BOOKS & ELECTRONIC MEDIA
Reproductive health and human rights: integrating medicine, ethics and law
Ana Langer
Population Council, Regional Office for Latin America and the Caribbean, Panzacola No. 62 102, Col. Villa Coyacan, Mexico City, Mexico (email: alanger@popcouncil.org.mx)
Authors: Rebecca J. Cook, Bernard M. Dickens, Mahmoud F. Fathalla
Publisher: Clarendon Press, Oxford; 2003
ISBN: 0 19 924132-5; hardback; 582 pages; price UK£ 60
0 19 924133-3; paperback; 582 pages; price UK£ 19.99
An adolescent woman requests a contraceptive method from a health provider in a country where access for under-aged users is restricted; a couple denounces an involuntary sterilization to a local nongovernmental organization; a woman requests a legal abortion in a context where termination of pregnancy is highly stigmatized and access to safe services is denied her. These are just examples of terribly unfortunate but common features in developing countries, where women, particularly poor women, lack the necessary power to successfully fight for their needs and rights.
A meaningful and appropriate response to these complex situations requires a comprehensive approach. As acknowledged by the authors of Reproductive health and human rights: integrating medicine, ethics and law, no single discipline or perspective will resolve the many dilemmas involved in protecting reproductive and sexual health. Health providers, advocates and public officials struggling with real cases on a daily basis are not always able to adopt such an inclusive view, largely because previously available publications dealt separately with sexual and reproductive health, rather than focusing on their links and interactions. This monograph is therefore an important addition to the scarce literature at the interface between medicine, ethics, human rights, and law, and represents a unique reference source that seeks to fulfil this unmet need.
The book's three parts complement each other. Part I, theoretical and conceptual, provides the reader with all the necessary tools to understand the challenging issues that form Part II, such as female genital cutting; use of sexual and reproductive health services by adolescent girls; medically assisted reproduction; involuntary female sterilization; counselling and care for women who are HIV-positive; and requests for pregnancy termination. The variety of examples discussed makes the book appealing to a global readership. Part III provides a historical and empirical framework for the previous sections: essential reproductive health data from around the world obtained from the most reliable international sources; a list of human rights treaties and UN conference documents with references to sexual and reproductive health; and bibliographic details of key relevant papers that have appeared over the last 50 years.
The authors' main objective is ambitious: to make readers understand that "reproductive and sexual ill-health does not occur in a vacuum, but is conditioned by cultures, laws and values." This is fully achieved thanks to the authors' encyclopaedic knowledge and international perspective. Although obvious to some, this perspective may be new for many readers who don't have access to views from disciplines other than their own or have knowledge of distant geographic areas and diverse cultural settings. A further objective is to stimulate readers to develop their own analyses and approaches based on local circumstances. Part II is instrumental in achieving this goal. Each of its fifteen chapters analyses the medical, ethical, legal and human rights aspects of a separate issue; provides solid recommendations for use at the clinical and health-care system levels; and describes the social actions needed to address the underlying problem involved. Relevant and concrete recommendations for improving the quality of care received by individuals with reproductive and sexual health problems are also given. This approach may, however, be limited in its usefulness: attempts to change prevalent practices, even when strong scientific evidence is available, have proven to be extremely difficult to realize.
The authors of this book are distinguished specialists with the highest credentials in sexual and reproductive health (Mahmoud F. Fathalla), reproductive and sexual health law (Rebecca J. Cook), and medicine and ethics (Bernard M. Dickens). They worked on this common endeavor for four years, during which time they were able to go beyond the limits of their disciplines and merge their complementary areas of expertise to produce a brilliant and unique book.
The intended readership includes health providers, lawyers, researcher workers, ethical analysts, health administrators, members of grassroots organizations, and legislative aides. The book's interdisciplinary approach, contents, and good balance between theory, concepts, concrete examples and recommendations will make it appealing and relevant to this broad audience. Additionally, it is written in a language that is relatively accessible and reader-friendly. Nevertheless, the complexity of some of the issues it discusses, its size and wealth of detail, may constitute a barrier for lay people and even for some professionals in developing countries. The fact that it is written in English may also be barrier to some readers in developing countries.
The publication of this book is opportune because this is a particularly challenging time for the sexual and reproductive health and rights movement. After gaining momentum during the 1990s, this movement has been dramatically affected by a conservative backlash and a financial recession that have undermined multilateral and bilateral international aid programmes and the support provided by many private foundations. This monograph highlights the crucial importance and complexity of sexual and reproductive health and rights, which are currently under attack and at risk of being excluded from international and national agendas. 