By Meghan Campbell
This post assesses how the leading international human rights instrument on women’s equality accounts for the critical role of rurality in the enjoyment of women and girls’ sexual and reproductive health rights .
Note: Rurality and sexual and reproductive health are rich fields of study and stretch across disciplinary silos. This post adopts an international human rights legal perspective. As a result, it employs the terminology used by UN treaty bodies and organisations while acknowledging and respecting different disciplines may have principled arguments for using different terminology.
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In human rights law, minimal attention is given to how the rural-urban divide impacts the realisation of the sexual and reproductive health rights of women and girls. This neglect of rurality is unwarranted: It is a meaningful, often lynchpin, explanatory factor for rural girls and women’s lack of access to high quality sexual and reproductive health rights.
In this piece, I explore how the leading international human rights instrument on women and girls’ rights addresses rurality in the realisation of sexual and reproductive health rights. I begin with a global survey to demonstrate the role of rurality in realising girls and women’s sexual and reproductive health rights. I then proceed to evaluate how international human rights law is accounting for rurality.
Geography impacts the realisation of sexual and reproductive health rights. The lack of public investment in rural areas means women and girls routinely must travel long distances to access sexual and reproductive health services, both in the global North and South. Some rural women are in economically dependent relationships with their family which can make overcoming distances particularly difficult, and tragically the cost of traveling can have life-and-death consequences. The low population densities in rural areas coupled with the high density of social acquaintanceship and gendered discourses makes accessing sexual and reproductive health services humiliating and creates risks of social ostracism. Living in a rural community also may increase vulnerability to serious bodily harm and may operate to isolate and silence the voices of women and girls.
An exception to this global trend is the UN Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). CEDAW is unique among UN treaties in that Article 14 protects the equal rights of rural women in various fields of life, including “access to adequate health care facilities, including information, counselling and services in family planning.” Lisa Pruitt observes that CEDAW “moves beyond the implicit focus on urban populations that characterizes a great deal of contemporary law making.” There are also provisions in CEDAW that apply to both rural and urban women, that both in theory and practice take account of rurality in sexual and reproductive health rights, including Article 5 (negative cultural stereotypes and attitudes), Article 10 (equality in education), Article 12 (equality in access to health care) and Article 16 (equality in family life).
There is rich promise within CEDAW to grasp how rurality shapes the realisation of sexual and reproductive health rights. On the positive side, many of the CEDAW Committee’s recommendations get to the heart of the geographic and social isolation in rural areas. The CEDAW Committee advocates for temporary special measures, sustained investment in rural spaces and rural women’s economic empowerment and participation. It highlights the prevalence of female genital mutilation and early forced marriage in rural areas. To end these violations of sexual and reproductive health rights, the CEDAW Committee encourages states to target awareness raising on these harmful practices to traditional leaders, men and boys; to enforce the laws prohibiting FGM and early forced marriage; to reduce evidentiary burdens when pursuing legal accountability; and to provide the necessary financial support for prevention and awareness-raising.
The lack of investment in rural sexual and reproductive health rights, the CEDAW Committee observes, results in “rural women [being] more likely to resort to unsafe abortion than urban counterparts.” Where abortion is decriminalised, the legal regimes that regulate access to abortion can significantly impact on rural women and girls. For example, the CEDAW Committee identifies waiting periods to access abortion can “impede access for rural women” who cannot afford to travel multiple trips to health care clinics or overnight accommodation. The synergy between distance from health services and financial costs also negatively impacts post-abortion care, as many rural women cannot afford to return to health clinics. The CEDAW Committee repeatedly encourages states to guarantee post-abortion care for rural women.
There is also space for more sustained engagement with rurality and women and girl’s sexual and reproductive health rights. There is less awareness on the role of rurality in sex education. The CEDAW Committee does advocate for comprehensive, scientifically accurate, gender responsive sex education which applies to both urban and rural girls. However, it does not touch upon social isolation and conservatism that can be severe and prevalent in rural communities that may limit sex education. The CEDAW Committee consistently advocates that rural women and girls must be able to access, affordable modern contraception. Unfortunately, the CEDAW Committee does not acknowledge the role of stigma in accessing contraception in rural communities, particularly close-knit rural communities. Its recommendations could be strengthened by harmoniously encouraging states to protect girls and women’s privacy and to tackle negative attitudes on sex education and the use of contraception so that rural women and girls can gain knowledge and use contraception without public shaming.
Rural girls and women are far too often invisible and their sexual and reproductive health rights are routinely violated. CEDAW shines the international spotlight on the intersection between rural, gender and sexual and reproductive health rights. The recommendations are targeted towards many of the structural inequalities in rural communities—investment in rural health services and transportation links, increasing women’s economic independence and participation in rural decision making. While the CEDAW Committee is attentive to rural women and girls’ lived experiences, there are still gaps in its approach to rurality. The lack of privacy and the social isolation combined with gendered norms characteristic of many rural areas can make exercising sexual reproductive health rights challenging. The CEDAW Committee’s recommendations should reflect this reality. It should encourage states to develop health services that protect women and girls’ privacy over intimate areas of their lives and also transform rural cultural attitudes that perpetuate shame and stigma. Overall, CEDAW’s sensitivity to rurality is to be commended and other domestic and international human rights bodies should similarly take account of the role of geography in shaping the realisation of human rights.
Meghan Campbell is a Senior Lecturer at the University of Birmingham, Deputy-Director of the Oxford Human Rights Hub and Managing Editor of the University of Oxford Human Rights Hub Journal. Her monograph, Women, Poverty, Equality: The Role of CEDAW explores how the concept of equality in the UN Convention on the Discrimination on the Elimination of All Forms of Discrimination Against Women can be interpreted to address gender-based poverty. The ideas in this blog post are explored further in the forthcoming edited collection Intersectionality and Human Rights (Hart 2020) edited by Shreya Atrey and Peter Dunne.