated, reproductive-rights movements seem to be, at last, gaining unprecedented momentum on the island country; Malta is to follow in Ireland’s footsteps.
Case Study 2: Sudan
Throughout history, religion has played a vital role in forming and determining the constitutions of numerous governments around the globe. Since religion is so personal, various faiths will inevitably have many interpretations. However, this event has led to the misguided application of religious misinterpretations in a veil of taboo to influence a patriarchal construct, where a male-dominated government has the authority to form laws related to the reproductive rights of women.
One such regime is that of Sudan. In a country which has been deemed “one of the worst countries in the Arab states for women’s rights,” with 97% of its population following Islam, Sudan’s 1968, 1973 and 1998 constitutions declared Sharia law as the chief source of all legislation. A survey conducted by the Thomas Reuters Foundation states, “strict interpretations of Islam curb Sudanese women’s freedoms.”
Assorted Sharia law interpretations can be found in Islamic countries all around the world. Some scholars consider the laws provided in the Holy Book, the Quran, to be lenient, and accommodating for women of all backgrounds. However, certain Islamic countries have austern laws regarding abortions, birth control methods and female genital mutilation. In countries like Tunisia, women can have abortions freely, but in Sudan, this practice can only take place under certain conditions. According to Sudan’s constitution, the circumstances under which an abortion is considered legal is one of these three conditions as mentioned in the criminal code of 1991.
(Arabic version, article 135 and 136): (1) The miscarriage is necessary to save the mother’s life, (2) the pregnancy is the result of rape which has occurred not more than 90 days before the pregnant woman has desired to have the abortion or (3) it is proved that the quick unborn child has died in the mother’s womb.
Despite these laws, the whole concept of abortion is frowned upon in Sudan’s conservative society. Oftentimes, women are forced to marry their assaulters, and give birth to a child concieved of sexual assault. It is not uncommon to see society blame women for the assault, citing their attire or environment as the entities at fault. Even in cases where the patient is allowed to undergo an abortion, inadequate health facilities result in poor reproductive health for Sudanese women.
One of Sudan’s main weakness in healthcare is the lack of infrastructure, i.e. hospitals or abortion clinics with sterilised conditions. With 47% of its population living below the poverty line, many women in Sudan have no access to even these scarce facilities. Sudan also faces a dearth of trained and able medical professionals, including doctors, nurses and midwives. Additionally, strong social stigma and religious misunderstandings pressure women into equating abortion with murder. Several organizations such as the African Union's Sexual and Reproductive Health have been working tirelessly to alleviate these issues in the society, and to provide better health facilities to challenge these “unsafe abortions.” As of 2014. 79.1% of Sudanese women conceive, and many of these pregnancies are unplanned.
Fewer than 10% of Sudanese couples use contraceptives, due to varying factors like culture and religion. The use of contraceptives has not been mentioned in the Quran, however, eight out of nine classic schools of Islamic law permit it. Around 12.1 million women and girls are victims of female genital mutilation. The New York Times details female genital mutilation as “a harmful practice that nine in 10 Sudanese women are said to have endured.” As of April 2020, the Sudanese government has outlawed this agonizing procedure; however, it may take decades to completely eradicate it from society.
The battle against a conservative community and government is long and sinuous, but Sudanese women are gradually becoming aware of their constitutional rights, emboldening them to revolt against oppression. Hala Al-Karib, a Sudanese women’s rights activist, told the Washington Post: women’s “lives have changed fundamentally in recent decades under the restrictive laws.”
Throughout history, religion has played a vital role in forming and determining the constitutions of numerous governments around the globe. Since religion is so personal, various faiths will inevitably have many interpretations. However, this event has led to the misguided application of religious misinterpretations in a veil of taboo to influence a patriarchal construct, where a male-dominated government has the authority to form laws related to the reproductive rights of women.
One such regime is that of Sudan. In a country which has been deemed “one of the worst countries in the Arab states for women’s rights,” with 97% of its population following Islam, Sudan’s 1968, 1973 and 1998 constitutions declared Sharia law as the chief source of all legislation. A survey conducted by the Thomas Reuters Foundation states, “strict interpretations of Islam curb Sudanese women’s freedoms.”
Assorted Sharia law interpretations can be found in Islamic countries all around the world. Some scholars consider the laws provided in the Holy Book, the Quran, to be lenient, and accommodating for women of all backgrounds. However, certain Islamic countries have austern laws regarding abortions, birth control methods and female genital mutilation. In countries like Tunisia, women can have abortions freely, but in Sudan, this practice can only take place under certain conditions. According to Sudan’s constitution, the circumstances under which an abortion is considered legal is one of these three conditions as mentioned in the criminal code of 1991.
(Arabic version, article 135 and 136): (1) The miscarriage is necessary to save the mother’s life, (2) the pregnancy is the result of rape which has occurred not more than 90 days before the pregnant woman has desired to have the abortion or (3) it is proved that the quick unborn child has died in the mother’s womb.
Despite these laws, the whole concept of abortion is frowned upon in Sudan’s conservative society. Oftentimes, women are forced to marry their assaulters, and give birth to a child concieved of sexual assault. It is not uncommon to see society blame women for the assault, citing their attire or environment as the entities at fault. Even in cases where the patient is allowed to undergo an abortion, inadequate health facilities result in poor reproductive health for Sudanese women.
One of Sudan’s main weakness in healthcare is the lack of infrastructure, i.e. hospitals or abortion clinics with sterilised conditions. With 47% of its population living below the poverty line, many women in Sudan have no access to even these scarce facilities. Sudan also faces a dearth of trained and able medical professionals, including doctors, nurses and midwives. Additionally, strong social stigma and religious misunderstandings pressure women into equating abortion with murder. Several organizations such as the African Union's Sexual and Reproductive Health have been working tirelessly to alleviate these issues in the society, and to provide better health facilities to challenge these “unsafe abortions.” As of 2014. 79.1% of Sudanese women conceive, and many of these pregnancies are unplanned.
Fewer than 10% of Sudanese couples use contraceptives, due to varying factors like culture and religion. The use of contraceptives has not been mentioned in the Quran, however, eight out of nine classic schools of Islamic law permit it. Around 12.1 million women and girls are victims of female genital mutilation. The New York Times details female genital mutilation as “a harmful practice that nine in 10 Sudanese women are said to have endured.” As of April 2020, the Sudanese government has outlawed this agonizing procedure; however, it may take decades to completely eradicate it from society.
The battle against a conservative community and government is long and sinuous, but Sudanese women are gradually becoming aware of their constitutional rights, emboldening them to revolt against oppression. Hala Al-Karib, a Sudanese women’s rights activist, told the Washington Post: women’s “lives have changed fundamentally in recent decades under the restrictive laws.”
Case Study 3: Latin America
Out of just six countries around the world that outlaw abortion in all cases, four are located in Latin America. These four countries are Chile, Dominican Republic, El Salvador and Nicaragua. The majority of the population is Roman Catholic majority. Roman Catholicism is El Salvador’s official state religion, which influences many of the country’s policies towards women. The lack of protection given to women’s fundamental human rights of liberty, health and life causes grave harm to many female citizens. For example, Chilean Andrea Quiroga was pregnant with a child with a heart deformation. She attempted to seek an abortion, but friends, family, and the government told her that she was not allowed to get one. She recalls, “they told me I had to wait for my baby to die inside me.”
In Chile, where women faced up to five years of detention for having abortions, there were still around 120,000 abortions per year through underground abortion clinics, midwives or self-medicating pills. Because of the illegality of these medical procedures, it is clear that they endanger women’s lives. Thus, in 2017, the Chilean Congress passed a reform that decriminalized abortion under three circumstances: if the life of the pregnant person is at risk; if the pregnancy is the result of rape; and if the fetus has severe conditions not compatible with life outside the womb. Despite this progress, one year later, in March 2018, President Sebatián Piñera issued a new rule that allowed hospitals to deny abortions without providing reasons to do so, which, consequently, includes the denial of abortions of women who live in those three circumstances. The denial is supported by all Catholic officials in a mostly Catholic country: according to a campaign published by religious leaders, including Catholic bishops, “It will be our obligation as pastors to warn our faithful…. [of] the moral prohibition to vote in favor of a candidate who has supported the abortion project” and asked all Christian legislators “to proceed with all your strength and wisdom in this historic moment for the future of our Christian nation.”
The Dominican Republic, also heavily influenced by the Roman Catholic institution, has a different timeline. In the country, arrests caused by abortions are rare - the law exists mainly to cause fear. Some doctors even perform abortions illegally, and most girls receive clandestine abortions. “In the Dominican Republic, women have always defied this denial of their rights,” said Sergia Galván, a leading women’s rights advocate in Santo Domingo. In 2018, President Danilo Medina had urged legislators to decriminalize abortion in the same three circumstances that Chile put forth. Yet, as of October 2018, the National Congress had not enacted any changes to the country’s criminal code on this issue, and the total criminalization of abortion in all circumstances remained in effect.
In El Salvador, the law is extremely strict: doctors have to inform the authorities if they think a woman has tried to end her pregnancy and can be arrested if they do not. The women who had abortions receive up to eight years in prison. In cases in which the foetus has died, the charge is changed to one of aggravated homicide, which carries a minimum sentence of 30 years. According to the Citizens' Coalition for the Legalisation of Abortion, 129 women were convicted of abortion-related crimes between 2000 and 2011 and twenty-six face murder charges. Yet, hope might exist for these women, as the president of El Salvador’s legislative assembly, Sigfrido Reyes, has named the legislation “medieval.”
In Nicaragua, women and girls who terminate pregnancies face sentences of up to two years in prison, and doctors can receive sentences of up to six years for providing abortions. The abortion punishment law is recent and prejudicial especially towards teenage girls.
In a politically and socially fragilized Latin America, the denial of human rights is an extremely important matter to all people; yet, these Latin American governments threaten the lives of women like Ms. Quiroga. These religion-oriented policies that control women also determine the future of these nations and the health of their citizens.
Out of just six countries around the world that outlaw abortion in all cases, four are located in Latin America. These four countries are Chile, Dominican Republic, El Salvador and Nicaragua. The majority of the population is Roman Catholic majority. Roman Catholicism is El Salvador’s official state religion, which influences many of the country’s policies towards women. The lack of protection given to women’s fundamental human rights of liberty, health and life causes grave harm to many female citizens. For example, Chilean Andrea Quiroga was pregnant with a child with a heart deformation. She attempted to seek an abortion, but friends, family, and the government told her that she was not allowed to get one. She recalls, “they told me I had to wait for my baby to die inside me.”
In Chile, where women faced up to five years of detention for having abortions, there were still around 120,000 abortions per year through underground abortion clinics, midwives or self-medicating pills. Because of the illegality of these medical procedures, it is clear that they endanger women’s lives. Thus, in 2017, the Chilean Congress passed a reform that decriminalized abortion under three circumstances: if the life of the pregnant person is at risk; if the pregnancy is the result of rape; and if the fetus has severe conditions not compatible with life outside the womb. Despite this progress, one year later, in March 2018, President Sebatián Piñera issued a new rule that allowed hospitals to deny abortions without providing reasons to do so, which, consequently, includes the denial of abortions of women who live in those three circumstances. The denial is supported by all Catholic officials in a mostly Catholic country: according to a campaign published by religious leaders, including Catholic bishops, “It will be our obligation as pastors to warn our faithful…. [of] the moral prohibition to vote in favor of a candidate who has supported the abortion project” and asked all Christian legislators “to proceed with all your strength and wisdom in this historic moment for the future of our Christian nation.”
The Dominican Republic, also heavily influenced by the Roman Catholic institution, has a different timeline. In the country, arrests caused by abortions are rare - the law exists mainly to cause fear. Some doctors even perform abortions illegally, and most girls receive clandestine abortions. “In the Dominican Republic, women have always defied this denial of their rights,” said Sergia Galván, a leading women’s rights advocate in Santo Domingo. In 2018, President Danilo Medina had urged legislators to decriminalize abortion in the same three circumstances that Chile put forth. Yet, as of October 2018, the National Congress had not enacted any changes to the country’s criminal code on this issue, and the total criminalization of abortion in all circumstances remained in effect.
In El Salvador, the law is extremely strict: doctors have to inform the authorities if they think a woman has tried to end her pregnancy and can be arrested if they do not. The women who had abortions receive up to eight years in prison. In cases in which the foetus has died, the charge is changed to one of aggravated homicide, which carries a minimum sentence of 30 years. According to the Citizens' Coalition for the Legalisation of Abortion, 129 women were convicted of abortion-related crimes between 2000 and 2011 and twenty-six face murder charges. Yet, hope might exist for these women, as the president of El Salvador’s legislative assembly, Sigfrido Reyes, has named the legislation “medieval.”
In Nicaragua, women and girls who terminate pregnancies face sentences of up to two years in prison, and doctors can receive sentences of up to six years for providing abortions. The abortion punishment law is recent and prejudicial especially towards teenage girls.
In a politically and socially fragilized Latin America, the denial of human rights is an extremely important matter to all people; yet, these Latin American governments threaten the lives of women like Ms. Quiroga. These religion-oriented policies that control women also determine the future of these nations and the health of their citizens.