I want a POLICY BRIEF 2000 words

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Policy Brief

Executive Summary

In this policy brief, we argue for increased access to abortion and contraceptive rights across the developing world. In this, we seek to advance the interests of women, in line with our commitment to feminist virtue ethics worldwide. We recommend increased provision of education and awareness programmes surrounding contraception, the advancement of female literacy, and for the broadest possible range of contraceptive options to be made available to women globally. We particularly include abortion rights, seeking greater openness and honesty in the way reproductive health choices are discussed in the developing world.

Issue

Lack of comprehensive contraception and access to abortions in the developing world foster numerous social problems, both for the affected regions and beyond. Large families are difficult to support, worsening the impoverishment of already destitute families.1 Young women unable to prevent pregnancy are thrust into parenthood at ages when they could undertake education to allow them a better place in society. Women, as a result, are more completely barred from taking part in professional life or politics than would otherwise be the case. Men, unused to women in educated or professional roles, therefore feel uncomfortable with women taking on any other tasks than those associated with children and families. The overpopulation caused by insufficient access to contraception also drives up unemployment, which itself translates into mass migration, affecting the entirety of global infrastructure. Overpopulation also creates issues when attempting to provide services to communities in the

1 John Cleland et al. (2006) ‘Family planning: the unfinished agenda’ in The Lancet (368: 9549).

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developing world, as health and education providers are unable to adequately offer their services to the whole population.2

The primary reasons for the neglect of contraception are partly cultural, and usually religious in origin. Large-scale providers of healthcare and education in Africa, including the Catholic church, take a moral stance against premarital sex, and consequently fail to provide any kind of effective birth control. State providers, including the United States government, may be unwilling to provide access to, or even advice about, abortions, and thus limit the effectiveness of their entire programmes.3 Other reasons for this current situation include a lack of accurate information disseminated by a trusted source (central government bodies, health education, lack of resources and infrastructure to spread public service announcements).4

Addressing this issue is thus a practical requirement to advancing the interests of the developing world, and improving living standards more generally. However, there is a particular ethical obligation to advance the interests of women in the developing world. Though constituting roughly half the population, women are grossly underrepresented in industry, leadership positions, politics, academia, and religious hierarchies. Their treatment under law is frequently inferior, and their ability to defend themselves against domestic violence or rape is minimal in a male-dominated culture. Promoting women’s empowerment by ostensibly small measures may dramatically improve women’s lives, and for more women than those immediately effected by the policy change.

Our commitment to Global Justice means that we, as human beings with fundamentally identical basic needs and universal rights, have a positive duty to lift fellow humans out of poverty and correct inequality worldwide.5 With the Global South bearing the brunt of poverty, overpopulation, and environmental degradation, the First World is obligated to assist. Increasing access to contraception in developing nations would be a definite step in fulfilling these moral obligations.

Critique of Current Policy

Virtue ethics provides an essential prism for examining and defining the social values which should shape ethical policy. Martha Nussbaum lists ten ‘central human functional capabilities’ against which one may assess the morality of human development activity. Though capability 2 (bodily

2 Yuhua Shi and Jie Zhang (2009) ‘On High Fertility Rates in Developing Countries: Birth Limits, Birth Taxes, or Education Subsidies?’ in Journal of Population Economics (22:3). 604.

3 ‘The U.S. Government and International Family Planning & Reproductive Health Efforts’ in Global Health Policy. 30 July 2019. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and- international-family-planning-reproductive-health-efforts/

4 Gilda Sedgh, Lori S. Ashford and Rubina Hussain (2016) ‘Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method’ in Guttmacher Policy Review.

5 ‘Global Gender Justice’ in Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/justice- global/#GloGenJus

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health) and capability 3 (bodily integrity) rank high in her list, she describes them all of being ‘of central importance and…distinct in quality’. Nevertheless, she states that the capabilities are related in various ways. By specifically including reproductive health in capability 2, and choice in matters of reproduction in capability 3, Nussbaum draws our attention to the centrality of reproductive rights to female and human rights.6 The current situation in developing countries is so frequently defended on a moral basis by religious figures (whether clerics or laymen, the latter particularly including politicians) that it is worth dissecting through the lens of feminist virtue ethics. The current situation leads to:

- The denial of female agency—women are effectively unable to choose whether or not, or when, to be mothers. If choice in one’s own affairs is assumed as a positive, then promoting that choice is a virtue, and denying it unethical.

- The denial of female opportunity—women who do not have children are considerably less burdened in pursuing their own goals. These include professional endeavours and educational opportunities. If being able to pursue one’s choice of future is a virtue, then limiting that choice (whether intentionally or otherwise) is discriminatory and unethical.

- The encouragement of misogynistic ideals—if less able to pursue careers and opportunities, women become increasingly confined to private space. This may in practice bar them from public space; if female advancement is contingent on men, men may deny them that advancement. If public space is overwhelmingly dominated by men, women may feel unwilling to enter it. And without women performing tasks, both men and women may feel women unable to perform them (and men unable to perform family care duties/ childcare responsibilities/ important household administration). The promotion of policies which lead to women being seen as unequal are unethical. Despite the International Conference on Population and Development resolving as early as 1994 that ‘people…have the capability to reproduce, and the freedom to decide if, when, and how often to do so’, this statement of intent reflects neither the reality across the developing world, nor the unanimous effort of the First World in providing aid.7

Part of this may stem from the consequentialist philosophy of the Western aid providers. Where contraception is provided, it may be for the wrong reasons, such as financial efficiency.8 Though a worthy goal in policy terms, it is the wrong option to pursue in comparison to female health or agency. Right-wing policy restrictions have caused a freeze in US contributions to family planning efforts, and opposition to abortion has resulted in the limiting of reproductive options available to the

6 Martha Nussbaum (2000) Women and human development: the capabilities approach. New York: Cambridge University Press. 78-81.

7 Report of the International Conference on Population and Development, Cairo, 5-13 September 1994. New York: United Nations. 40.

8 Sneha Barot (2015) ‘Sexual and Reproductive Health and Rights Are Key to Global Development: The Case for Ramping Up Investment’ in Guttmacher Policy Review (18:1).

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developing world.9 This is a denial of female agency, risks female health, and consequently may limit female opportunity while allowing misogyny to flourish.

Policy Recommendations

The moral obligation of hegemonic bodies to provide aid is substantiated by John Rawls, who notes that ‘we have a natural duty not to be cruel, and a duty to help one another, whether or not we have committed ourselves to these actions’.10 The West, we contend, has committed itself to aid for developing nations, and particularly to providing contraception. For nations such as the United States to seek to withdraw from these obligations would increase the incidence of unwanted pregnancies, and therefore be an unconscionably cruel policy choice.

We recommend the promotion of education, particularly for women and girls. This will include the public awareness of contraception, delivered through campaigning. We also recommend simple, yet accurate written medical advice to be available, whether trained medical staff are present or not. We propose the provision of qualified teachers in every primary and secondary school, and equal access for girls to be educated. We consider the provision of timely and accurate contraception information in the developing world to be an ethical necessity. This is morally required because inaccurate information surrounding birth control can lead to many more unwanted pregnancies, thus increasing women’s hardship— without accurate advice available, unreliable methods (including withdrawal) may be resorted to.11

Moreover, we consider truth to be an essential ethical virtue in all contexts; we cannot consider it morally justifiable to tell women convenient ‘half-truths’ or ‘white lies’ to assist our policy objectives. Nussbaum’s sixth functional capability (practical reason) depends on women’s access to the facts.12 This particularly underlies our opposition to the ‘Mexico City rule’, which forbids American federal funding of abortion advice. Nussbaum also describes the value of literacy in controlling population, contrasting it with permanent methods such as sterilisation. By noting that female literacy ‘enhances, rather than extinguish[es], capabilities’, she reminds us that increasing women’s access to information is a

9 ‘U.S. Government and International Family Planning’. Global Health Policy.

10 John Rawls (2009) A Theory of Justice. Harvard University Press. 98.

11 Chelsea Polis et al. (2016) ’Contraceptive Failure Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries’ in Guttmacher Policy Review.

12 Nussbaum, Women and human development. 79.

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virtue in its own right, but also expands female choice in choosing whether to use contraception, enter into a relationship, or pursue careers.13

We advocate the promotion of cultural acceptance of contraception across the developing world. This must vary in approach according to local customs, as use of and access to contraceptive methods vary by region. In Pakistan, evidence demonstrates that contraception may often be used, but that usage increases when local religious leaders have deemed the practice acceptable.14

Nevertheless, we reject the religious basis for the provision of family planning services which has often limited the effectiveness of birth control provision, or limited the range of contraceptive options available. In particular, we advocate against the use of religious organisations to supply these services. This was a particular policy during the presidency of George W. Bush, whose administration gave preference to religious providers—ostensibly because of their existing aid infrastructure—resulting in ‘limit[ed] condom distribution in a wide variety of settings’.15 At present, however, with studies demonstrating fairly broad condom availability across much of the developing world, greater focus must go toward promoting their use. This is partly educational, as trust in partners is the primary explanation given by monogamous couples for neglecting to use condoms.16 We acknowledge the added benefit of condom usage in diminishing suffering, by providing increased protection against STIs.

We argue that legal, safe, affordable, accessible abortion must be promoted in the developing world. Susan A. Cohen notes that this issue has two important strands, both of vast importance. First, developing nations host most of the world’s clandestine and unsafe abortions, costing numerous lives. This issue primarily affects poor countries, as their citizens are unable to travel to a more liberal jurisdiction to procure an abortion. Secondly, Cohen emphasises the moral argument, as forced pregnancy (in the view of the UN Special Rapporteur for Health) may easily be equated with forced abortion or forced sterilisation.17 We promote the expansion of safe and lawful choices for women in the developing world.

We advocate legal, safe, affordable, and universal access to a range of contraceptive options. We prefer a range of options to be available in part (to accept the consequentialist argument) because of

13 Ibid., 95.

14 Ali Mohammad Mira and Gul Rashida Shaikha (2013) ‘Islam and family planning: changing perceptions of health care providers and medical faculty in Pakistan’ in Global Health: Science and Practice (1:2). 229.

15 Stephen Porter and Jacques de Wet (2009) ‘Who will guard the guardians? Amartya Sen’s contribution to development evaluation’ in Development in Practice (19:3). 291.

16 S. Agha, T. Kusanthan, K. Longfield et al. (2002) ‘Reasons for Non-Use of Condoms in Eight Countries in Sub-Saharan Africa’. https://www.psi.org/publication/reasons-for-non-use-of-condoms-in-eight-countries-in- sub-saharan-africa/

17 Susan A. Cohen (2012) ‘Access to Safe Abortion in the Developing World: Saving Lives While Advancing Rights’ in Guttmacher Policy Review (15:3).

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the varying effectiveness rates of contraceptive methods, but also because of the fundamental, liberating value in making women the arbiters of their own futures and bodily decisions. Like Amartya Sen, we deprecate the use of coercion to lower birth rates; a narrow range of options available may unfairly inhibit the agency of women in the developing world, in effect a form of coercive control.18 To expand the options of women in their future decisions, we advise against the promotion of sterilisation in most instances. This will advance female agency and autonomy.

Bibliography

Agha, S., Kusanthan, Longfield, T., K. et al. (2002) ‘Reasons for Non-Use of Condoms in Eight Countries in Sub-Saharan Africa’. https://www.psi.org/publication/reasons-for-non-use-of- condoms-in-eight-countries-in-sub-saharan-africa/

Barot, Sneha (2015) ‘Sexual and Reproductive Health and Rights Are Key to Global Development: The Case for Ramping Up Investment’ in Guttmacher Policy Review (18:1).

Beutelspacher, Austreberta Nazar, Martelo, Emma Zapata and Garcia, Veronica Vazquez. ‘Does Contraception Benefit Women? Structure, Agency and Well-Being in Rural Mexico’ in Bina Agarwal, Jane Humphries, Ingrid Robeyns (eds.) (2005) Amartya Sen's Work and Ideas: A Gender Perspective. Oxford: Taylor and Francis.

Cohen, Susan A. (2012) ‘Access to Safe Abortion in the Developing World: Saving Lives While Advancing Rights’ in Guttmacher Policy Review (15:3).

Cleland, John et al. (2006) ‘Family planning: the unfinished agenda’ in The Lancet (368: 9549).

‘Global Gender Justice’ in Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/ justice-global/#GloGenJus

Mira, Ali Mohammad and Shaikha, Gul Rashida (2013) ‘Islam and family planning: changing perceptions of health care providers and medical faculty in Pakistan’ in Global Health: Science and Practice (1:2).

Nussbaum, Martha (2000) Women and human development: the capabilities approach. New York: Cambridge University Press.

Polis, Chelsea et al. (2016) ’Contraceptive Failure Rates in the Developing World: An Analysis of Demographic and Health Survey Data in 43 Countries’ in Guttmacher Policy Review.

18 Austreberta Nazar Beutelspacher, Emma Zapata Martelo and Veronica Vazquez Garcia. ‘Does Contraception Benefit Women? Structure, Agency and Well-Being in Rural Mexico’ in Bina Agarwal, Jane Humphries, Ingrid Robeyns (eds.) (2005) Amartya Sen's Work and Ideas: A Gender Perspective. Oxford: Taylor and Francis. 232.

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Porter, Stephen and de Wet, Jacques (2009) ‘Who will guard the guardians? Amartya Sen’s contribution to development evaluation’ in Development in Practice (19:3).

Rawls, John (2009) A Theory of Justice. Harvard University Press.

Report of the International Conference on Population and Development, Cairo, 5-13 September 1994. New York: United Nations.

Sedgh, Gilda, Ashford, Lori S. and Hussain, Rubina (2016) ‘Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method’ in Guttmacher Policy Review.

Shi, Yuhua and Zhang, Jie (2009) ‘On High Fertility Rates in Developing Countries: Birth Limits, Birth Taxes, or Education Subsidies?’ in Journal of Population Economics (22:3).

‘The U.S. Government and International Family Planning & Reproductive Health Efforts’ in Global Health Policy. 30 July 2019. https://www.kff.org/global-health-policy/fact-sheet/the-u-s- government-and-international-family-planning-reproductive-health-efforts/