Reproductive Healthcare as Human Security
By Sonja Woolley
“Life, liberty, and the pursuit of happiness.” Written in the American founding documents is the promise to protect these three unalienable rights, and while this is not legally binding, it forms a basis for understanding and guiding governance in the United States. Across the world, each one of us has indispensable rights which underpin our ability to live our lives freely and with the ability to pursue happiness. This understanding of human rights, especially through the context of a responsibility to protect freedom, forms the basis for human security.
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Human security is a paradigm for reframing and prioritizing security threats through the lens of the individual, human experience. This paradigm is structured around the importance of three freedoms: freedom from fear, freedom from want, and freedom from indignity.
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Reproductive rights have been long-ignored as a category integral to human rights and the human security framework. But its importance cannot be overstated. For child-bearing people, the ability to retain bodily autonomy and make personal decisions to guide the direction of one’s own life are uniquely intertwined with access to reproductive healthcare. When child-bearing people are denied obstetric care, birth control, the facts about reproductive health, or safe abortion, as many across the world are, their human security is infringed upon, as are their human rights. When this access is restricted, child-bearing people and those that support them no longer have the means to direct their own lives.
Freedom from Fear
What does it mean to have freedom from fear? This freedom represents the ability to live without the constant threat of physical or emotional harm, often tied to war, conflict, or persecution. In many ways, this aspect of security is based on the idea of a right to life. And across the world, the right to life is threatened by a lack of reproductive resources. The World Health Organization estimated that approximately 295,000 women died due to maternal causes in 2017. This translates to approximately 10% of all deaths among women of reproductive age (15-49 years) worldwide. [1]
However, the burden of maternal mortality is not evenly distributed, and the majority of maternal deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa. In these regions, maternal mortality accounts for a much larger proportion of female deaths. In the visualization, we can see the extent of cross-country inequality. In high-income countries, maternal mortality has decreased significantly. The average rate in the EU is 8 maternal deaths per 100,000 live births. The US is considered to have the worst maternal mortality rates of all high-income countries, with an average rate of 24 maternal deaths per
100,000 live births. [2] But for childbearing people in Sierra Leone, their chances of death during and immediately following pregnancy are 300-400 times greater than the chances of a pregnant person in a high-income country. At the rate of 1360 deaths per 100,000 live births, almost 1-in-75 pregnancies in Sierra Leone end in the death of the child-bearer. This comparison is amplified by the overall risk of death from maternal causes in one’s lifetime – maternal mortality rates tend to be higher the more children are had. The average birthing person in Sweden or the UK has 1 or 2 children, whereas the average birthing person in Niger has 7. [3] The visualization below shows what percentage of women are likely to die from pregnancy-related causes. Across the world, risk is less than 1%. But in Chad, that risk jumps to almost 7%. That’s around one in every 15 women.
Maternal deaths are almost always preventable, and the tools to lower high maternal mortality rates exist – contraception, safe abortions, C-sections, better pre- and post-natal care – but the distribution of resources and training available is where changes can really take place. A WHO report found four key factors that contribute to high maternal mortality rates:
1. Health system failures that translate to delays in receiving care, poor quality of care, shortage of supplies, poor accountability
2. Social determinants including but not limited to income, education access, race and ethnicity
3. Harmful gender norms, biases, and inequalities that lead to a low prioritization of resources
4. External factors contributing to instability of the system, such as climate change or humanitarian crises
Securing freedom from fear means combating the above factors and investing in reproductive healthcare that can assist child-bearers in safe pregnancies.
Freedom from Want
In essence, "freedom from want" means that every person should have the ability to meet their basic needs, regardless of their income or social status. This part of the human security framework can be connected to the relationship between reproductive healthcare and positive outcomes for child-bearers. Studies in the U.S. have shown that child-bearers are better off when they have access to family planning methods like contraception, abortion, and broader forms of birth control. Outcomes – including educational attainment, labor force participation, career outcomes and earnings – show a positive correlation with access to legal contraceptives. [4]
Fundamentally, having access to birth control measures allows people who can get pregnant the ability to choose when to have children, giving them the opportunity to invest in higher education and/or choose an occupation. This opportunity leads to higher workforce
participation, lifetime earnings, and improved maternal and child health. [5] Access to contraceptives has been shown to increase educational outcomes in particular – college enrollment increases by 12% to 20% for those who have contraceptive access in comparison to those who do not. [6] One study linking survey and census data in Colorado found that the 2009 Colorado Family Planning Initiative (CFPI), which greatly expanded contraceptive access to low-income Colorado child-bearers and teenagers, was associated with an increase in high school graduation rates. [7] More broadly, studies show that higher rates of education lead to higher incomes and better outcomes for themselves and their families. In the United States in 2020, nearly one-quarter (24.7%) of people aged 25 and up without a high school diploma live in poverty.
This number decreases with each level of education [8], demonstrating the importance of access to contraceptives in how it relates to educational attainment.
The Institute for Women’s Policy Research’s report on the Economic Effects of Contraceptive Access examined the impacts of reproductive healthcare on poverty and its alleviation. Beyond just educational attainment, having the ability to choose when is the right time or the wrong time is intimately connected to poverty alleviation. This choice comes down to access to not just contraceptives, but abortion, too. Unintended pregnancies can have significant economic costs for individuals and families, including lost wages and increased expenses related to child-rearing. These economic costs are amplified by the fact that unintended pregnancies occur at higher rates among groups more likely to be facing poverty – adolescents, people of color, low-income parents, and single parents – making the financial burden of pregnancy especially acute. [9] Additionally, research shows that the majority of those who seek abortions tend to be experiencing “disruptive life events.” A recent survey conducted by the Guttmacher Institute estimates the following:
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97% are adults
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49% are living below the poverty line
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59% already have children
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55% are experiencing a disruptive life event such as losing a job, breaking up with a partner, or falling behind on rent [10]
It is not unreasonable to imagine that access to an abortion could be pivotal in the financial lives of these patients, demonstrating that increased access to reproductive healthcare gives people a greater chance to provide for their basic needs.
Freedom from Indignity
Finally, connected to all of the above discussions of mortality, education, poverty, is the discussion of dignity. For many in the US, the prospect of losing access to contraception or abortion is becoming more and more realistic, prompting a response that demonstrates the salient connection between bodily autonomy and reproductive healthcare access.
Indignity noun
a) an act that offends against a person's dignity or self respect
b) humiliating treatment [11]
Not only does access to reproductive healthcare, particularly contraception and abortion, lead to better economic outcomes for people who can get pregnant, but it is also the simple matter of autonomy and freedom. In reaction to the 2022 Dobbs decision, which overturned Roe v. Wade, ruling that the federal government does not have a responsibility to protect abortion access [12], columnist Keeanga-Yamahtta Taylor wrote, “If [child-bearers] cannot dictate this most basic aspect of their being, then the Supreme Court has effectively consigned them to a distinctly secondary tier of citizenship.” [13] Taylor writes clearly about the impact of the loss of abortion access, and how it removes a level of freedom and control in one’s life that is imperative to full participation in society. This removal of rights is a form of indignity, placing people in a position where they do not have full control over their bodies based solely on which reproductive organs they were born with. This is discrimination and a threat to individual freedom and human security.
“Being able to control when or if we have children is essential to the freedom of the women in this nation. Without bodily autonomy we are not free.” [14]
1. “Maternal Health - PAHO/WHO | Pan American Health Organization,” Pan American Health Organization, n.d., https://www.paho.org/en/topics/maternal-health.
2. “The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison,” Improving Health Care Quality (blog), December 1, 2022, https://doi.org/10.26099/8vem-fc65.
3. “Fertility Rate: Children per Woman,” Our World in Data, 2022, https://ourworldindata.org/grapher/children-born-per-woman.
4. Cory Stieg, “Birth Control Access Has Contributed to Women’s Wage Increases, Says New Study,” CNBC, September 26, 2019, https://www.cnbc.com/2019/09/26/contraception-birth-control-access-contributes-to-womens-wage-increases-says-new-study.html.
5. Anna Bernstein, Kelly Jones, and Anna Bernstein and Kelly Jones, “The Economic Effects of Contraceptive Access: A Review of the Evidence,” IWPR (blog), September 26, 2019, https://iwpr.org/iwpr-issues/reproductive-health/the-economic-effects-of-contraceptive-access-a-review-of-the-evidence/.
6. Congressman Don Beyer, Vice Chair, “The Economic Benefits of Birth Control and Access to Family Planning” (Joint Economic Committee, February 2020), https://www.jec.senate.gov/public/_cache/files/bb400414-8dee-4e39-abd3-c2460fd30e7d/the-economic-benefits-of-birth-control-and-access-to-family-planning.pdf.
7. Katie Genadek, “New Census Bureau Research Shows Link Between Contraception Access and High School Completion,” United States Census Bureau, May 10, 2021, https://www.census.gov/library/stories/2021/05/access-to-contraception-can-increase-womens-educational-attainment.html.
8. “DataPoints: Education, Income and Poverty,” American Association of Community Colleges, October 26, 2021, https://www.aacc.nche.edu/2021/10/26/datapoints-education-income-and-poverty/.
9. Michele Troutman, Saima Rafique, and Torie Comeaux Plowden, “Are Higher Unintended Pregnancy Rates among Minorities a Result of Disparate Access to Contraception?,” Contraception and Reproductive Medicine 5, no. 1 (October 1, 2020): 16, https://doi.org/10.1186/s40834-020-00118-5.
10. Rachel K. Jones and Jenna Jerman, “Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008-2014,” American Journal of Public Health 107, no. 12 (December 2017): 1904–9, https://doi.org/10.2105/AJPH.2017.304042.
11. “Definition of INDIGNITY,” in Merriam-Webster, April 26, 2023, https://www.merriam-webster.com/dictionary/indignity.
12. “Supreme Court Case: Dobbs v. Jackson Women’s Health Organization,” Center for Reproductive Rights, n.d., https://reproductiverights.org/case/scotus-mississippi-abortion-ban/.
13. Keeanga-Yamahtta Taylor, “Abortion Is About Freedom, Not Just Privacy,” The New Yorker, July 6, 2022, https://www.newyorker.com/news/our-columnists/abortion-is-about-freedom-not-just-privacy.
14. Colleen P Judge et al., “‘Without Bodily Autonomy We Are Not Free’: Exploring Women’s Concerns about Future Access to Contraception Following the 2016 U.S. Presidential Election,” Contraception 96, no. 5 (November 2017): 370–77, https://doi.org/10.1016/j.contraception.2017.07.169.