Achieving Reproductive Rights in Brazil Magaly Marques Pacific Institute for Women’s Health

February 2003Pacific Institute for Women's Health 2 Background Political Scenario Demographic Trend Social/Economic Situation Civil Society Mobilization

February 2003Pacific Institute for Women's Health 3 Political Scenario 1970s and 1980s Dictatorship & military regime Development goals with no policies Top-down population programs Women excluded from decision making Mobilization for democracy

February 2003Pacific Institute for Women's Health 4 Demographics in the 1970s and 1980s Programs with excessive focus on fertility reduction High maternal mortality rates per 100,000 FP policies (or lack of) led to - sterilization and C-Section abuse, limited contraceptive options, scarce access to services High abortion rates /severe legal restrictions on abortion Decline of fertility rates - demographic transition completed in the 1980s, a trend that continued into the 1990s

February 2003Pacific Institute for Women's Health 5 Social/Economic Situation vis-à-vis population in the 1970s/1980s International funding for FP from USAID, World Bank was attached to development policies and population control agreements Foundations and European agencies funding small women’s groups

February 2003Pacific Institute for Women's Health 6 Civil Society Mobilization Activism, organized left, women’s groups Women leaders detach from left parties to re-define priorities Women’s movement organize around violence, abortion, and discrimination

February 2003Pacific Institute for Women's Health 7 Goal: Political will Democratic environment Public recognition of health problems Policies directed at accepted problems Mechanisms to ensure policy enforcement Civil society surveillance systems Government accountability

February 2003Pacific Institute for Women's Health 8 The Reproductive Health Movement in the 1980s Women’s Groups organize as NGOs Women’s Health Advocates launch national initiative for Women’s Comprehensive Health (PAISM) The new Constitution calls for attention to reproductive health matters International support make possible for local NGOs to develop

February 2003Pacific Institute for Women's Health 9 From Activism to Public Policy Change - the 1990s’ events Feminists in Women’s Health Movement join in government agencies National advocacy efforts increase public interest and awareness Women in parliament become aware of reproductive rights issues National Feminist Reproductive Health Network is founded

February 2003Pacific Institute for Women's Health 10 “As opposed to the dictatorship years, the recent Henrique Cardoso administration produced economic, political and institutional stability. The development of sound national policies, development of mechanisms to ensure enforcement of these policies, and the constant dialogue and collaboration with civil society allowed for an increased sense of accountability and recognition of human rights as universal.” Sonia Correia

February 2003Pacific Institute for Women's Health 11 “The 2000 survey tells us that the national fertility rates are 2.3 children per woman. But in São Paulo, Rio and the South fertility is already below replacement level. This is not surprising as women have expanded their participation in the labor market, they are investing in their own education and professional lives and they have decided to provide good care to just one or two children. This trend is here to stay ”. Elza Berquo, PhD

February 2003Pacific Institute for Women's Health 12 Institutionalizing Women’s Rights Aftermath of U.N. Conferences enhanced creation of mechanisms to monitor policy implementation locally PAISM re-defined in 1997 (compromise and focus) Maternal Mortality Committees to monitor city level implementation of PAISM ICPD/Cairo language incorporated at all levels (from FP to RH)

February 2003Pacific Institute for Women's Health 13 U.N. Conferences Absorbing the International Process 1993 Human Rights Conference led to National Human Rights Program in 1995, re-defined in 2002 as state policy including gender, racial, sexual, and HIV/AIDS related discrimination/violence; access to abortion ICPD led to National Commission on Population and Development in Beijing+5 led to National Secretary for Women's Rights; ratification of the CEDAW Protocol ( Convention on the Elimination of Discrimination against Women)

February 2003Pacific Institute for Women's Health 14 Achievements National Council on Women’s Rights 1988 Constitution spells out a national FP legislation Creation of 387 city-level maternal mortality committees Reduction in hospital-based mortality from 34 to 24 in women

February 2003Pacific Institute for Women's Health 15 Policy enforcement for epidemiological investigation of all maternal deaths Increased coverage of pre-natal care from 5.4 million women in 1997 to 10.1 million in 2001 Approval of health system protocol mandating and establishing guidelines for services to be offered to women who undergo sexual violence (1998)

February 2003Pacific Institute for Women's Health 16 Protocol mandating routine registration into the health system of all cases of gender-based violence attended Increase from none to 165 health services providing legal, safe abortions in case of rape

February 2003Pacific Institute for Women's Health 17 Lessons Learned Combination of activism and negotiation Alliances, partnerships were needed Networking of various types of organizations (grassroots, research, advocacy) International liaising and local focus

February 2003Pacific Institute for Women's Health 18 Unfinished Tasks, and Challenges Ahead Full access to legal abortion Increased understanding about the links among health, development and human rights issues. Paradigm shift in the way sexuality is conceived and promoted at all levels. Full incorporation of women as leaders and decision makers into the democratic process