Pandemic patriarchy: regulation, access, and governance in reproductive rights
Structural inequalities in women’s rights are exacerbated by the pandemic and leave poor and racialized women most vulnerable to the denial of reproductive rights.
A signs reading "Legal abortion saves lives," was placed by protesters on the facade of the Amaury de Medeiros Integrated Health Center (CISAM) in Recife, a public maternal clinic of reference in the country for abortion procedures, in Recife (Brazil). EFE / DIEGO NIGRO
The global coronavirus pandemic has challenged health rights worldwide, directly and indirectly. We must better recognize the gendered impact of this global crisis on reproductive and sexual health rights, especially as these recently recognized international human rights are vulnerable to patriarchal regression and nationalist securitization.
Reproductive rights and the right to safe abortion as integral to health are progressively becoming recognized by the United Nations ￼as essential to women’s right to life, self-determination, and gender equality: beginning with the Cairo Conference in 1994, General Assembly Key Actions outlined in 1999, and most recently in the 2016 General Comment by the UN Committee on Economic, Social and Cultural Rights. Yet pandemic conditions and policies threaten reproductive rights in new ways, including increased vulnerability to unwanted pregnancy associated with the surge in domestic violence during lockdowns, lack of access to contraception, prenatal care and abortion services, and rights-regressive policies adopted by reactionary governments under cover of the crisis.
Structural inequalities in women’s rights and access to health care are highlighted by the pandemic and the implementation of government policies ￼that leave poor women—especially women from the global South and women of color—most affected by pandemic patriarchy and most vulnerable to denial of reproductive rights.
A human rights approach that centers on the fulfillment of SRHR in this time needs to overcome three barriers rising from this form of pandemic patriarchy. Access to abortion is especially urgent, since safe interruption of pregnancy is by its nature timely. While some governments use regulatory power to restrict women’s access to abortion services, others trade pandemic restrictions against reproductive health access. In a parallel vein, globalized disruptions in medical abortion supply chains and pharmaceutical dependency pose deeper challenges across the global South that are linked to the downgrading of women’s reproductive health rights to a “non-essential” service.
The first aspect of pandemic patriarchy is a revival and deepening of government restrictions on women’s right to choose, amid a lack of reproductive rights standard-setting and monitoring that permits roll-backs to legislation. Restrictions and lack of counterbalances are a threat to the right to life of the tens of thousands of women who die each year from unsafe abortions.
Poland, with one of the most restrictive abortion laws in Europe, has taken advantage of the crisis to push through limitations previously rejected due to social protest in 2016. In the US, restrictionist states already reducing availability of clinics—including Ohio, Texas, Mississippi and Kentucky—have used the pandemic to block surgical abortions as an “elective non-essential service” suspended due to the crisis. These moves are being contested by legal activism. In addition, the US is restricting the availability of medical abortion nationwide due to a unique FDA classification of mifeprestone as a prescription that must be issued in person in a clinical setting, despite COVID-related lockdowns that make such visits unavailable. This restriction has recently led to an ACLU lawsuit.
The second aspect of pandemic patriarchy is limited access to abortion services, even where access is legal. The Mexican Secretary of Health, for example, guaranteed access to sexual and reproductive health services, including abortion, in the Health Guidelines for the Pandemic. However, Sofía Garduño from Fondo MARÍA argues that women who need to travel to Mexico City or Oaxaca for surgical abortions are denied access because they cannot travel, while local restrictions of movement make it almost impossible for them to get the pills for medical abortions from pharmacies. As the Mexican feminist organization GIRE stated: “We cannot assume that just because rights are available in theory they will be guaranteed in practice.”
One response has been solidarity among healthcare providers and civil society organizations to foster networks to distribute abortion pills nationwide and teach about in-house abortion procedures, while another has been to strengthen networks of midwives (especially among Indigenous populations).
The last aspect of pandemic patriarchy results from the interaction between lockdowns and the disruption of supply chains for drugs, and pharmaceutical dependencies in a masculinist global market. Kenya and Uganda have been facing a shortage of medical abortion pills and other contraceptive supplies because they depend on imports. As DKT International explained, packages that were arriving to Kenya got stuck at the New Delhi airport for nearly six weeks. Because manufacturing in Asia was hit hard by COVID-19, severe lockdowns and restrictions on pharmaceutical exports and imports made women who depend on low-cost supplies that often originate in China especially vulnerable.
We cannot assume that just because rights are available in theory they will be guaranteed in practice.
In Latin America, where abortion is mostly illegal but the use of pharmaceuticals rather than surgical abortion is often tolerated, providers in Brazil and Bolivia have been completely dependent on external sources in the last couple of years, putting them in a difficult position to fulfill the demand of misoprostol through the pandemic. In Brazil, the patriarchal Bolsonaro regime has undermined its own health officials’ attempt to safeguard reproductive rights during the pandemic.
Government spending to compensate for supply chain problems also faces backlash in Latin America, as the director of IPAS Mexico and Central America explains, because abortion and contraception drugs are considered by conservative groups as luxury products, rather than a necessity. The mayor of Buenos Aires was questioned about buying 80,000 misoprostol pills to ensure access would not be disrupted due to COVID, rather than investing that money in ventilators.
Despite these worrying barriers to reproductive rights, there is an emerging coalition of countries that recognize the problem and pledge to maintain sexual and reproductive health rights in crisis. A joint statement ￼￼sponsored by 38 countries from all continents, on behalf of 59 countries (but excluding the US, Russia, China and India, among others), recognized the need to safeguard sexual and reproductive health rights amidst restrictive measures designed to limit the spread of the virus around the world.
Ironically, some of the countries supporting these global standards include those cited above that still struggle in national practice, such as Mexico and Argentina—but in both cases, there are signs of change. The signatories reminded world leaders about the central role of Universal Health Coverage in which sexual health services remain essential to save lives. Moreover, global gender rights promote cooperation and NGOs are fostering rights-based international cooperation to compensate for pandemic disruptions and resource disparities in reproductive medication access.
Overall, the best response is global recognition of integrated health rights and empowerment of midwives, nurses and community health workers who bridge community health with sexual and reproductive health. Reinforcing reproductive rights is key to debunk narratives that use health panic as a way to roll back global efforts to construct indivisible health rights that are accountable to multiple systems of oppression based on gender, race, disability, poverty, and migratory status.
Human rights can help serve as a counterweight to pandemic patriarchy through greater recognition of reproductive rights and their intersectionality, through advocacy at the national and global levels, through greater translation and mobilization of grassroots health rights initiatives, and through increased attention to the economic and social inequities that interrupt the fulfillment of rights in practice.
This piece is part of a series published in partnership with Occidental College’s Young Initiative on the Global Political Economy, the division of Social Sciences at Arizona State University, and USC’s Institute on Inequalities in Global Health. It flows out of a September 2019 workshop held at Occidental on “Cross-cutting Global Conversations on Human Rights: Interdisciplinarity, Intersectionality, and Indivisibility.
Alison Brysk is the Mellichamp Professor of Global Governance at the University of California, Santa Barbara.
Miguel Fuentes Carreno is a doctoral candidate at UCSB based in Mexico who has worked with the UNPFA.