CEDAW seeks to end discrimination against women in health care, and to ensure that prenatal and obstetrical care is made available to all women who need it.[1] Through these broad provisions, CEDAW seeks to improve women’s health throughout their life spans, from birth to old age. Improving women’s health requires not only access to good medical care, but also access to education, good nutrition, and the elimination of violence against women, both in the home and in armed conflicts.[2] In making recommendations to ratifying countries, the CEDAW Committee has accordingly expressed concern with barriers to good health ranging from a general lack of adequate health care for women and girls, to the increasing number of women contacting HIV/AIDs, and to high maternal mortality rates.
CEDAW’s focus on health is fully in line with the value placed on promoting women’s health in the U.S. For example, U.S. law prohibits sex discrimination in federally funded health care services,[3] and the U.S. National Institute of Health has worked to ensure that women, as well as men, are included in clinical research studies.[4] The U.S. has addressed violence against women through measures such as the Violence Against Women Act. Consistent with CEDAW, the U.S. also promotes maternal health and nutrition through programs such as Medicaid, the Special Supplemental Food Program for Women, Infants, and Children (WIC), and Maternal and Child Health block grants, to name only a few, as well as the Global Health Initiative, which includes a particular focus on women’s health. Ratification of CEDAW would reaffirm and forward these efforts.
• CEDAW Seeks to Ensure That All Women Have Access to Necessary Health Care
CEDAW seeks to address the gaps in women’s physical and mental health care across their lifespan. For example, the CEDAW Committee has pointed out the health care needs of older women, who generally live longer than men and who will also often bear responsibility for caring for aging spouses. It has also addressed the particular vulnerabilities of women with physical or mental disabilities.[5] CEDAW’s focus on health care for older women and advancing the health and dignity of women with disabilities mirrors the U.S.’s attention to these issues through programs like Medicare and the Pre-Existing Condition Insurance Plan and through laws like the Americans with Disabilities Act.
CEDAW also focuses on women’s mental health. For example, the CEDAW Committee has asked countries to address high suicide rates for girls and women.[7] In Guatemala, where women have suffered traumas in conflict situations, the Committee has expressed its concern that there are no mental health programs specifically for women. This focus is in accord with laws in the U.S., such as the Paul Wellstone and Pete Domenici Mental Health Parity Act (which requires insurance coverage of mental health services in many circumstances and which is particularly important to women given that in the U.S. women are two-thirds of the users of mental health services[8]).
• CEDAW Seeks to Reduce HIV/AIDS Infection in Women
Globally, women make up half of the 33 million people living with HIV/AIDS.[9] In sub-Saharan Africa, they are a majority of those with the disease.[10] Women and girls need accurate information about HIV/AIDS and how to protect themselves from infection. In interpreting CEDAW, the CEDAW Committee has recognized that the “issues of HIV/AIDS and other sexually transmitted disease are central to the rights of women and adolescent girls to sexual health.”[11] Practices such as female genital mutilation, polygamy, sexual abuse, and trafficking not only exploit and harm women, but also increase the risk of HIV/AIDS.[12] The Committee has also observed that respect for privacy and confidentiality are always important in the provision of medical care, and that they are especially important with regard to sexually transmitted diseases.[13]
The Committee has frequently expressed concern about increasing HIV/AIDs infection rates of women and girls.[14] To respond to this problem, it recommends that countries study the factors that are causing the increase in order to develop appropriate strategies to reverse this trend and reduce women’s vulnerability to the disease. It also calls for programs for both girls and boys to “foster responsible sexual behavior.”[15] These recommendations are fully in accord with the United States’ commitment to stopping the spread of HIV/AIDs, a commitment evidenced by the President’s Emergency Plan for AID’s Relief (PEPFAR) that was begun in 2003 and that now includes a particular focus on women, newborns, and children as part of the Global Health Initiative.[16] CEDAW affirms that the special needs of women must not be overlooked in addressing this crucial public health issue.
• CEDAW Seeks to Address High Maternal Mortality Rates
Another critical health issue for women, especially in developing countries, is high maternal mortality rates. In 2008, an estimated 358,000 women died worldwide from complications during pregnancy and childbirth, meaning that close to 1000 women are dying every day.[17] The major causes of death are severe bleeding after childbirth (25%), infection (15%), unsafe abortion (13%), hypertensive disorder (12%), and obstructed labor (8%).[18] Another 20% of maternal deaths have indirect causes such as diseases that are complicated or aggravated by pregnancy, including malaria, anemia, and HIV.[19]
Just as the U.S. has sought to reduce its maternal mortality rate by expanding the availability of care, CEDAW seeks to end maternal mortality by promoting “safe motherhood services and prenatal assistance.”[20] For example, the CEDAW Committee has expressed concern over ratifying countries’ lack of “skilled birth attendance and adequate post-natal care”[21] and the lack of obstetric services.[22] In addition, it has sought to reduce maternal mortality by urging increased access to information about reproductive health and contraception.[23]
The CEDAW Committee has also expressed its concern about the high rates of maternal mortality in countries that criminalize women seeking abortions, even victims of rape or incest, or women whose lives are endangered by pregnancy. For example, in Chile, which criminalized abortions in all circumstances, the Committee was concerned that women would “seek unsafe, illegal abortions, with consequent risks to their life and health, and that clandestine abortions are a major cause of maternal mortality.”[24] To address the risk of maternal death posed by unsafe abortion, the CEDAW Committee has suggested that women not be denied health care for complications from illegal abortions and that women not be subject to criminal punishment for obtaining abortions.[25] These recommendations are not only consistent with U.S. law, but also with the broad consensus in the U.S. among those on both sides of the abortion debate that women should not be jailed or denied potentially life-saving health care because they have had an abortion.
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U.S. ratification of CEDAW would reaffirm the value we place on women’s health across women’s lifespans.
Created by the National Women’s Law Center and the American Civil Liberties Union. The National Women’s Law Center and the American Civil Liberties Union co-chair the CEDAW Task Force Legal Committee.
[1] CEDAW, Article 12.
[2] General Recommendation 24, ¶¶ 7, 15, 28.
[3] Affordable Care Act, 42 U.S.C. § 18116.
[4] 42 U.S.C. § 289a-2; see also Office of Research on Women’s Health, Inclusion of Women in Research, available at http://orwh.od.nih.gov/inclusion.html.
[5] General Recommendation 24, ¶¶24, 25.
[6] Finland, ¶¶ 27-28, U.N. Doc. CEDAW/C/FIN/CO/6 (2008); Estonia, ¶¶ 111-112, U.N. Doc. A/57/38 (2002); Cuba, ¶ 271, U.N. Doc. A/55/38 (2000).
[7] Guatemala ¶ 35, U.N. Doc. CEDAW/C/GUA/CO/7 (2009).
[8] Mental Health Care Utilization, available at http://mchb.hrsa.gov/whusa08/hsu/pages/309mhcu.html
[9] Global Health Council, At Risk Groups—Women and Youth, available at http://www.globalhealth.org/hiv_aids/risk_groups1/.
[10] Id.
[11] General Recommendation 24, ¶ 18.
[12] Id.
[13] Id., ¶¶ 18, 22.
[14] Bhutan, ¶ 27-28, U.N. Doc. CEDAW/C/BTN/CO/7 (2009); Estonia, ¶ 111, U.N. Doc. A/57/38 (2002) (also expressing concern about the increase of tuberculosis among women); Guatemala, ¶¶ 37-38, U.N. Doc. CEDAW/C/GUA/CO/7 (2009); Iceland, ¶ 33, U.N. Doc. CEDAW/C/ICE/CO/6 (2009); Liberia, ¶ 36, U.N. Doc. CEDAW/V/LBR/CO/6 (2009); Mexico, ¶ 445, U.N. Doc. A/57/38 (2002); Suriname, ¶ 29, U.N. Doc. CEDAW/C/SUR/CO/3 (2007).
[15] Czech Republic, ¶ 102 , U.N. Doc. A/57/38 (2002); Estonia, ¶ 112, U.N. Doc. A/57/38 (2002); Kyrgyzstan, ¶ 158, U.N. Doc. A/59/38 (2002).
[16] The Global Health Initiative is described at http://www.pepfar.gov/ghi/index.htm
[17] Maternal Mortality: 1990 to 2008, Estimates developed by WHO, UNICEF, UNFPA and The World Bank, p. 17 (2010), available at http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf
[18] Maternal mortality, Fact sheet of the World Health Organization, available at http://www.who.int/making_pregnancy_safer/events/2008/mdg5/factsheet_mat...
[19] Id.
[20[ General Recommendation 24, ¶31(c).
[21] Liberia, ¶ 36, U.N. Doc. CEDAW/C/LBR/CO/6 (2009).
[22] Rwanda, ¶ 35, U.N. Doc. CEDAW/C/RWA/CO/6 (2009).
[23] Burundi, ¶¶ 61-62, U.N. Doc. A/56/38 (2001). Accord Mali, ¶ 34, U.N. Doc. CEDAW/C/MLI/CO/5 (2006); Pakistan, ¶ 41, U.N. Doc. CEDAW/C/PAK/CO/3, (2007).
[24] U.N. Doc. CEDAW/C/CHI/CO/4, ¶ 19 (2006). Accord, Honduras, U.N. Doc. CEDAW/C/HON/CO/6, ¶ 24 (2007).
[25] See, e.g., Nicaragua ¶ 18, U.N. Doc. CEDAW/C/NIC/CO/6 (2007) (“The Committee recommends that the State party consider reviewing the laws relating to abortion with a view to removing punitive provisions imposed on women who have abortions and provide them with access to quality services for the management of complications arising from unsafe abortions, and to reduce women’s maternal mortality rates. . . .”). See also Brazil, ¶¶ 29-30, U.N. Doc. CEDAW/C/BRA/CO/6 (2007) (same); Malawi, ¶ 36, U.N. Doc. CEDAW/C/MWI/CO/6 (2010) (same); Philippines, U.N. Doc. ¶ 28 CEDAW/C/PHI/CO/6 (2006) (same).