Sexuality and reproduction were long governed by religious and political ideology, enforced through criminal law. Individual control over these matters was regarded as threatening to moral values, gender hierarchies, and family security. Birth control, abortion, and certain forms of sexual behavior were, and in many countries remain, defined as crimes against morality (Cook et al., 2003).
Empirical evidence of the dysfunction and harmful health effects of punitive laws contributed to the adoption of policies that promoted individuals’ interests in their own health and welfare. At the 1968 International Conference on Human Rights in Tehran, Iran, reproductive health became a recognized subject of international human rights. Governments affirmed that ‘‘[p]arents have a basic human right to determine freely and responsibly the number and spacing of their children’’ (United Nations, 1968, paragraph 16). Public health and welfare interests were recognized as best served by individuals’ free and responsible decision making.
The health and welfare rationale garnered support in international development debates regarding fertility reduction. In 1974, the first World Population Conference in Bucharest, Romania, promoted the reformulated basic right of ‘‘all couples and individuals … to decide the number and spacing of their children and to have the information, education and means to do so’’ as an effective tool to achieve population and development goals (United Nations, 1974, paragraph 14f ). At the 1984 International Conference on Population in Mexico City, Mexico, this language was reaffirmed (United Nations, 1984).
Rights In Respect Of The Inherent Dignity Of The Individual
During the United Nations Decade for Women (1976–85), a growing international women’s rights movement also advocated for the right to reproductive decision making. While adopting the language of Tehran, Bucharest, and Mexico City, the movement articulated a different rationale to support the right. In 1975, the World Conference of the International Women’s Year affirmed that ‘‘[t]he human body, whether that of woman or man, is inviolable and respect for it is a fundamental element of human dignity and freedom’’ (United Nations, 1976, Art. 11). The right to decide matters related to sexuality and reproduction derives from this respect for women’s dignity and freedom. The conception of sexual and reproductive health from the perspective of women as equal and autonomous individuals was reaffirmed at subsequent international women’s conferences in Copenhagen, Denmark (1980) and Nairobi, Kenya (1985) (United Nations, 1980, 1985).
In 1979, the United Nations General Assembly adopted the Convention on the Elimination of All Forms of Discrimination against Women (the Women’s Convention) (United Nations, 1979). The treaty codified the right to reproductive decision making as a legally enforceable right. Prior to the Women’s Convention, recognition of the right was limited to international conference documents that bind governments politically but not legally.
Article 16.1 of the Women’s Convention specifically guarantees to women, on the basis of equality with men, the:
same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education, and means to enable them to exercise these rights.
In the tradition of the international women’s movement, the right is recognized as an important end in itself. It serves the sexual and reproductive health needs and preferences of individual women. It is a human right premised on the inherent dignity of the individual.
The 1993 United Nations World Conference on Human Rights in Vienna reflected the transformation of women’s interests from the periphery to the center of human rights discourse. Women’s rights were recognized as ‘‘an inalienable, integral and indivisible part of universal human rights’’ (United Nations, 1993, paragraph 18). The Conference reaffirmed:
on the basis of equality between women and men, a woman’s right to accessible and adequate health care and the widest range of family planning services, as well as equal access to education at all levels. (United Nations, 1993, paragraph 41)
An International Consensus On Reproductive Rights
At the 1994 International Conference on Population and Development in Cairo, Egypt, a human rights perspective was adopted in the development context. In a paradigm shift, the ICPD Programme of Action departs from the instrumentality of rights in the service of demographically based targets. It promotes policies that respect women’s inherent dignity, recognizing individual women’s perceptions, needs, and circumstances as the basis for reproductive decision making. The ICPD Programme of Action expressly acknowledges that:
[t]he empowerment and autonomy of women and the improvement of their political, social, economic, and health status is a highly important end in itself. (United Nations, 1994, paragraph 4.1)
As defined in the ICPD Programme of Action, reproductive rights:
rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so … free of discrimination, coercion and violence. (United Nations, 1994, paragraph 7.3)
More broadly, reproductive rights include the ‘‘right to attain the highest standard of sexual and reproductive health,’’ defined as:
a state of complete physical, mental and social wellbeing .. . in all matters relating to the reproductive system and to its functions and processes. (United Nations, 1994, paragraph 7.2)
Reproductive health further encompasses sexual health and:
a satisfying and safe sex life … the purpose of which is the enhancement of life and personal relations. (United Nations, 1994, paragraph 7.2)
The promotion of these rights became:
the fundamental basis for government and community-supported policies and programmes in the area of reproductive health, including family planning. (United Nations, 1994, paragraph 7.2)
and the normative standard against which to assess government action.
At the 1995 Fourth World Conference on Women in Beijing, People’s Republic of China, governments reaffirmed their commitment to the ICPD Programme of Action, and extended the definition of reproductive rights to recognize that:
[t]he human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality … free of coercion, discrimination, and violence. (United Nations, 1995, paragraph 96)
The Beijing Platform for Action further recognizes that:
[i]n most countries, the neglect of women’s reproductive rights severely limits their opportunities in public and private life, including opportunities for education and economic and political empowerment. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights. (United Nations, 1995, paragraph 97)
By 2004, over 90% of governments committed to the ICPD Programme of Action and the Beijing Platform for Action had adopted legislation or implemented policies in furtherance of the consensus objectives (United Nations, 2004).
Since 2000, the United Nations Millennium Development Goals (MDGs) have become the primary international development framework. The MDGs include: poverty eradication, improvement in education, promotion of gender equality and women’s empowerment, reduction of child mortality and improving maternal health, and the combating of HIV/AIDS. In 2006, the United Nations General Assembly adopted ‘‘universal access to reproductive health by 2015’’ as an explicit target under the MDG framework (United Nations, 2006)