Birth, old age,

Sickness, and death:

From the beginning,
This is the way
Things have always been.
Any thought
Of release from this life
Will wrap you only more tightly
In its snares.
The sleeping person
Looks for a Buddha,
The troubled person
Turns toward meditation.
But the one who knows
That theres nothing to seek
Knows too that theres nothing to say.
She keeps her mouth closed.
Ly Ngoc Kieu, Vietnam, 1041-11131

Where, after all, do universal human rights begin? In small

places, close to homeso close and so small that they cannot be
seen on any maps of the world....Such are the places where
every man, woman, and child seeks equal justice, equal oppor-
tunity, and equal dignity, without discrimination.
Eleanor Roosevelt, U.S.A., 19582
 1
Womens Health, Poverty, and Rights

Every two seconds, somewhere in the world, eight babies are born, about
half of them girls.3 Some 81% will live in poor countries. As we shall see in
this and the next chapter, their births are all too often something more to
be endured than to be celebrated.

Let us put a human face on the numbers. Think of Hope, the mother of
Mary, a baby girl born in western Kenya. Hope was in her mid-thirties and
already had five children when I visited the area in 2004 and heard about
her from a traditional birth attendant at the local health clinic. Hope was
disappointed to produce yet another girl, another mouth to feed, and she
was feeling weak and very tired. Her other five childrenthree girls and
two boyswere all under age twelve. To try to pay for the daily costs of her
family, her husband searched for work in a nearby town even though he had
been feeling very sick, while Hope sold vegetables in a local market. She
struggled up after giving birth, thanked the village midwife who had helped
her at the birth, and gave the new baby a breast to be shared with a sibling.
Several thousand miles north and east, in a rural village near Lucknow,
India, baby Kamla was born in a small house made of clay and palm fronds.
Kamlas young mother, Laxmi, age seventeen and already the mother of another
little girl, was unhappy. Because she had not borne a son, she had failed as a wife.

1
2 outrage to courage

Her one-year-old and the new baby were weak because the family she had
married into was poor and she had not had sufficient good food to nurture
a growing fetus and provide enough milk for her baby. Laxmi had gone to
school for a year, not quite enough time for her to learn to read. Her parents
arranged her marriage when she was twelve, and she went to the home of her
husband when she was fourteen. Her in-laws were mistreating her and resented
her for giving birth only to girls. When Laxmis husband judged that she had
not been working hard or keeping the house in order, he sometimes struck
her. And here she was with Kamla, another girl, another burden.
My companion on this trip was a woman from BETI (Better Education
through Innovation), a womens group working in the Lucknow area. She
explained that not all stories of girls births in India and other poorer coun-
tries are sad; many girls are welcomed into the world. But the hard truths
are that most women in the world who are giving birth today are poor and
illiterate, with little access to health care; that most girls in our world will
face discrimination, poverty, unequal access to education and health care,
and unequal pay for equal work. And about a third of women giving birth
today will face violence at the hands of a partner, a violation of human rights
that all too often happens in small places, close to home, so small and so
close that they cannot be seen on the maps of the world.
Womens health cannot be understood or improved without understand-
ing the contextual relationshipthe subordination of women, poverty, and
violence, resulting in unequal access to education, food, health care, and
paid employment.

Women and Poverty

What does poverty mean? The World Bank, in its 2000-2001 report on
poverty, offered this description:
Poor people live without fundamental freedoms of action and choice that
the better-off take for granted. They often lack adequate food and shelter,
education and health, deprivations that keep them from leading the kind of
life that everyone values. They also face extreme vulnerability to ill health,
economic dislocation, and natural disasters. And they are often exposed to
ill treatment by institutions of the state and society and are powerless to
influence key decisions affecting their lives.
 womens health and human rights 3

In an attempt to document the extent of poverty, the report continues:

The world has deep poverty amid plenty. Of the worlds 6 billion people,
2.8 billionalmost halflive on less than $1 a day, with 44% living in
South Asia. In rich countries, fewer than one child in one hundred does
not reach its fifth birthday, while in the poorest countries, as many as one
in five children do not. And while in rich countries fewer than 5% of all
children under five are malnourished, in poor countries as many as 50%
are....The average income in the richest twenty countries is 37 times the
average in the poorest twentya gap that has doubled in the past forty
years....In East Asia the number of people living on less that $1 a day
fell from around 420 million to around 280 million between 1987 and
1998....Yet in Latin America, South Asia, and Sub-Saharan Africa, the
numbers of poor people have been rising. And in the countries of Europe
and Central Asia in transition to market economies, the number of people
living on less than $1 a day rose more than twenty fold during that period.4

The World Bank report notes further that experiences of poverty are very
different at sub-national levels in countries and for minorities and women.
Based on measures of school enrollment and infant mortality rates, women
face more severe disadvantages than do men.5 Worldwide, womens wages,
when women have access to the formal economy, are about two-thirds of
mens. The majority of women are in low-wage situations or work informally
for part-time wages with little or no benefits. In this age of globalization,
which touts the spread of democracy and equality through market forces,
the wage gap between men and women persists and is so prevalent that it is
now commonly referred to as the feminization of poverty. Rural women,
in particular, have suffered; over the past two decades, the number of rural
women worldwide living in absolute poverty rose by nearly 50%. 6
The Human Poverty Index (HPI), introduced in the 1997 Human Devel-
opment Report from the United Nations Development Programme (UNDP),
attempts to quantify poverty in the world today by accounting for and try-
ing to measure aspects of poverty beyond income, including lack of access
to opportunities and resources.7 The report suggests that the HPI provides
a better, though still incomplete, measure of womens experience of poverty.
Though the practice of measuring by entire households makes it difficult to
4 outrage to courage

discern bias and different levels of poverty within the home, it is clear that
poverty strikes women particularly harshly.8
Povertys greater burden on women has been known for years. It was
described in the Platform for Action of the UN Fourth World Conference
on Women, 1995: In the past decade the number of women living in pov-
erty has increased disproportionately to the number of men, particularly in
the developing countries. In addition to economic factors, the rigidity of
socially ascribed gender roles and womens limited access to power, educa-
tion, training and productive resources . . . are also responsible.9 It is clear
that poverty affects households in general, but because men and women do
different work and have different responsibilities for the household, women
bear a greater burden as they manage consumption, some production, and
scarce resources.
Many conditions of womens lives set them up to have fewer financial
resources than their male counterparts, and poverty in turn can influence
these conditions. For example, level of school enrollment, one measure of
poverty, reveals that more women than men are denied the education and
skills to support themselves. Worldwide, 79% of females over the age of fifteen
are literate, compared with 88% of males. In less developed countries the
percentages are 74% and 86% respectively.10 More examples of challenging
conditions for women are addressed in more detail in later chapters.
Unsurprisingly, the percentages of economically active women in virtu-
ally all countries are consistently lower than the percentages of men. For
example, 21% of women are economically active in North Africa compared
with 68% of men; 49% in Latin America and the Caribbean, compared with
79% of men.11
If a mother is undernourished, often because she is poor, her baby is
likely to be underweight and may even be born with a smaller brain. Mater-
nal mortality, another measure of womens poverty, persists: complications
of pregnancy and childbirth, when met with inadequate medical care at the
time of delivery, can be deadly. Quality care saves lives, and it doesnt have
to be done in a very wealthy country, as Malaysia and Chile have demon-
strated. Skilled personnel attended 96% and 100% of births in those coun-
tries, respectively, resulting in the deaths of sixty-two and sixteen women
per 100,000 live births. In Niger, by comparison, where only 18% of births
 womens health and human rights 5

are attended by skilled personnel, 1,800 women died per 100,000 live births
in 2005. In Indonesia, 73% of births were attended by skilled personnel, and
420 women died per 100,000 live births.12
Discrepancies in infant death rates illustrate womens disadvantaged status in
poorer countries, as is discussed in the next chapter. Their disadvantaged status
is also expressed in the situation of young women with regard to HIV/AIDS,
discussed in a subsequent chapter, where it is noted that the HIV/AIDS epidemic
has had a profound impact on the lives of women, especially those whose
economic dependence on men and low social status leave them powerless to
avoid risky sexual behaviors.
Access to money matters. Poverty is directly correlated with poor health.
In a study of socioeconomic status and health, Nancy Adler et al. state:
Throughout history, socioeconomic status (SES) has been linked to health.
Individuals higher in the social hierarchy typically enjoy better health than
do those below....The effects of severe poverty on health may seem obvious
through the impact of poor nutrition, crowded and unsanitary living condi-
tions, and inadequate medical care....There is evidence that the association
of SES and health occurs at every level of the SES hierarchy.... Not only do
those in poverty have poorer health than those in more favored circumstances,
but those at the highest level enjoy better health than do those just below.13

Health Defined
Now it becomes clear why a narrow definition of health that would refer only
to physical fitness and/or an absence of illness would not help much with
understanding the situation of women and their health and taking action to
improve it. In contrast, the concept and ideal of health defined by the World
Health Organization (WHO) as a state of complete physical, mental and
social well being and not merely the absence of disease or infirmity makes a
lot of sense. Indeed, it is the definition used in this book as not only illnesses
(e.g., HIV/AIDS) but also other conditions affecting health (e.g., education
and work) are discussed.
Using the WHO definition of health raises the challenge of measuring
health status across societies and groups that are very different one from
another in terms of culture, economy, history, demography, and medical his-
tory.14 Nevertheless, the United Nations and other multinational agencies
have attempted to measure health status; in combination they provide the best
6 outrage to courage

statistics and information currently available on the subject. Drawing from

many sources, including as careful work as possible by various multinational,
governmental, and nongovernmental agencies, researchers and officials have
no doubt that in no society today, do women enjoy the same opportunities as
men. As a 1997 UN Development Programme report notes: This unequal
status leaves considerable disparities between how much women contribute
to human development and how little they share its benefits.15 Three years
later, another UN report, The Worlds Women 2000: Trends and Statistics,
showed some gains but still found persistent disparities between women
and men worldwide in six areas: health, human rights and political decision-
making, work, education and communication, population, and families.16
The extent of poverty and ill health discussed above contrasts with a
genuine revolution in human health and well being in the world as a whole.
People are living longeraverage life expectancy at birth in many developed
countries nearly has doubled, from about 45 in 1900 to about 77 in 2009,
and poorer countries have also experienced dramatic improvements in terms
of declines in mortalityalthough this positive trend has reversed in some
African countries as a result of the HIV/AIDS pandemic.17,18 There have
been great improvements in health in general and success at controlling such
diseases as smallpox and cholera. At the same time, however, the health of
people around the world has been threatened by illness-causing substances,
including some, like smoking and high-fat diets, that encourage unhealthy
behavior. HIV/AIDS and TB have become scourges in more and more coun-
tries, threatening whole populations and weakening societal structures.
We live in a paradoxical world: while there have been tremendous health
gains in some parts of the world and among some populations, these are
counterbalanced by stagnation and decline in others. Health improvements
have been unevenly distributed.19 Gro Brundtland, former head of the World
Health Organization, in a 1998 press release, was quoted as follows: Never
have so many had such broad and advanced access to healthcare. But never
have so many been denied access to healthcare. The developing world car-
ries 90% of the disease burden, yet poorer countries have access to only
10% of the resources that go to health.20 Had Brundtland been highlight-
ing womens health, she might have added that women carry the majority of
the ill health burden but have access to a minority of resources to lighten it.
 womens health and human rights 7

Women and Human Rights: A Slow Dawning

The reports mentioned above hint at but do not explicitly indicate the dire
consequences that the persistent discrimination against women has for their
health status. Jonathan Mann, who spent his life as a champion of human rights
and health, made the link clear: Discrimination against ethnic, religious,
and racial minorities, as well as on account of gender, political opinion, or
immigration status, compromises or threatens the health and well-being
and, all too often, the very lives of millions....Discriminatory practices
threaten physical and mental health and result in the denial of access to care,
inappropriate therapies, or inferior care.21 Being born female is a health
hazard, at times a fatal one.
Mann is, to be sure, talking more broadly about human rights, a concept
that first became a worldwide preoccupation after the Second World War,
when representatives of the newly formed United Nations tried to identify
and agree upon what governments should not do to people and what they
should assure to all. Out of these discussions came the Universal Declara-
tion of Human Rights, promulgated on December 10, 1948.22 But as signifi-
cant as this achievement was, the Universal Declaration was a product of
its time. The concept of universal human rights was, after all, developed
by a particular set of people, people who were in positions of power at that
time. For the most part, they were male, with the notable and inspiring
exception of Eleanor Roosevelt. In subsequent decades, as individual people
and groupspreviously marginalized and certainly not party to the earlier
discussionsbegan demanding their rights, the UN had to rethink its
definitions, broadening them to include the needs of people whose special
vulnerabilities were not taken into consideration in the pastwomen, chil-
dren, indigenous people, the disabled, and so on.
Despite progress, the process was slow. These days, the idea that womens
rights are human rights seems obvious, but it was not until 1993, when the
UN held a conference on human rights in Vienna, that the member states
began to talk about abuses such as rape and domestic violence as human
rights violations. It took even longer and prodding by womens and human
rights organizations for the UN Security Council to recognize the par-
ticular violations of womens human rights in situations of war and armed
conflict, including systematic rape as a policy of war and sexual slavery for
8 outrage to courage

the comfort of soldiers. As Human Rights Watch noted, Combatants

and their sympathizers in conflicts, such as those in Sierra Leone, Kosovo,
the Democratic Republic of Congo, Afghanistan, and Rwanda, have raped
women as a weapon of war with near complete impunity.23
The problem, though, was much deeper and broader than had been rec-
ognized. As Human Rights Watch put it:
Millions of women throughout the world live in conditions of abject depri-
vation of, and attacks against, their fundamental human rights for no other
reason than that they are women. . . . Men in Pakistan, South Africa, Peru,
Russia, and Uzbekistan beat women in the home at astounding rates, while
these governments alternatively refuse to intervene to protect women and
punish their batterers or do so haphazardly and in ways that make women
feel culpable for the violence. As a direct result of inequalities found in
their countries of origin, women from Ukraine, Moldova, Nigeria, the
Dominican Republic, Burma, and Thailand are bought and sold, traf-
ficked to work in forced prostitution, with insufficient government atten-
tion to protect their rights and punish the traffickers. In Guatemala, South
Africa, and Mexico, womens ability to enter and remain in the work force
is obstructed by private employers who use womens reproductive status
to exclude them from work and by discriminatory employment laws or
discriminatory enforcement of the law. In the U.S., students discriminate
against and attack girls in school who are lesbian, bisexual, or trans-gen-
dered, or do not conform to male standards of female behavior. Women in
Morocco, Jordan, Kuwait, and Saudi Arabia face government-sponsored
discrimination that renders them unequal before the lawincluding dis-
criminatory family codes that take away womens legal authority and place
it in the hands of male family membersand restricts womens participa-
tion in public life....Abuses against women are relentless, systematic, and
widely tolerated, if not explicitly condoned. Violence and discrimination
against women are global social epidemics, notwithstanding the very real
progress of the international womens human rights movement in iden-
tifying, raising awareness about, and challenging impunity for womens
human rights [and health] violations.24
In response to ever-louder criticisms and complaints, the UN promulgated
two conventions of particular importance to women and girls: the Convention
on the Elimination of All Forms of Discrimination Against Women (known
 womens health and human rights 9

as CEDAW or the womens convention, adopted in 1979 by the UN General

Assembly)25 and the Convention on the Rights of the Child (adopted in
November 1989 and entered into force in September 1990).26 Both of these
conventions laid out guidelines to protect the rights of women and children,
but like many such documents, they lack the enforcement mechanisms that
are indispensable to creating meaningful change.
The Universal Declaration and other UN documents spelling out human
rights are not as far removed from the everyday health concerns of women as
they may seem. After all, as Mann wrote, Human rights and public health
are two complementary approaches, and languages, to address and advance
human well-being.27 Invoking international agreements like these lends
strength to womens groups and others who try to encourage governments
to improve conditions that affect womens health. In 1992, for example, at a
Global Fund for Women meeting of a womens circle working to eliminate
trafficking in women, some American participants asked activists from South
and Southeast Asia what they (the Americans) could do to help the most.
Expecting the activists to say that they needed more money for their work,
the eager donors were awakened by the answer: The most important thing
that you and other Americans can do to help is to get the U.S. Government to
ratify the womens convention [CEDAW] and the Convention on the Rights
of the Child, both of which address the issue of trafficking in women and
girls. The activists explained that without U.S. ratification of such conven-
tions, it was difficult, if not impossible, for them to lobby their governments
for legal change in such countries as Nepal, the Philippines, and Thailand.
The UN may seem distant to many of us, and its ways are often bureau-
cratic, but womens groups around the world have used the UN system to
lobby for change in their own countries. These activists were saying that
around the world, caring women and men must join together to demand
full human rights for all women. (As of 2012, the U.S. Government has not
ratified CEDAW or the Convention on the Rights of the Child. For infor-
mation, see section on Some Useful Resources, pp. 277283.)
For decades, womens health issues have been approached as purely
development issues (i.e., improving economic and social development).
This focus is an instrumental one (i.e., improving womens health in order
to increase productivity or providing family planning in order to reduce
population levels). Why now complicate things by shifting to a human rights
10 outrage to courage

framework? The answer highlights a critical difference: The human rights

approach moves the intention away from a broad instrumental approach to
an individual, human approachto improving womens health and/or pro-
viding family planning simply for the sake of justice.
The stories of Kamla and Mary, the little girls born in India and Kenya,
would not have been relevant if we were to take a strictly developmentalist
approach to their situations without addressing their rights as human beings.
Recall that both were born into poor families, that one of the mothers had
suffered violence, and that just because they were born female, both were
destined to have problems gaining access to education and other services.
Arguing a development rather than a human rights approach would result
in the idea that the poor will always be with us, that governments should try
to educate girls in order to increase national productivity, and that domes-
tic violence is a private rather than a public matter and need be considered
primarily to calculate a societys health costs.
A human rights perspective demands that we recognize that providing
education for girls, for example, is not only a good development decision but
also a question of justice, of individual rights. It leads us to see that tolerating
sexual abuse is not just a bad economic choice, in terms of health costs, but also
a violation of a womans right to bodily integrity. A human rights view reveals
that maternal mortality is not only a tragedy because it deprives children of a
caregiver but an abrogation of the right of a woman to basic health care.
The rights to life, liberty, and security of person and to freedom from
slavery or servitude and cruel, inhuman, or degrading treatment or pun-
ishment in articles 3, 4, and 5 of the Universal Declaration were to be guar-
anteed to every person. Who could take issue with that? The problem is the
context: these words referred to civil and political prisoners, not to people
who were subjected to slavery, torture, or cruel, inhuman, or degrading
treatment in their homes or places of work. It was the human rights advocates
who highlighted the importance of equality and freedom from bodily harm
for individual people whose circumstances were not recognized in early
international conventions on human rights. It was womens advocacy groups
who proclaimed at the 1993 UN Conference on Human Rights in Vienna:
Womens rights are human rights. This is an idea that Eleanor Roosevelt
would surely have fully understood, but it is an idea that did not make its
way into public consciousness until the 1990s.
 womens health and human rights 11

Why Focus on Women?

The discrepancies in opportunity and access for women already highlighted
here may be reason enough to focus a discussion on women. But there are
other reasons to learn more about the experiences of women and their health.
Women, whether healthy or not, are at the heart of family and society.
A womans health affects every area of her life and therefore of her family and
community. Today, for a variety of reasons, women often end up as the sole
supporters of their children. While percentages vary around the world, in
many countries more than 30% of households are headed by single females.28
Women are not just productive members of a family; often they are its safety
net. If the truth of womens lives, in all their complexity, is hidden from us,
change is unlikely.
The subordination of women as well as the persistence of poverty, the
proliferation of violence, and continuing gaps in access to food, health care,
education, and living wages are in their breadth and depth like a war on
women. These inequalitiesthese violations of the human rights of women
stem from a basic dislocation in society that distorts the lives of both men
and women. This dislocation has to do with the way we conceive of ourselves
in relation to others. Focusing on and learning more about the situation of
women may help us transform our either/or way of thinking and change
the way that we view and treat each other in this world.
At the moment, we are caught in a paradigm of behavior that is unhealthy.
It is an either/or paradigm that leads us to categorize people and then assign
values to the various categoriesblack versus white, male versus female,
strong versus weak, educated versus uneducated, rich versus poor. Instead
of appreciating and welcoming such differences, we use these dichotomies
to separate ourselves and even pit ourselves against one another. Although
there is nothing inherently unequal or even negative about assigning
categoriesperhaps a natural human tendencyit is the destructive value
judgments that follow that need to be eliminated. This paradigm of see-
ing people who are different from ourselves as the other and possibly of
lesser value has resulted in the marginalization and subordination of certain
groups over the years (groups such as people of color, indigenous people,
differently abled people, and women). The result has been the development
of hierarchical social structures, structures that have subordinated more
than half of the worlds populationwomen and groups of marginalized
12 outrage to courage

men as well. We need to understand and work to change the paradigm of

either/or to both/and.
The either/or paradigm is perfectly illustrated by the significant state-
ments: Its a girl! or Its a boy! Societys different and value-laden reac-
tions to these two statements will determine the course and health of a
persons life.
The subordination of women is deeply ingrained in the lives of both men
and women. Sometimes it is explained in terms of biological differences.29
Over time, culture, religion, and most social systems, including educational,
legal, and medical systems, which in both traditional and modern forms tend
to be hierarchical in structure, have assigned less status and power to women
and other marginalized groups.30 The subordination of women and girls takes
many forms. At the moment of birth, celebrations may differ according to
the sex of the baby. In childhood, girls and boys access to food, health care,
and education often differs. Later in life, womens subordination is illustrated
in the objectification of womens bodies, the gendered division of labor, and
persistent abuse of women and girls.
As the realities of womens lives demonstrate, the state of womens health
is critically connected to the subordination of women. Throughout this
book, many examples of this subordination will be cited and described. How-
ever, it is important to remember, as Gerda Lerner argues in The Creation
of Patriarchy, that:
While women have been victimized by...many other aspects of their
long subordination to men, it is a fundamental error to try to conceptual-
ize women primarily as victims. To do so at once obscures what must be
assumed as a given of womens historical situation: Women are essential
and central to creating society; they are and always have been actors and
agents in history. Women have made history, yet they have been kept
from knowing their history and from interpreting history, either their own
or that of men....The tension between womens actual historical experi-
ence and their exclusion from interpreting that experience I have called
the dialectic of womens history....[which] has been a dynamic force,
causing women to struggle against their condition....This coming-into-
consciousness of women becomes the dialectical force moving them into
action to change their condition and to enter a new relationship to male-
dominated society.31
 womens health and human rights 13

The examples of womens groups, listed at the end of each chapter in this
book, represent this coming-into-consciousness of women, that force that
is moving them into action to change their condition.
A final and important reason to understand the complex health situa-
tion of poorer women is to better appreciate our global interconnectedness.
William Budd, a physician, writing about typhoid in 1931, noted: This disease
not seldom attacks the rich, but it thrives among the poor. But by reason of
our common humanity we are all, whether rich or poor, more nearly related
here than we are apt to think. The members of the great human family are, in
fact, bound together by a thousand secret ties, of whose existence the world
in general little dreams. And he that was never connected with his poorer
neighbor, by deeds of charity or love, may one day find, when it is too late,
that he is connected with him by a bond which may bring them both, at once,
to a common grave.32 Adding SARS, avian flu, or HIV/AIDS along with one
or two politically correct changes in pronouns makes this quote timely today.
Women in poorer countries are much more vulnerable to the kinds of
infectious diseases alluded to in the previous paragraph than are people in
richer countries. Still, women around the world deeply feel their shared
struggles around such health issues as domestic violence, reproductive rights,
and equal access to paid employment.
But the clarion call in Dr. Budds statement, to me, is the phrase by reason
of our common humanity [my emphasis] we are all, whether rich or poor, more
nearly related here than we are apt to think. Though women and men may
share vulnerabilities and struggles relating to issues of health and human
rights, our true bond of interconnectedness is in our common humanity.
We can choose to live by universal standards of justice, and we can choose
to create change to make that justice possible for all.
To improve womens health we must treat specific health problems, but
the conditions of womens lives must also change so that we women can gain
more power over our lives and our health. At the base of such social change
is extending womens capacity to be in charge of our own lives, to exercise
our human rights.
We focus on women, therefore, because womens experiences are dif-
ferent and under-studied, because societies need women to be healthy and
fully engaged, because it is only fair that women have full equality in their
14 outrage to courage

societies. And we focus on women because understanding their unique chal-

lenges is a prerequisite to justice.

Womens Courage: Womens Groups Taking Action

Brazil: Rede Feminista de Sade

In Brazil, a woman experiences violence every fifteen seconds, and there
are almost 1.1 million unsafe abortions performed a year, the second largest
cause of hospitalization among women. In the midst of these pressing sexual
health issues, the Rede Feminista de Sade (Feminist Network for Health,
Sexual Rights, and Reproductive Rights), in Porto Alegre, was formed in
1991 to coordinate political action among womens groups around issues
of sexual health and rights. The main aims of the group are strengthening
the womens movement both internationally and nationally around issues of
sexual and reproductive health and rights, framing the issues of sexual and
reproductive rights as human rights, and sexual, racial, and domestic vio-
lence as violations of human rights, and fighting for holistic womens health
and the legalization of abortion.
Toward this end, the group has organized feminist advocacy actions,
health trainings for women, and workshops such as Training Women for
Social Control of Health Policy. The Network publishes media reports
on the status of womens human rights and has created the Brazilian Net-
work of Youth, Sexual Rights, and Reproductive Rights, in recognition of
the high prevalence of violence, unsafe pregnancy and abortion, and HIV/
AIDS among youth. Currently (January 2010) the group is creating a project
entitled Pathways to Womens Health, to train women in health advocacy,
and is furthering their attempts to include youth in the reproductive and
sexual health movement.

China: Rural Women Knowing All

Formed in 1993 as Rural Women Knowing All, this group became the
Beijing Cultural Development Center for Rural Women in 2001. It works
 womens health and human rights 15

to increase literacy and education among poor women throughout China.

In 1998 the group began the Practical Skills Training Centre for Rural
Women, providing literacy classes, physical and mental health services, and
opportunities for rural women to participate in political life. Another main
focus is on migrant women, whose health and rights are not protected by
labor laws because of their informal employment status. In 2003 the group
started the Domestic Workers Support Network, conducting a field survey
to assess domestic workers needs; as a follow up, they developed training
workshops on legal rights and skill development, for about 30,000 women.
The group also focuses on rural womens empowerment through adult lit-
eracy and political participation classes and the creation of resource centers,
hoping to increase womens political participation in China to at least 33%.
More recently, the group has focused on suicide in rural China, where
rates of suicide among poor women are on the rise. In 1996 the group started
publishing a column on the subject in its magazine, the only magazine
focused on rural womens issues in China. A report followed in 1999, and
then a manual in 2001 on Preventing Rural Womens Suicide and another
in 2005 on Community Action for Life Crisis Intervention. The group
has successfully implemented suicide prevention projects in six villages of
Hebei province, in which suicide rates have dropped from seventy-two to
zero in these villages.

Congo: Society of Women Against AIDS in Africa

The Society of Women Against AIDS in Africa (SWAA), based in Kin-
shasa, is a continent-wide association of women dedicated to ending the
spread of HIV among women through research, education, and advocacy.
The SWAA chapter in the Democratic Republic of Congo (DRC) was started
in 1989. It focuses mainly on the link between poverty and HIV prevalence.
The DRC has one of the highest numbers of adults living with HIV/AIDS
in Africa, especially in the Eastern Congo, where systematic use of rape and
sexual mutilation is used as a weapon of war. Moreover, 55% of women in
the DRC are illiterate, which, in conjunction with womens subordinate sta-
tus and lack of economic opportunities, is a key factor increasing womens
susceptibility to HIV. The Society addresses these regional issues through
programs aiming to increase womens awareness of HIV and economic inde-
pendence. Satellite offices around the DRC run womens centers, offering
16 outrage to courage

counseling to HIV positive women, workshops, vocational training, literacy

classes, credit facilities, and meeting places for women.
Recently, responding to the link between poverty, sex work, and HIV,
SWAA has focused efforts on promoting sustainable livelihoods to women
who would otherwise turn to sex work. The womens centers provide train-
ing on tailoring, agriculture, and food processing, and they offer credit to
women to start and sustain business activities. SWAA also participates in
community outreach and political lobbying. The group conducts training
for community-based organizations on the promotion of the female condom
and the link between gender-based violence and HIV prevalence in women,
and is lobbying to punish rapists and provide medications to pregnant women
with HIV to prevent mother to child transmission.

Congo: SOS Femme Enfant en Catastrophe

SOS Femme Enfant en Catastrophe (Organization for Women and Chil-
dren in Catastrophe, SOS) was established in Uvira, in the Eastern part of
the Democratic Republic of Congo (DRC), in 1996 to promote rural wom-
ens rights. The group mainly focuses its efforts on awareness campaigns on
issues such as HIV/AIDS and gender based violence, human rights education,
and networking with peer organizations to strengthen the womens rights
movement. The group also provides direct counseling and legal services to
survivors of sexual violence, and assists these women to take action against
their perpetrators. They also provide adult literacy classes and support to
refugees. SOS has also developed an advocacy program to lobby elected
officials and traditional government officials to address issues pertaining to
womens rights. In the midst of civil war and a growing number of refugees,
SOS provides critical, holistic care for women survivors of violence, and it
acts as a vocal advocate for womens health and human rights in the region.

Egypt: Egyptian Association for Community Participation Enhancement

The Egyptian Association for Community Participation Enhancement
was formed in Cairo in 2001 to address womens human rights, including
the implementation of CEDAW, and a project entitled Towards a More Fair
Family Law, to address the womens rights issues within the current Family
Law framework. To promote womens human rights awareness, the group
has hosted a variety of workshops, capacity-building training for NGOs
 womens health and human rights 17

involved in womens rights, and events such as one to celebrate International

Day to Prevent Violence Against Women. The Association plays an integral
part in implementing CEDAW within Egypt, and it is involved in protect-
ing womens legal rights through advocacy, legal assistance, and monitoring
womens rights violations. Its main goal is to increase womens empowerment
and decision-making power within society as a way of achieving womens
equality and securing womens human rights.
The group is now branching out to create educational programs to teach
children about human rights both in and out of the classroom. In 2008, the
Association held four summer camps that involved two hundred students
and eighty female and male teachers with the aim of instilling the value of
human rights among the students and encouraging teaching about human
rights in classrooms.

Fiji: Womens Information Network

The Womens Information Network was established in Suva in 2001 as a
volunteer-based organization to address Fijian womens human rights, spe-
cifically focusing on reproductive and sexual health. The group conducts
political advocacy and community outreach programs, including workshops
on CEDAW, issues related to child abuse, womens sexual and reproductive
health, violence against women and children, and HIV. Recently the group
collaborated with the National Council of Women to prevent the passage
of a bill that was detrimental to womens rights, despite lobbying from a
variety of stakeholders.
In the future, the group plans to do outreach with rural Fijian women
about the increasing trend in suicide by women in those communities, as
well as addressing the growing scarcity of water as a resource.

Ghana: African Womens Development Fund

Established in 2000 in Accra, the African Womens Development Fund
works for social justice, equality, and respect for African womens human
rights through technical and financial support for womens organizations. It
raises funds for womens organizations, gives grants to organizations working
for the rights and health of African women, communicates the achievements
of these organizations, and offers technical assistance for group sustainability
to grantee organizations. AWDF is the first continent-wide Fund in Africa
18 outrage to courage

and the first run by African women. Since its founding, the Fund has made
grants to 575 womens organizations in forty-one African countries for a
total of US$2 milllion.
In 2008, the Fund organized the Second African Feminist Forum which
took place in Kampala, Uganda. This forum represents the overarching
goals of the Fund, which are to create political unity and build the womens
movement on the continent.

India: Kutch Mahila Vikas Sanghatan Bhuj

The Kutch District of Gujar State, India, has recently seen rapid industrial
development (including thirteen Special Economic Zones), which under-
mines traditional sustainable occupations. To combat this changing and
crippling economic situation, Kutch Mahila Vikas Sanghatan Bhuj (KMVS)
was established in 1989 to provide training to rural women to increase eco-
nomic independence and to support womens participation in governance.
The group emphasizes processes of ownership by women, not just par-
ticipation, and has concentrated on building local leadership and creating
womens collectives in rural villages. The womens collectives now span 165
villages with a membership of 15,000 women; their advocacy efforts focus
on issues of violence against women, reproductive health, support for women
in local governance, and campaigns on issues related to the rapid industrial
development. KMVS also has a strong media presence, including a com-
munity radio program and a bi-monthly newsletter.
Over the last four years the program has expanded from support to women
in government to a revival of traditional crafts to counter the increasing
economic dependence on SEZs. The group provides trainings on alterna-
tive livelihoods and traditional crafts, and helps link women to appropriate
buyers. The community centers also provide women easier access to local
administration and motivate women to purchase land and property in their
name. They hope to expand to work on issues of violence against women,
which has risen over the past few years in the region.

Israel: Kayan
Kayan was established in 1999 in Haifa as the first feminist organization
devoted to Palestinian womens issues, such as social standing, education,
and employment. The group aims to increase womens leadership and par-
 womens health and human rights 19

ticipation in public life and thereby increase Palestinian womens status in

society and decrease misogyny.
In recent years, Kayans work has centered on legal advocacy for Pales-
tinian women living in Israel, as well as coalition of various womens com-
munity organizations. In 2008, the Legal Department gave counsel and
representation to 160 Palestinian women in legal cases in family, social,
labor, and criminal law. The group published two brochures containing
information on the Law for the Prevention of Sexual Harassment, and the
Rights of Victims of Crimes Law. Also in 2008, Kayan participated in the
first Arab-Israeli conference ever dedicated to the topic of sexual abuse of
minors, and they held a leadership course entitled Womens Activism for
Social Change. In 2009, Kayan won the case it filed with Physicians for
Human Rights to grant social and health rights to Palestinian women from
the occupied area who are married to Israeli citizens and live legally there.
It also started programs to bring together single women and single moth-
ers and organized a conference in August of 2009 on the Status of Single
Women in Arab Society. Through efforts to facilitate communication and
coalition among womens groups in the region, Kayan has been an integral
part of creating a vibrant Arab feminist movement.

Jamaica: St. Elizabeth Women

The St. Elizabeth Women was founded in South-East St. Elizabeth in
2008 by a group of rural women. They state: In the global economic con-
text, rural women in small countries such as Jamaica must organize to make
the necessary changes in their lives in order to ensure food and personal
security and the empowerment of women and girls at the community level.
The group addresses the many social and economic problems facing Jamai-
can women in a holistic manner, including reproductive health issues, high
rates of teenage pregnancy and risky sexual behavior among adolescents,
the spread of HIV/AIDS and other STIs among young women, domestic
violence, and the overrepresentation of women amongst the poor. Although
recently created, the group is integral to the development of community-
based advocacy and education on a broad range of topics related to womens
health and human rights in Jamaica.
20 outrage to courage

Kyrgyzstan: Asteria
Asteria was founded in 2007 in Bishkek by a group of sex workers, women
living with HIV/AIDS, and women drug users, to address the rights and
needs of these marginalized communities. The organization monitors human
rights violations, promotes gender equality, and advocates for marginalized
womens rights through outreach and workshops. They have conducted and
presented research on the psychological, medical, and legal conditions of sex
workers, women living with HIV, formerly incarcerated women and women
drug-users. Currently, the group has expanded to provide direct services to
these women. Asteria publishes informational bulletins, provides free legal
and medical services, runs educational trainings on reproductive health, and
organizes support groups. Asteria provides vital support and advocacy for
groups of women whose needs often go unrecognized.

Nepal: Tewa
Tewa, which means support in Nepalese, was established in 1995 in
Lalitpur to generate resources within Nepal to benefit women and girls. Tewa
provides womens groups with seed grants and educates women to better
exercise control and decision-making in the use of their own resources. Tewa
aims to reduce dependence on foreign donors by cultivating a fund within
and from Nepal. The organization grants money to rural womens groups
in Nepal working on domestic violence, women in conflict and war, dowry
deaths, trafficking, sexual assault, sex workers rights, and girls education.
Since 1996, 197 womens groups in fifty-one districts have received funds
from Tewa totaling US $100,000. Tewa also has a strong volunteer program,
which empowers and inspires Nepali people to positively contribute to their
community, and they run a childrens program that focuses on orphans.
Nepal recently emerged from a ten-year civil war; as a consequence, Tewa
is currently focusing on womens groups that advocate for peace and a peace-
ful transition to a new government, particularly during the time when the
new government will develop a new constitution. Tewa has also continued
to support womens sexual rights, by funding organizations that held the
first national conference for lesbians in 2008.
 womens health and human rights 21

Palestine: Union of Palestinian Womens Committees

Gaza, surrounded by an Israeli security wall, has been labeled an open-air
prison, with one of the highest rates of unemployment in the Middle-East
region at 51%. Women bear a double burden, not only of economic oppres-
sion, but also of gender inequality. The Central Bureau of Statistics stated
in 2006 that among married women in the Palestinian occupied territories,
61.7% suffer psychological, 23.3% physical, and 10.9% sexual violence. In
1980, the Union of Palestinian Womens Committees was created in Gaza
to address gender-based discrimination and the economic needs of women.
To this end, they hold psychological counseling sessions for women and
married couples and provide workshops on issues such as violence against
women. The group also provides vocational training programs, job placement
programs, and classes on the management of a kitchen, Womens Hands,
which employs women to cook meals and sell them to various organizations.
In 2009, the Union trained 550 women in leadership skills and organized
a gallery to showcase embroideries made by its members, emphasizing the
preservation of traditional crafts and livelihoods. The group actively monitors
the prevalence of honor killings. Following Israels war on Gaza in 2009, the
group held psychological counseling sessions for women, married couples,
and groups for children affected by the violence.

Russia: Crisis Center for Women Help

According to Amnesty International, a woman dies every hour in Russia
at the hands of a partner, former partner, or family member. In response to
this epidemic of violence, the Crisis Center for Women Help was established
in Salansk in 1999, providing a hotline and counseling center for women
and children experiencing violence. In 2009, the Crisis Center provided
legal and psychological counseling to 1,028 individuals, as well as violence
prevention trainings for 580 girls.
Recently, the groups work has expanded into the areas of trafficking,
intravenous drug use, HIV, and breast cancer screening. Russia has one of the
fastest growing HIV/AIDS epidemics in the world, with six people diagnosed
every hour. Moreover, the Center is situated on the major highway that leads
to the Chinese border and is thus at the nexus for drug and human traffick-
ing. To address both the high rates of HIV and sex work, the Center edu-
cates sex workers on HIV/AIDS and STIs and provides them with condoms.
22 outrage to courage

They also work with intravenous drug users, which is the second major cause
of increasing HIV prevalence in the country. The center operates a needle
exchange program, distributes condoms, performs medical examinations,
and provides referrals to intravenous drug users. The Center also created
the first database of all women and children with disabilities, and it provides
social services and meeting spaces for this marginalized group. Future plans
of the group include an interactive website for the disabled and a shelter for
HIV positive women and their families, as well as programs to address the
increasing numbers of divorces and suicide attempts in the country.

Serbia: Belgrade Womens Studies and Gender Research Center

The Belgrade Womens Studies and Gender Research Center (BWSC)
was established in 1992 and continues to be a very important gender-oriented
study, research, and advocacy center in the region. Every year the Center
gives two hundred lectures on topics related to the intersection of gender
and ethnic tolerance, nationalism, pacifism, queer rights, and ecology. The
Center designs programs for Roma women, women workers, educators, and
women politicians.
BWSCs belief is that creating a gender-sensitive culture will only be
achieved through mainstreaming gender concepts into educational systems.
Toward this end, they continue to create curricula, one of which was main-
streamed into the curriculum of the Faculty of Political Sciences. Other
curricula focus on persons who are not enrolled in classical academic edu-
cation, such as feminist and peace activists, working women and mothers,
and those in marginalized groups.

Sri Lanka: Rural Womens Front Support Group

In Sri Lanka, according to the UN Report on Violence Against Women,
60% of women experience gender-based violence. This, coupled with the
crippling effects of a twenty-six year civil war, sparked the creation of the
Rural Womens Front (RWF) in Galle in 1988, formed to address the prob-
lems of poverty and human rights violations that women experience in rural
areas. The group focuses on political advocacy and economic empower-
ment for rural women. In 1994, RWF demonstrated on behalf of 238 female
migrant workers at the silver line garment factory, which ended in worker
 womens health and human rights 23

compensation, and they started a micro-lending program recently to pro-

mote self-employment.
The Front also works on mediating domestic violence and has reunited
thirty families with the assurance of a violence-free future. RWF identi-
fies a culture of male chauvinism as the root of gender-based violence in Sri
Lanka and seeks to address this root cause. In the future, they hope to pro-
vide workshops on legal options for victims of violence against women, free
legal consultations, and weekly counseling sessions for children affected by
domestic violence as a way to educate women and children to prevent the
continuation of a culture that accepts violence against women.

Turkmenistan: Hazar
Founded in 1997, Hazar focuses on womens economic empowerment by
facilitating summer camps for children of single mothers. Since 2001, Hazar
has focused its work on womens rights, professional trainings for women,
and womens reproductive health. They are committed to providing sup-
port to women in emergency situations, as well as fostering a safe space for
womens activism. Hazar provides help and counseling to women in socio-
economic and personal crisis situations, and emergency support to activists
in crisis. Hazar also provides capacity building for other NGOs working on
womens rights through trainings and workshops, and it acts as legal advo-
cates for women human rights defenders.