Jacqueline Sharpe is a consultant child and adolescent psychiatrist from Trinidad and Tobago and the president of the International Planned Parenthood Federation (IPPF), a global service provider and a leading advocate of sexual and reproductive health and rights working in 150 countries. Its areas of action include abortion, access, adolescents, advocacy and AIDS/HIV.
Although there is an area of over-lap between them, sexual and reproductive rights are two separate issues.
Sexual rights include the right of all people to make free and responsible decisions about all aspects of their own sexuality, including deciding to be sexually active or not and protecting and promoting their reproductive and sexual health; The right to be free from discrimination, coercion and violence in one’s sexual life, and when making sexual decisions; The right to expect and demand equality, full consent, mutual respect and shared responsibility in all sexual relationships and to pursue a satisfying, safe and pleasurable sexual life.
On the other side reproductive rights include the rights of couples and individuals to freely and responsibly decide the number, spacing and timing of their children; The right to have the information, education and means to make the above decisions; The right to attain the highest standard of sexual and reproductive health and the right to make decisions free from discrimination, coercion and violence.
Sexual and reproductive rights are included in international conventions such as CEDAW (see blogroll), the 1995 Beijing Platform for Action, and the Plan of Action which emerged from the International Conference on Population and Development (El Cairo, 1994).
In the IPPF’s webpage it is stated that “young people (those who are btw 10 and 24 years old) face the barriers of cost, stigma and fear of going to a clinic. The lack of information targeted at their needs and (in many countries) the need for parental consent, limits young people’s awareness of the issues of sex and sexuality. High rates of unwanted pregnancy and sexually transmitted infections are powerful evidence that programmes are failing to meet their needs”.
How does IPPF work to meet young people’s needs?
We strongly believe that young people should be aware of their sexual and reproductive life to make decisions. Since we recognize and respect that people have belief systems what we try to do is provide young people with information, education and services and also to have them negotiate their values so that the decisions they make are congruent with themselves.
IPPF works with religious leaders in several countries also to have young people negotiate with them. In the Family Planning Association of Trinidad and Tobago, for instance, we have a specific project on youth sexuality in the context of preventing HIV and we have been working with the Anglican church. We started with one priest and now have several church communities wanting to participate in our programme. I think it is something that has to be done project by project and place by place.
In addition to provide services to young people we also want to encourage them to participate in the organization. At the moment 20 percent of the board directors of IPPF are people under the age of 25.
Would you say religion is the main detractor toward a different way of living people’s sexual and reproductive lives?
It is much more complicated than that.
So what other elements work as detractors?
First of all I believe that we, the people working to advocate for sexual and reproductive health, need to open up a dialogue with religious leaders and to define a space for common ground because there are many of them out there who are willing to be supportive but unfortunately it is only extremists who are perhaps speaking…But I also think there are other issues that impact people’s sexual and reproductive health and rights that don’t necessarily have to do with religion but with people’s prejudices.
Laws that criminalize sodomy that remain on statue books may have as much to do with not accepting sexual diversity out of fear and prejudice as with religion and I think these can be changed by changing how we think and feel without necessarily addressing people’s religious convictions.
We have recently published a Declaration on sexual rights where we did a lot of work in relating sexual rights to the human rights conventions. As a result of that I think a lot of young people have come to understand issues around sexual rights including sexual diversity in a more humane and rights based way and it has been a chance for us to expend the dialogue, because we often talk to adults but not to young people.
Homophobia keeps being one of the main problem kids face in schools worldwide. How do we deal with it?
I once again think we need a human rights perspective on things and this has to be part of the comprehensive sexuality education. Together with other organizations we developed a curriculum for comprehensive sexuality education that also speaks specifically to issues of gender and health. We believe that comprehensive sexuality education, education about gender equality and education about human rights and HIV are all connected and we are now advocating for its implementation in schools.
The IPPF’s webpage says “We challenge practices and cultural norms that are harmful to young people”. For instance?
One very obvious cultural norm is FGM (Female Genital Mutilation. According to estimations of the United Nations, more than 8 000 girls become victims of this crime every day) which is still practiced in many of the countries that are members of IPPF (FGM is practised by both Muslims and Christians and continues to be performed in Africa but also in Asia, Europe, America and Australia, especially among immigrants). In these countries we are working to reduce its incidence through specific projects aiming at changing the laws and we started working to train FGM’s practitioners do other things, for instance becoming birth attendants in countries such as Mauritania, where the laws have been changed but the practice continues.
There are also other many traditional practices not as dramatic as FGM, for instance girls not going to school when they have their period, that also need to be changed. Sometimes it is simply that girls don’t have access to sanitary napkins therefore they can’t go to school, so one of the things that our member associations do is make sure that girls have access to them.
In the IPPF’s webpage it is also stated that without meeting the agreed funding requirements to ensure universal access to sexual and reproductive health services by 2015, the Millennium Development Goal (MDG) of poverty eradication will not be realized. What is exactly the direct relationship between the two things?
Poverty eradication will depend on women’s empowerment, on women being able to have the number of children they can support and on access to money as well. One of the things we really believe is that if we can have families have the children that they want and if women can choose to have more for their children than more children, we will have reduced the dependence of families on handouts for instance.
Together with other partners IPPF has worked very hard to specifically advocate for the inclusion of universal access to sexual and reproductive health services in the MDG 5 on maternal mortality, which was not mentioned when the goal was first announced in the year 2000. In 2005 it was finally included as a specific target called 5B.
How far are we from achieving the MDGs and what is missing?
The achievements of the MDGs have been quite variable and some countries are doing better with some Goals than they are with others.
One of the Goals we have done best on is infant mortality while one that is largely staying behind is the reduction of maternal mortality (Of the 500,000 annual maternal deaths, complications from unsafe abortion account for approximately 70,000, or 13 per cent, of all deaths. Some 19 million women annually are forced to risk their health and lives to undergo an unsafe abortion). However in the last year there has been again a big commitment for instance from the UN into the activities around the issue. I think we have to be hopeful, people are talking more about it.
The programme of action of the International Conference of Population and Development of 1994 clearly underlines the things that would be needed to achieve the Goals.
What are they?
The conference was groundbreaking because moved from seeing issues on population and development from numbers to people. I think that any goal that relates to human development has in the final analysis got to be rights based and people centred. It is difficult to do it but what has happened lately in some countries shows that it is possible.
There are countries that in fact work very hard to make sexual and reproductive health part of their agenda and this has really changed the lives of the women and men in those countries. They are the same countries that according to the Human Development Index have been successful over the last 15 years in significantly improving their status on many of the indicators that make up the Index and much of this is the result of the work that has been done on issues that were outlined in the Cairo Programme of Action.
When you say that issues related to sexual and reproductive health need to be handled project by project and country by country do you also include abortion and therefore think that an international legislation on it would not be a valid option?
If we look at experience to date it has really been country by country and dependent on whether the law on abortion has been changed.
The Cairo Conference stated that where abortion is legal it should also be safe for instance and the Beijing Platform stated that countries should consider reviewing laws containing punitive measures against women who have undergone illegal abortions. I think those have been points from which people have been able to advocate. There have been changes in abortion laws in some countries also thanks to many of our IPPF member associations which have worked very hard to modify strict laws.
So I think in the final analysis it has to be a country by country activity.
Are the specific issues of LGBTI people’s sexual health and rights addressed by IPPF?
At the Federation level we have policies on non-discrimination in terms of how our staff is hired and at a specific project level our Member Associations are working with communities that are sexually diverse for instance in Cameroon, Peru, Colombia and Trinidad and Tobago.
To be fair, though, this has not been IPPF’s main avenue of activities. However it has been one of the things that motivated us to work on the Declaration of Sexual Rights because we felt we had to do some work internally to sensitize all our Member Associations specifically around issues of sexual diversity. In many situations we need to be educating ourselves and understand issues better so as to provide services, and some of our member associations are reaching now the sexually diverse populations and wanting to provide services.
But the heterosexual normative still rules even in the movements that work to reach non discrimination on the basis of sexual orientation and gender identity, right?
Our work in this area is really at the beginning but one of the things that we have been working on and that came out of our work on HIV especially is a stigma index which will help us to reduce them and I think it is part of what we have to do when working with sexually diverse population.
It is a very important issue because if we are a right-based organization, which we are, then we need to make sure that we are recognizing the rights of everyone.
How did you end up dealing with issues of sexual and reproductive rights?
In the Seventies after graduating from medical school I worked in Barbados and I did my internship at the general hospital there. Every day I used to see young women who had had septic incomplete abortions coming to the hospital for follow up and that made a huge impact on me because I was a young woman myself and I realized that if I needed to terminate a pregnancy I certainly would not have had a backstreet abortion even though abortion was not legal there at that time.
It became clear to me that access to safe, legal abortion is both a health and a social justice issue.
Then a friend of my mother and my mother invited me to join the Family Planning Association in Barbados and I became a volunteer. Afterwards my work in psychiatry made it very clear to me that if you don’t get your sex life sorted out you quite often don’t get your mental health sorted out.
Many of the women whose children I am seeing have themselves had problems with their sexual and reproductive lives have started their reproductive lives before they were ready and quite often the children I am seeing are not their first child. What is clear is that they didn’t have a chance to handle their own lives.
Do you have children?
I think it is how life has turned out for me, certainly it was not a direct decision not to have children.
What are the main obstacles to your attempts to gain support for sexual and reproductive health and rights?
The perception among some political leaders that the anticipated crisis of a ‘population explosion’ has diminished, and therefore providing contraceptive services is not seen as a pressing issue has resulted in reduced funding.
The general conservative backlash, particularly in the US, which has labelled our work ‘controversial’ and has resulted in a retreat from funding sexual and reproductive health.
Last but not least the global economic situation has made money for aid less available.
What could be done to overcome some or all this obstacles?
I think we have to tell our story well and have people to see that money spent on prevention is money well spent but it takes a while to see its benefits sometimes.