Gender & Sexuality Studies Politics of Women's Health Mehra Shirazi

POLITICS OF HEALTH later that night i em atlas in my lap rem my gers across the whole world and where does it hurt ?

it answered everywhere everywhere everywhere During the course of writing this chapter , has had an unprecedented global impact , taking the lives of more than lion people worldwide . It is critical to understand the dire effects the pandemic has had on the health of women and girls . There has been a 148 percent increase in violence during the quarantine period , increased economic and Food , and lack of access to sexual and reproductive health care ( 2020 ) Additionally , while women comprise 70 percent of the global health workforce , they hold only 25 percent of senior roles ( van et al . 2020 ) Only percent of 115 expert task Forces have gender parity in their membership . Male dominance in global health leadership positions is the symptom of a broken system . These power fail to reflect gender , sex , geographic , racial , or nomic equity within and beyond health , and the lack of women and practices in bodies has ultimately cost lives ( van et al . 2020 ) Thus the Shire The pandemic reveals global health disparities pandemic has highlighted the fact that women across the globe suffer from tremendous health

106 POLITICS OF WOMEN HEALTH inequities , including those related to unequal power relations , poverty , violence , and decreased access to education ( Mark 2020 ) The denial of access to health care , combined with the disparities compounded by systemic racism and against women , create an overwhelming international health crisis . In order to enact and maintain functional health care systems , radical and systemic change that utilizes and practices is crucial . Such work requires an intersectional framework to health analysis and tion , which recognizes the existence of inequities based on gender , race , income , class , sexuality , geography , ability , and more . This chapter focuses on gender and health within a transnational context . It presents health as a human right and discusses ways the politics of gender , or the ways power and resources are distributed according to gender , help construct health outcomes . Using an intersectional feminist framework and centering marginalized communities , the part of the chapter seeks to understand health inequities . Later in the chapter , I conceptualize various approaches to health equity and health care that address historical roots of oppression and structures of power . The chapter ends with a focus on disability justice , taking into sideration the context of the present global pandemic . The World Health Organization ( WHO ) makes the case for health as a human right , it as a state of complete cal , mental and social and not merely the absence of eases and infirmity ( 1948 ) Central to this is the point that health involves not merely a right to be healthy or to access health care , but also a holistic notion of grounded in Image from a 2009 rally to protect women health a wide range of social , cultural , and economic factors that mote conditions in which people can lead healthy lives . Human rights related to health are embedded in international rights instruments as well as national all over the world . More than years ago , in 1966 , for example , the International Covenant on Economic , Social and Cultural Rights ( declared the right of everyone to the enjoyment of the highest attainable standard of physical and mental According to the United Nations High Commissioner for Refugees ( it called for the reduction of infant mortality and the maintenance of child health the improvement of environmental and industrial conditions to ensure good health and the prevention , treatment , and control of common diseases that occur at a constant but low rate ( endemic ) and those that involve new cases in ways that exceed what might be expected ( epidemic ) 1966 ) In 2000 the UN Committee on Economic , Social and Cultural Rights the right to health to include ( availability of functioning public health and facilities , goods and services , as well

POLiTiCS OF ) HEALTH i 107 as programs in quantity ( accessibility of health facilities and goods and services for everyone ( accessibility implies the idea that no one should be denied access as a result of discrimination , physical disability , lack of economic resources , or lack of access to information ) acceptability of health services and facilities in terms of medical ethics that included cultural and gender sensitivity and ( ample quality of health services that meet scientific and medical standards . This report also emphasized the need for timely and appropriate primary health care access to safe and potable water and adequate sanitation an adequate supply of safe food , improved nutrition , and housing healthy occupational and environmental conditions and access to education and tion , including information on sexual and reproductive health . A section required nations to create national public health plans of action that address the health concerns of the entire population . In this way , the right to health is not to be interpreted as only a right to have health services , but it should also embrace a wide range of socioeconomic factors for healthy living ( and 2005 ) The Sustainable Development Goals Is It Time to Reexamine ?

The United Nations General Assembly ( 2015 ) agreed upon seventeen Sustainable Development Goals ( listed below , under the overarching principle of leaving no one Sustainable Development Goals ( Goa . End poverty in all its forms everywhere . Goa . End hunger , achieve food security and improved nutrition , and promote sustainable agriculture . Goa . Ensure healthy lives and promote for all people at every age . Goa . Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all . Goa Achieve gender equality and empower all women and girls . Goa . Ensure availability and sustainable management of water and sanitation for all . Goa . Ensure access to affordable , reliable , sustainable , and modern energy for all . Goa . Promote sustained , inclusive , and sustainable economic growth , full and productive employment , and decent work for all .

108 OF HEALTH Goa . Build resilient infrastructure , promote inclusive and sustainable industrialization , and foster . Goa 10 . Reduce inequality within and among countries . Goa 11 . Make cities and human settlements inclusive , safe , resilient , and sustainable . Goa 12 . Ensure sustainable consumption and production patterns . Goa 13 . Take urgent action to combat climate change and its impacts . Goa 14 . Conserve and sustainably use the oceans , seas , and marine resources for sustainable development . Goa 15 . Protect , restore , and promote sustainable use of terrestrial ecosystems , sustainably manage forests , combat , halt and reverse land degradation , and halt biodiversity loss . Goa 16 . Promote peaceful and inclusive societies For sustainable development , provide access to justice for all , and build effective , accountable , and inclusive institutions at all levels . Goa 17 . Strengthen the means of implementation and revitalize the global partnership for sustainable deve . Lost in the Desert by Sarah Baum When we think of a desert , a dry , desolate place comes to mind . The same thing is true when it comes to food deserts . The US Department of Agriculture a food desert as an area . with limited access to affordable and nutritious food , particularly such an area composed of predominantly lower income neighborhoods and For urban areas to qualify as a region of low access , they must have at least hundred people at least 33 percent of the census population residing more than one mile from a supermarket in rural areas the distance is ten tend to think deserts as a US problem , but it a global one , affecting people across the globe in both developed and developing tries . Living in a food desert doesn just mean limited access to a grocery store , but also limited selection of affordable , healthy options , leaving residents to rely on junk foods , limited variety , and options with low nutritional value .

OF ) HEALTH 109 In Cape Town , South Africa , there is an 81 percent rate of food insecurity because of the fractured transportation system , people spend so much time commuting that they rely on foods , which are expensive and unhealthy . Australia also is dealing with the food desert issue . In Western , access to fruits and vegetables is often limited season distance and much higher . In some areas , families would need to spend nearly 60 percent of their income to buy healthy food . Food deserts are a growing global problem that is not easily solved , but one to which we must a solution . Originally , the core goal of these policies was to set an agenda to reduce global health inequities within the population by enabling access to comprehensive health care and services . Prior to the , considering these from a feminist perspective gave rise to both praise and critique . Praise emerged primarily in response to how the have improved upon or departed from limitations in the 2000 Millennium Development Goals ( In particular , the have attempted to not only address gender and women rights through a goal , but also to incorporate these issues as into several other goals . Furthermore , the creation of entailed a more equitable and inclusive process than the approach that led to the . The are applicable worldwide , ing individual countries to adapt them as their needs require , whereas the targeted nations . The also addressed hierarchies within countries and the inequalities between the Global North and the Global South . Lastly , the set forth a more comprehensive framework for and outcomes than did the ( Consortium on Gender , Security and Human Rights 2017 ) Nevertheless , feminist perspectives also offer criticism of the . these critiques focus on structural issues of the , noting that the encourage traditional economic models and fail to address power relations and social structures . These critiques apply to areas in which the remain silent or undeveloped for example , the fail to discuss their impact on nonconforming genders and different sexual , lack a focus on collective action , and are absent of human rights language . critiques address the themselves for example , Goal is critiqued for its assumption that greater presence of women in politics will all women , and it falsely equates gender equality with economic equality . Finally , critics points out weaknesses surrounding the implementation of these goals , asking whether the goals are too ambitious and abstract , and whether they will be weakened as a result of adapting to pressures within different countries ( Consortium on Gender , Security and Human Rights 2017 ) To address these concerns and to reexamine the progress of the , the United Nations Political Forum convenes annually . Each year , they focus on a set of goals and review the mentation progress in certain countries . After the 2017 forum , the Women Major Group laid out

110 OF ) HEALTH critiques of the current progress they recommended that be implemented with a human rights approach a meaningful representation of women should be involved civil society spaces should be and strengthened through diversity should resource women rights groups and ability must be taken by all . Until these criticisms are addressed , women rights and feminist groups will continue to ensure these areas of improvement or need are brought to the public attention ( Consortium on Gender , Security and Human Rights 2017 ) Progress across the before the pandemic was slow , and of the seventeen , only two were close to being achieved . But because of the global pandemic , most of these goals are now out of reach , and advocates are calling for a radical shift in , in relation to gender inequities and violence against women , girls , and other marginalized communities . The impacts of have contributed to a rise in domestic violence as well as additional access barriers to sexual and reproductive health care for women . It is estimated that more than 71 million people were pushed into extreme poverty in 2020 , and women suffered disproportionately from loss of employment and additional accessing food , shelter , child care , education , health care , and aster relief services ( United Nations Department of Economic and Social Affairs 2020 ) Although health has been constituted as a human right , it must also be understood in the context of gender relations and other differences among women . A recent article from the Lancet Commission on Gender and Health argued that despite the body of knowledge regarding gender and health , for decades consideration of gender in global health has been neglected , with the authors stating that Gender is where in global health discourse and promises , but nowhere in action or accountability plans , meaning the world community is not on track to meet its Sustainable Development Goals ( Hawkes et al . 2020 , 528 ) We must consider the links among women , gender , and health beyond increased risk factors , and look at historical structures and systems that create health inequities . An intersectional approach to health and health research has gained widespread interest and momentum in recent years . The term was coined by Crenshaw in 1989 and is rooted in Black feminist theory and scholarship . It has been widely recognized as an approach to analyze the systems of power and oppression that produce and maintain health inequities and other kinds of inequities . Further , moves beyond individual factors such as biology , socioeconomic status , sex , gender , and race . Instead , it focuses on the relationships and interactions between such factors , and across multiple levels of society , to determine how health is shaped across population groups and geographical ( and 2018 , 2589 ) Understanding global health inequities requires an intersectional approach , and gender not be considered in isolation without acknowledging the complex ways that power operates to create inequities in health and other layers of and discrimination .

POLITICS OF HEALTH I 111 Globalization , and Health Inequities Globalization and play a major role in shaping political and economic relationships across the world and are a driving force for health inequities . Structural adjustment policies , or SAPs , are imposed by global multilateral organizations such as the International Monetary Fund ( IMF ) and the World Bank as a condition of international lending , thus furthering . SAPS require indebted countries to reduce levels of public expenditure in order to assist the repayment of international debt or readjust spending patterns in line with perceived needs of a world economy . These policies directly health outcomes as a result of what is sometimes called a hollowing out of states that reduces the provision of health care and other services ( et al . 2019 ) While these practices may increase gross national product ( measures in these countries destroy national structure and bring hardship to individual citizens , especially women and communities . In countries , such conditions mainly affect and communities of Black , Indigenous , and Other People of Color ( By expanding markets for transnational corporations , economic globalization tends to drive out rural production in countries and instead provides work with low pay , little job security , shelter , or , and potential health hazards . The end result has been loss of livelihood and ancestral farms along with increased health problems . One example of the toll these global health inequities have disproportionately had on certain populations can be seen in the marginalized of both the majority and minority worlds . Economic tion has created transnational factory production as a result of the relocation of factories ( such as garment and some electronics manufacturing ) to areas in Asia and Latin America . In these zones , companies are often exempt from health , safety , and environmental regulations that affect the health and of workers . Often , young women are sought as cheap , easily controlled labor and treated as disposable with no or few concerns about health consequences . For example , since the passage of the North American Free Trade Agreement ( in 1994 , Mexico is home to more than three thousand ( assembly sweatshops producing for export ) that employ mostly female Mexican workers . are owned by US , Japanese , and European companies , and some could be considered sweatshops , with young women working for as little as an hour , for up to ten hours a day , six days a week . These women workers have no job security or and are often subject to sexual harassment and unsafe working conditions ( Demeter 2019 ) The high number of in Ciudad ua rez have made the state of Chihuahua the epicenter of the pandemic . But with direct reports of more than two hundred deaths of workers alone , only 50 of the city 320 factories closed , with workers rights violated and their lives put at risk repeatedly since the start of the pandemic ( Lopez 2020 )

112 I OF HEALTH Incarcerated Women of Color Are Especially Vulnerable to by Cristina Rodriguez Women are always at high risk of disease ( AIDS , tuberculosis , and hepatitis ) while incarcerated in crowded prisons . The pandemic is an extreme example . In many facilities , there is a age of ( personal protective equipment ) such as masks , and air may be , spreading the Virus . Some of these facilities have conditions in general as well as inadequate ical care . Women may be forced into rehabilitation programs to comply with probation requirements and are therefore put in difficult situations in order to better themselves and reunite with their families . For example , Elizabeth from California wrote Governor Gavin a letter expressing her about being forced to attend a drug reentry program after being diagnosed with the week ofjuly IS , 2020 . of color are affected by such poor conditions . They already face higher rates of incarceration than white women , they may be economically and educationally disadvantaged , and they may have mental health issues , all of which make them more vulnerable to disease . As the crisis , women will continue to suffer the consequences from a justice tem that puts them in vulnerable positions . India is another place where marginalized groups and have suffered disproportionately from . There , migrants and urban slum dwellers have faced multiple challenges brought about by the pandemic . India was first locked down by government order in March 2020 . Because these lockdown restrictions severely affected the economy , they were gradually relaxed and lifted over the following months despite infections continuing to rise . As of April 2021 , India was third in the world in terms of the number of cases , with more than 10 million people reported infected the actual number of infections was likely higher owing to limitations in testing and tracing ( Raju , and 2021 ) In considering the Indian hit hardest by , 95 percent of reported infections were localized to urban spaces ( Chennai , Delhi , Mumbai ) and one in six urban Indians resides in an area characterized by high poverty , with several factors that increase the risk of , such as high population density , weak health services , and informal income structures . Furthermore , 35 percent of those living in such areas have no access to clean water or sanitation , and these areas are already prone to high rates of infectious diseases such as pneumonia , diarrhea , and tuberculosis such

POLITICS OF HEALTH I 113 ties present a grim outlook for people living there to successfully off . Also contributing to this poor outlook is the fact that social inequality , poverty , and mental health issues decrease one ity to respond to stress ( Raju , and 2021 ) Migrants in India have also been especially by the pandemic . Migrant workers typically reside in informal settlements built around existing factories or industrial areas . Here , they lack access to able health care and face heightened health and safety risks . The travel and lockdown restrictions often left these migrant workers unable to leave , but without work , they became stranded , impoverished , and without sustenance . These groups already faced high levels of discrimination and stigmatization before the pandemic , and the current global health crisis has exacerbated these issues ( Raju , and 2021 ) Gender disparities and food insecurities have also worsened in impoverished and migrant communities . Women have been forced to perform more unpaid work , and often people are forced to choose between starving or food and potentially increasing their risk of . In migrant communities , pregnant women have died without access to maternal health services . Women have suffered from increases in domestic abuse during the pandemic , and with many women losing their employment and source of income , they become more susceptible to this abuse , creating a vicious cycle ( Raju , and 2021 ) Racial Inequity in by Huss Inequities in health care are by no means limited to the Majority World . has highlighted the inequities inherent in the US health care system . In Michigan in particular , this divide has been scored during the pandemic the state is made up of 13 percent Black people , yet Black people accounted for more than 40 percent of deaths early on . In attempting to understand this pattern , the particularly tragic story of one woman is notable . Susan Moore studied medicine at the University of Michigan and graduated in 2002 . In 2020 , during the height of the pandemic , Moore reported to her hospital colleagues the symptoms and pain she was experiencing , advocating repeatedly for proper care . Nevertheless , her pleas were repeatedly dismissed . Less than a week before Christmas , Moore died ( 2021 ) Realizing how tragically easy it was for a highly educated medical happened to be a Black be so easily disregarded stresses how profoundly ingrained systemic racism is

114 OF ) HEALTH in the US health care system . The University of Michigan is working to rectify this imbalance with the Oversight Committee and plans to address diversity , yet Moore story exposes this devastating reality for people of color in the United States . How will the rest of the states and our society holistically address this inequity ?

Health inequities also exist as a result of the environments our systems create and impose upon groups . Globalization has precipitated environmental degradation and has endangered the health of agricultural workers and families living in communities through exposures to toxic herbicides and . Paul Webster in his article , Canadian Petrochemical Plants and Gender Imbalances , discusses the health problems among the North American on Canada Reserve , where chemical plants pollute the environment . The tribe complaints were ignored until a recent study found a reduction of male births caused by the toxins . This was not the first time toxins have posed serious environmental and health effects to this region , though earlier events have been grossly ied oil workers in the faced high levels of exposure to asbestos , and in 1985 , more than thirty arsenic , mercury , and ( at the bottom of the Clair River after a chemical dump . Air quality is also highly jeopardized by emissions from nearby , some of which are located across the street from Aboriginal homes and a kindergarten ( Webster 2006 ) These problems gained greater attention after a medical intern at the University of noted declines in the male birth rate during the into the 20003 . From 1999 to 2003 , only 46 of 132 babies born were male historically , the ratio of births was . Though Webster ( 2006 ) reports that the link between pollutants and reproductive effects remains speculative , indication of such a link has been widely shown in animal studies , as various species exposed to the chemicals in this area have displayed reproductive abnormalities such as embryonic mortality and interference of hormone tion . Nevertheless , a comprehensive study of the issues faced by these marginalized people remained out of reach without the monetary support of the Canadian government ( Webster 2006 ) Economic globalization has affected marginalized groups in ways beyond these environmental detriments . It has facilitated wars worldwide that disproportionately affect women and other underrepresented health . Women face displacement and destruction caused by conflict , and they are often targets of violence . Of the more than 79 million refugees and internally displaced persons as a result of armed conflict or natural disasters , 52 percent were women and more than 40 percent were children in 2019 ( 2020 ) Wars often limit access to clean drinking water , food , adequate shelter , facilities , and health services , resulting in higher risk of epidemics and nutritional problems . Armed

OF HEALTH 115 threatens women rights , including reproductive rights and health , and can exacerbate culturally rooted gender inequalities . Women refugees also often face unwanted and unplanned pregnancies owing to sexual violence and a lack of access to contraceptive services ( and 2018 ) Access to nutrition and health care during these pregnancies is often lacking or absent . Forced ( often as means of dishonor or furthering the nationality of the perpetrator ) sterilization , and ing are also common ( International Committee of the Red Cross 2004 ) The lack of sanitary supplies for menstruation can impede the mobility of women and girls and may cause them to experience discomfort , shame , and isolation for several days each month . Pregnant women and nursing mothers may also that there is limited care available . While or during early settlement , or because of delays and conditions required to reach a hospital even when this is an option , women may have to give birth in conditions hazardous both to them and their children ( International Committee of the Red Cross 2004 ) Such conditions often result in higher maternal mortality rates . A study of Afghan refugees , for example , showed that 41 percent of women deaths were from maternal causes , exceeding any other cause ( et al . 2005 ) Comparing women of reproductive age , those living near areas of high have a rate three times higher than those in peaceful environments , and the number of women living near areas of high conflict has increased in recent years , from 185 million in 2000 to 265 million in 2017 ( Singh et al . 2021 ) Rape , sexual exploitation , and sex for survival during war lead to early and put women at greater risk of , sexually transmitted infections ( an increase in ( often unsafe ) abortions , psychological harm , and immediate and serious physical injuries , such as ity , obstetric , and vaginal bleeding . The negative effects of war and displacement on mental health also disproportionately affect women , likely as a result of violence . Depression and anxiety disorders among those who have been displaced are estimated to be two to four times higher than those in peaceful settings . Children , too , have higher rates of mental health problems in the face of war and displacement , likely able to increased domestic and sexual violence , and structural breakdown in the familial unit ( Singh et al . 2021 ) War and Birth Defects in Iraq by War and its repercussions are another way that systems of violence affect communities . In Iraq , babies and children bear the brunt of reproductive violence , as birth defects are a visible

116 POLITICS OF HEALTH of the enduring toxic legacy of war for future generations and the environment ( 2020 ) It is not uncommon for babies in , Iraq , to be born with hydrocephaly , cleft palates , tumors , gated heads , overgrown limbs , short limbs , and malformed ears , noses , and spines . Case reports of babies who are incompatible with life or stillborn are also not unusual . a pediatrician at General Hospital , first began noticing the wide range of uncommon birth defects among infants just after the US occupation in 2003 ( 2020 ) The birth defects were strange in that they were numerous , with 144 babies being born with deformities for every live births . These alarming rates exceed those of and emphasize the connections of , public health , global inequities , and environmental racism ( 2020 ) The bodies of these children are a consequence of the toxic legacy of war in Iraq , as it has been suffering under decades of war , bombings , burn pits ( waste disposal ) sanctions , and other military interventions that cause cascades of environmental degradation as well as destroy necessary health care and public ( 2020 ) While environmental effects tend to disproportionately affect marginalized groups , natural environmental changes and disasters also severely impact these groups . In terms of climate change , the health consequences ( including death ) of tsunamis , hurricanes , and tornadoes are tremendous for all involved . The 2004 tsunami in the Indian Ocean highlights the disproportionate harms women face in disaster situations . According to Note ( 2005 ) in the four villages of the Indonesian district , 189 of the 676 survivors were female . In four villages in Indonesia North district , women accounted for more than of the deaths , and in , India , almost three times as many women were killed as men . In fact , in one entire village , the only people to die were women ( Note 2005 ) From the time disaster strikes , women become more susceptible to violence that compromises their physical and emotional health . For example , after the Indian Ocean tsunami , some women who were pulled out of the water alive were assaulted as payment for being saved ( ing Note 2005 ) Such environmental health effects again came into focus this past year . In 2020 the world suffered from both the repercussions of and an onslaught of climate crises , including , rising sea levels , hurricanes , and droughts . As has been observed historically , these natural disasters have affected minority groups . Communities of color have been hit the hardest by both the pandemic and climate crises . hate crimes have spiked in the United States , as have discriminatory actions toward Muslims . Racial minorities , often making up a large proportion of , domestic servers , and food , commonly lose their jobs as a result of climate change . Exacerbating these ties is the fact that there are gender imbalances in positions of regarding the

POLiTiCS OF ) HEALTH i 117 pandemic and climate . Class lines have also been highlighted . Those with greater wealth have been able to shield themselves from many of the negative effects of the pandemic and environmental changes ( being able to travel by private jet , having greater access to health care and resources ) Sultana 2021 ) Community Health Workers Providing Most of the World Health Care by Shannon In rural communities across the globe , community health workers ( are the backbone of medical care . are as any health worker carrying out functions related to health care delivery trained in some way in the context of the intervention and having no formal professional or or tertiary The United Nations ( UN ) estimates nearly a million people work as across Africa . In communities without hospitals , clinics , or even a local nurse , help with childbirth , family planning , diagnosing malaria , bandaging wounds , and other vital health services . i go door to door in their local are generally lay members ofthe same communities they are seeking to serve . The value of their services is evident , a community health worker in , says , Ever since I became a community health worker in my community , no woman or child has died during The pandemic has introduced additional challenges shortages of personal tive equipment ( like gloves , and the need to change between each patient , means services may be slower . of Mali says , I typically visit up to 32 homes a day . However , when there are many children requiring my attention , I may not be able to visit as many also offer the majority of health services across Southeast Asia , and in Russia , are being trained to administer first aid in remote villages where there are no medical professionals or clinics have been closed for lack of funding . The UN notes this can be a sustainable path for women to gain ment as they work in their communities . The year 2020 also laid bare the state of reality for different groups of women . As mentioned above , white women were able to avoid many pitfalls of the virus , while this period simultaneously for others , whereby socially reproductive labor burdens on migrant women and women allowed for greater success for others based on whiteness and class ( Sultana 2021 ) Traversing the lines of class and race , all women faced reduced access to reproductive and preventative medical care . Furthermore , climate crises increase the workload for man women who shoulder )

118 I OF HEALTH dens of water provision in the Global South . In and areas , this task became onerous when water was needed more than ever for and sanitation measures necessary to combat . When women were not able to carry out this critical role , increases in domestic violence rose ( Sultana 2021 ) In terms of both wars and natural disasters , alongside the health hazards of living in refugee and placement camps in crowded conditions without adequate sanitation levels and with limited resources , patriarchal practices ( such as sewing a greater portion of nutritious foods to males and avoiding medical attention for women exhibiting signs of malnutrition ) can result in women decreased immunity and increased disease . Female children , both inside and outside of refugee camps , who have lost one or both parents in or disasters may be forced into child marriage or trafficking for economic and reasons fueled by patriarchy . Other than child marriage and human trafficking , wars , natural , and global crises also lead to increased sex selection and intimate partner violence ( The humanitarian crisis as a result of has proven no different . A recent report by the United Nations Population Fund ( shows that has undermined critical efforts to end child marriage and violence as well as access to education and reproductive health services for women and girls ( Economic has led to a widened gap and increased inequality around the world , placing a greater burden on women and children . Today , 736 million people are living on less than a day , in Africa and southern Asia . During the past twenty years , for example , despite several decades of deve , poverty levels for rural women in countries of the Majority World have increased by almost a . Female poverty affects women roles in maintaining food security for families and households and therefore affects community health ( United Nations Department of nomic and Affairs 2020 ) Globally , one in nine people is hungry or undernourished . Data show that nearly 690 million people , or percent of the world population , are by 10 million ple in one year and by nearly 60 million in years . The majority of the worlds stil found in Asia . According to the Food and Agricultural Organization ( more than 250 million live in Africa , where the number of undernourished people is growing faster than in any other region oft world ( 2020 ) The majority of undernourished people in Africa are found in the subregion , which shows an increase of about 32 million undernourished people since 2015 . Hunger has been on the rise throughout Africa since 2014 , though the increase has been especially in the eastern and the western , and women and children are especially affected ( 2020 ) As already mentioned , women and girls have access to fewer household resources like food , leading to higher malnutrition and mortality rates . Because of their lower social and economic status as well as their physiological needs ( such as childbirth and lactation ) women are often more vulnerable to nutritional

OF HEALTH 119 problems . As the price of food has increased around the world , women face higher risks of malnutrition because they usually eat last , and less , after providing for their children and family . Food security and nutrition are closely connected . Since households in the Majority World spend an average of 70 percent of their incomes on food ( compared to the 15 to 18 percent spent in countries ) increases in food prices cause them to sink further into poverty . Poor female nutrition early in life reduces learning potential , increases reproductive and maternal health risks , and lowers productivity . Frequent pregnancies and heavy , combined with poor diets and frequent infections , can severely weaken a woman health . In South and Southeast Asia , 45 to 60 percent of women are underweight , and up to 80 percent of pregnant women are iron . Period Poverty and the Tampon Tax by Shannon Period poverty and tampon tax have become international catchphrases as activists , government officials , corporations , and brave individuals have worked to break taboos against speaking about menstruation and the need for girls and women to have safe access to supplies . In many parts of the world , women still use rags when they menstruate and because of local religious rules are not allowed to wash and dry their rags outdoors . Rags are hidden under beds and bacteria grow quickly , leading to illness . Period poverty describes the economic reality that most women can not afford basic hygiene supplies when they menstruate . As part of this , the tampon tax ( which refers to the fact that in many places products are subject to sales taxes rather than being exempt , as are other essential supplies ) has been recalled in several countries and thirteen states in the United States . King ended its tax in 2004 and South Africa in 2019 . In addition to adding menstrual supplies to medical lists , period poverty has seen a number of groups partnering to bring free supplies to schools and communities . While supplies are more , in countries without water or with religious taboos , women need disposable supplies to menstruate safely . In Africa , one in ten girls still misses school on days she is having her period . In some countries , girls are simply withdrawn from school when they start menstruating . Indian inventor of a machine is featured in Pad Man , a film able on . Because this topic is so urgent and affects half of the worlds population , we invite you to further explore locations and topics of interest . Follow the links to learn more .

120 i POLiTiCS OF HEALTH All these factors contribute to women diminished ability to gain access to other assets later in life and undermine attempts to eliminate gender inequalities ( 2008 , 2020 ) In addition , malnutrition is from one generation to the next , as up to 20 million children are born annually with low birth weight as a result of maternal malnourishment . babies are four times more likely to die in the week of life from infections such as diarrhea and face a tenfold higher risk of dying ing the month of life . Those who survive are more likely to remain malnourished throughout hood and face cognitive difficulties that impair their ability to learn ( 2020 ) In these ways , investment in women nutrition improves not only household nutrition generally but also overall human capacity , women ke roles in welfare . Why Do Women Still Die Giving Birth ?

The disparities women face do not merely threaten the health or educational prospects of them and their children their very survival is threatened . Complications related to pregnancy and childbirth are among the leading causes of death for women of reproductive age in many parts of the Majority World . The maternal mortality ratio ( or number of maternal deaths per live births , is an tion of the risk of death of women for reasons related to pregnancy and childbirth . According to the most recent data , around girls and women die every every preventable causes related to pregnancy and childbirth . Death is not the only tragic consequence of complications associated with reproductive health , since nonfatal complications can also have serious effects . For every woman who dies , an estimated 20 or 30 encounter injuries , infections , or disabilities that have painful and effects on a woman quality of life .

These high maternal mortality rates draw attention to the vast in reproductive health status as a result of poverty , natural disasters , displacement , and inadequate and quality services that contribute to these high numbers . Africa and southern Asia accounted for approximately 88 percent of the estimated global maternal deaths in 2017 . Africa alone accounted for roughly ( of maternal deaths , while southern Asia accounted for nearly ( PA 2019 ) Nevertheless , progress has been made in maternal health , and the maternal mortality ratio fell by 38 percent between 2000 and 2017 , from 342 deaths to 211 deaths per live births worldwide . On average , the global maternal mortality ratio declined by percent each year over this period . Still , this is less than half of the percent annual rate needed to achieve the global target of 70 maternal deaths per live births by 2030 . Afghanistan has one of the highest maternal mortality rates in the world , according to United Nations data . There , 638 women die per live births , and fewer than 60 percent of births are overseen by skilled health professionals . The causes of maternal death are consistent around the world . Some 80 percent OF HEALTH 121 Complications related to pregnancy and childbirth can be deadly for women are due to direct obstetric complications hemorrhage , sepsis , complications of abortion , and eclampsia , and labor . About of deaths have indirect causes generally , existing medical conditions that are aggravated by pregnancy or delivery . These include anemia , malaria , hepatitis , and AIDS ( 2019 ) by Huss Health Care and Childbirth in Afghanistan In Afghanistan , 638 ofevery live births result in the mother ofthe highest nal mortality rates worldwide . Several variables contribute to this statistic , including inaccessibility to health services , poverty , and a low rate of skilled health professionals overseeing births . In response to these , Afghanistan community midwifery program is supported by the Canadian

122 OF ) HEALTH ment and the United Nations Fund for Population Activities ( the trained midwives that from this program establish family health houses to provide health care to rural and remote areas of the country ( The value and skill of these midwives can not be understated . a graduate who manages a family health house in , has provided critical , medical care to hundreds of women in her village . When one of her patients became pregnant with her seventh child , advised the patient to seek medical care at the provincial hospital because of the baby breech position . Nevertheless , it was whom family called upon in the middle ofthe night as began labor . Though this delivery was beyond the scope of training and education , she had no other option but to carry it out family could not afford to travel to the hospital . called a gynecologist at the hospital and helped deliver the baby with no more than oral instructions . After less than two hours , successfully helped deliver a healthy baby boy ( 2020 ) Although this experience was undoubtedly stressful , walked away from it with a sense of pride . The implications of this account are both hopeful and indicative of the reality that still affects women worldwide adequate medical training , services , and accessibility are essential to decrease the mortality rates facing pregnant mothers in certain countries . A steady decline has also been observed worldwide in the adolescent birth rate . It fell from 48 births ally per women aged 15 to 19 years in 2010 to 45 in 2015 and 41 in 2020 . Contributing factors include efforts to promote healthy reproductive and sexual behavior among adolescents , a reduction in child marriage , and increased access to modern contraception . Yet stark disparities persist across regions in Africa , the adolescent birth rate remains at 101 births annually per women . The Global Gag Rule In seeking to understand why these disparities still exist and so profoundly affect marginalized groups , it is imperative to realize the impact that US foreign policy has had and continues to have on a global scale , particularly on women . The federal Mexico City Policy of 1984 prohibits all foreign nongovernmental organizations that received US international family planning assistance from utilizing their own provided funds to provide , counsel , or refer abortion services as a method of family planning ( Goldman , and Cooper 2019 ) These strict restrictions became known as the global gag rule ( owing to their inhibitive and silencing effect on any sort of abortion advocacy . Until 2017 , these restrictions had only been limited to family planning however , a presidential memorandum expanded the gag rule to almost all billion in global health foreign assistance provided by the United States . Studies have

OF HEALTH 123 concluded that the does not decrease rates of abortion , and its implementation has been associated with consistently poor impacts of health systems functions and outcomes on a global scale ( Goldman , and Cooper 2019 ) The gag rule limits women access to family planning worldwide by closing health clinics that provided a range of reproductive health services as well as HIV testing and counseling . Although the administration rescinded the in 2021 , enacting the Global Bill would prevent future presidents from unilaterally reinstating the global gag rule via executive action and end the policy intermittent use ( and Ahmed 2021 ) i i Activists protest the ban on abortion US Women in Contraceptive Deserts by Sophie Within the United States , more than 19 million women of reproductive age are living in contraceptive deserts . Despite the increased development of modern contraception methods , limitations in practice are still found . As , nearly half of the pregnancies within the United States were unintended , even with North America having the highest male sterilization rate in the world . Contraceptive deserts are locations where the quantity of health centers is inadequate to meet the needs for the population of women eligible for publicly funded contraception . In order for a county to not be considered a contraceptive desert , there must be one available health center per women of the population . Around million women in these contraceptive deserts live in counties that lack any form

124 OF HEALTH of health center , requiring them to travel multiple hours while they must take off time from work or pay for childcare services in order to be able to receive the care they need . There are numerous other barriers that can impede a person access even within existing clinics across the country . Unavailability of providers , cost , environment , transportation services , day service , and other factors can stand in the way . Environment pertains directly to the treatment of individuals when they seek care at a health clinic . Trans men , trans women , folks , and others that the gender binary does not include face an increased in the number of health centers able to them owing to discrimination . The primary populations affected by contraceptive deserts are communities and the ( Black , Indigenous , People of Color ) communities . The Title Family Planning Program was in 1970 as a mode of providing reproductive health services and family planning for communities . In 2019 , however , under the Trump administration , a Title gag rule was implemented , putting affordable care even further out of reach for many , predominantly transgender people and Black women . In October 2021 the administration repealed the rule , bringing hope to the hundreds of thousands across the United States who need affordable and accessible reproductive health services . Women Should Be Able to Live without Fear of Breast Cancer Breast cancer is the most common cause death among women around the globe . ing to World Health Organization ( WHO ) statistics from 2020 , about million women were diagnosed with breast cancer in 2020 , resulting in an estimated deaths . Breast cancer incidence and rates vary considerably by region . Rates are highest in Australia , North America , and northern and western Europe , and lowest in the and countries of Asia and Africa . Intermediate els are reported in Eastern Europe . survival rates vary based on country for example , it is more than 90 percent in countries versus 66 percent in India and 40 percent in South Africa . Breast cancer has now surpassed lung cancer as the world mostly commonly diagnosed cancer , and it is responsible for one in six of all cancer deaths among women ( WHO 2021 ) While age is an important Factor affecting breast cancer risk , biological risk is also increased by inheritance of genetic mutations ( a personal or Family history of breast cancer , high breast tissue density ( a measure of the amount of glandular tissue relative to fatty tissue in the breast ) and radiation to the chest as a result of medical procedures . According to WHO ( 2021 ) almost half of breast cancers develop in women who have no breast cancer risk Factor

OF ) HEALTH 125 other than sex ( female ) and age ( over 40 years ) Other factors that increase the risk of breast cancer include increasing age , weight , excessive use of alcohol , reproductive history ( age that menstrual periods began and age at pregnancy ) tobacco use , and hormone therapy . Cigarette Smoke Continues to Cloud Our Health by Shannon Despite all we know about the effects of smoking , people still pick up cigarettes every day . In that process , they also expose others to secondhand smoke and its negative health effects . While tobacco use is not banned outright , it is considered wrong by some religions such as Islam and Christianity . In the United States , tobacco is no longer allowed to advertise as an appealing product . All cigarettes carry warning labels , and the law sets minimum age requirements for purchase . Around the world , however , smoking is still common in most countries . In 2008 , the World Health Organization ( WHO ) put forth a tobacco treaty . In it , countries have agreed to measures much like those in the United States , where taxes discourage purchase , age limits are set , and advertising is eliminated . Tobacco companies that have lost market share in the United States have switched to aggressive internationally . Asia in particular has long been a market for promoting smoking . The European Union is following the US lead in decreasing smoking , but areas such as Africa and offer to grow markets of new smokers . In , for example , more than 60 percent of men smoke , but less than 20 percent of women do . Slim cigarettes are marketed to women and children to increase revenue for companies . The death rates in places like the island nations of the success of these efforts . of men and a quarter of women die from noncommunicable diseases such as heart attacks , diabetes , and other diseases related to smoking and obesity . In homes where the men smoke , 22 percent of the monthly household income is spent on tobacco products instead of food and education . In countries , guidelines outlining best approaches to early detection , diagnosis , and ment of breast cancer have resulted in increased cancer survival rates . Even so , women of color in the United States are more likely than white women to be diagnosed at an advanced stage of the disease and have higher death rates . For example , Black women have a lower incidence rate but a higher mortality rate of breast cancer compared with their white counterparts . Black women have the highest breast cancer death rates of all racial and ethnic groups and a 41 percent higher rate of breast cancer death than white women . These breast cancer disparities mainly stem from institutional racism , racial segregation ,

126 OF ) HEALTH , socioeconomic factors , and reduced access to resources and care such as inadequate screening , inadequate treatment , and lack of access to treatment ( 2019 et al . 2019 ) On the global scale , the overall survival rates for Australia , Canada , northern Europe , the United Kingdom , and western Europe is estimated to be higher than 85 percent . survival rates are much lower in and countries like Algeria ( percent ) Brazil ( percent ) and South Africa ( 53 percent ) mostly as a result of diagnoses that lead to higher death rates when by limited treatment capacities . Many and countries have less than percent of the resources required for adequate cancer control , and according to WHO ( 2021 ) more than 80 cent of cancer patients in these countries will be incurable at the time of diagnosis . Alongside insufficient resources , barriers to improving cancer care arise from lack of public knowledge and awareness , lack of screening guidelines , and lack of effective measures for early diagnosis and treatment by the and the organizing health care facilities ( WHO 2021 ) Medical Racism A Casein Point by Jones In August 2020 , Asia Muhammad said , there absolutely no reason Why any Black person should trust the medical To understand this statement , we need to look at the historical lack of access to health care among Black , Indigenous , and other People ( Medical racism , also called medical apartheid , is the systemic use of racism against Within the medical system . It is the reason people say racism is a public health issue . Medical mistrust is by the centuries of abuse , mistreatment , and neglect that have killed communities . It has been said that doctors are to Black women what police are to Black men . A case in point is the athlete Serena Williams during the birth of her daughter , Alexis . Even her wealth and fame didn afford her the luxury of being heard . The day after she underwent a cesarean section , she explained her history of pulmonary and shortness of breath , requesting a computed ( scan and a heparin drip . Instead of listening and doing as she requested , her nurse assumed the medication she was receiving was the problem and her doctor ordered an ultrasound instead . When the ultrasound didn reveal anything , she was granted a scan , revealing several small blood clots in her lungs . Williams birth experience highlights a recurring theme of Black women ( and in general ) being devalued and disrespected by the medical . It illustrates that bias shapes how ical professionals perceive and treat their patients .

POLiTiCS OF ) HEALTH i 127 A Transnational Feminist Approach to Reproductive Justice Women across the globe suffer adversely from institutional systems , both medical and societal , that are not designed with their best interests in mind . Another realm that disproportionately affects women , some more than others , is that of reproductive rights . It was in 1994 that the United Nations International on Population and Development ( UN ) held in Cairo , eventually articulated the concept of reproductive rights in a clear statement in its program of action . Three rights in particular were the basic right of all couples and individuals to decide freely and responsibly the number , spacing and timing of their children and to have the information and means to do so , and the right to attain the highest standard of sexual and reproductive health . It also includes their right to make decisions ing reproduction Free of discrimination , coercion and violence , as expressed in human rights documents ( UN 2014 1994 , 58 ) The question is whether these ambitious goals are within reach in most parts of the world where there is no universal health care and various governmental policies and agendas limit and control women access to reproductive rights . Thus the idea and such framing of the reproductive rights movement has come under criticism by social justice activists as mainly the needs and experiences of privileged women in western countries with access to health care . For example , in the United States , related death for Black women is more than three times higher than that of white women , implicating the devastating impacts of racism in access to health care and health care delivery ( Planned 2019 ) Bill Disguised as Protection by Kelsey Senator Eduardo , We Can ( Podemos ) Party , introduced in December 2020 . This bill , known as the Statute of the Pregnant Woman , was said to women who become pregnant as the result of rape , while actually their legal rights to abortion ( already strictly ) coercing them to continue with unwanted pregnancies , and giving the men who raped them the status of parents . claimed that the bill would be an advance in the humanitarian point by protecting nant women and holding men But local feminists say it put on a facade of activism , and

128 OF ) HEALTH instead of working to aid in proper women rights and reproductive safety , it took the form of a rape subsidy . The bill prompts the creation of a fund to support survivors of only if the woman proceeds with the pregnancy . Unfortunately , the bill doesn identify a source for the funding or specify how long it will last , and it excludes women who have resources . In addition , the proposal includes a requirement that women in all must provide information to the father about the child , even if that father was their women to stay in contact with the men who raped them . Finally , the bill would prohibit harm to the fetus starting from tion , by act or decision of any of its parents , so that not only would abortion be illegal , but pregnant women might avoid other needed medical treatments , such as chemotherapy . 2020 would ignore the fundamentals of women rights and instead create a situation where women are not only at risk for lack of proper health care but also face further mental and physical gers in keeping in contact with the men who abused them . Feminist and anthropologist summed it up by stating , Criminal laws are not the best way to health needs and abortion is a health 2020 had not yet been voted upon at this writing . Follow up and out whether the bill was passed , or coded into law . To get a better sense of the reproductive disparities in the United States , we must consider maternal rates . Though the maternal mortality rate in the United States declined steadily from 1900 to 1987 , this statistic has increased since then in 1987 , of every live births resulted in the mother death , while of every live births resulted in the mother death in 2015 . This trend has been observed in no other developed nation . As a frame of reference , the 2015 maternal mortality rates in Australia , Japan , and Canada were , and out of , respectively ( Planned Parenthood 2019 ) We can not look at these numbers in isolation . From 2011 to 2014 , the rate of death for Black women in America was 40 per , more than three times that for white women per . It is no trivial task to identify the factors responsible for this imbalance , especially as there are likely many at play . One variable that has been posited is weathering , which is premature cellular aging that results from the stress of racism , disrespect , and bias inherent in the medical system in the United States ( Planned Parenthood 2019 )

POLITICS OF ) HEALTH 129 Considering that more money per capita is spent on health care in the United States than in any other country , this trend is particularly disturbing . Nonetheless , the United States is the only try where employers are not required to offer paid leave to new parents . Though it is not medically mended , nearly 25 percent of new mothers return to work within two weeks of childbirth . Furthermore , the status quo of health insurance in the United States has resulted in over 30 million Americans being uninsured , and proportions of those who do have insurance are . As a result , many people are unable to afford adequate medical care throughout their pregnancies and this is particularly true among women in rural areas and among Black women . Tragically , the Centers for ease Control and Prevention ( estimates that approximately 60 percent of maternal deaths in the United States are preventable ( Planned Parenthood 2019 ) How do we address these shortcomings in the structural fabric of ( maternal ) medical care in the United States ?

To remedy the that lead to a hostile environment for people of color , the Harvard Chan School Maternal Health Task Force suggests hiring a diverse staff and providing training on scious and overt biases . Furthermore , they vie for the importance of making prenatal and postpartum care affordable and accessible to all . Several other organizations , including the Black Mamas Matter Alliance and the Center for American Progress , are working to decrease the maternal mortality rate among Black women . Some have argued for to assist with the birth of Black mothers , as they can help advocate against the biases these women are likely to face ( Planned Parenthood 2019 ) As these issues and systems of oppression against women of color are deeply ingrained into the medical motherhood process in the United States , the efforts of groups such as these are critical in decreasing the maternal mortality rate . Yet will they be enough , or will more radical change to our medical system be ?

Studies have found that the severe levels of stress that result from experiencing racism are highly impactful on maternal health . This high maternal mortality rate is found consistently among Black mothers at all levels of education and is also higher than that of Latina women , who are twice as likely as Black women to be without health care ( Planned Parenthood 2019 ) A study that spanned across hospitals in seven states showed that hospitals that predominantly served Black patients performed worse in twelve of health care delivery indicators , including deliveries , nonelective cesarean births , and maternal mortality ( Planned Parenthood 2019 ) The effects of racism on the outcomes of expectant mothers are ing , which is why it is urgent that we apply an intersectional lens when seeking solutions to our broken health care system . Fueled by the concept of as a source of empowerment , reproductive justice is a work that was coined by twelve Black women in 1994 in order to recognize the commonality of our experiences , and from the sharing and growing consciousness , to a politics that will change our lives and inevitably end our oppression ( Ross 2017 , 286 ) Reproductive justice is by the core belief that

OF HEALTH every woman has the right to determine if and when she will have a baby , to decide if she will not have a baby , and to parent the child she already has in a safe environment and healthy community without the threat of either interpersonal or state violence ( Stevens 2017 ) The thus implies that all women , including poor women , who are disproportionately likely to also be women of color , have access to free and legal abortion without barriers . Reproductive justice is not solely about abortion , however , though abortion access is critical . A broad approach to tive justice addresses aspects of women social status that promote or interfere with her power in relationships , bodily integrity , and ability to engage in family planning and reproductive making ( 2013 , It also encompasses equitable access to contraception , comprehensive sex education , STI prevention Reproductive justice asserts that . people should have the right to nancy care , domestic violence assistance , wages to have Children not have Children and care , alternative birth options , adequate prenatal and port our families , environmental justice , and much more . In order arid the WE have . safe and sustainable Communities to achieve reproductive justice , we must analyze systems of power in order to eradicate , sexualized , and acts of dominance ( Sister Song , The issues surrounding reproductive justice in the United States have by no means been limited to acts of omission or matters of merely conforming to the status quo . To the contrary , those in power have actively sought out ways to harm and impair the reproductive rights of marginalized groups . The United States has a long and problematic history with eugenics , forced , experimentation , and medical without consent , particularly within vulnerable communities . In response to the momentum of the eugenics movement , US states began passing laws to permit the forcible sterilization of persons in 1907 . The Supreme Court upheld these controversial practices in 12 . Bell ( 1927 ) and more than sixty thousand people were forcibly sterilized under these laws . Those who were subjected to coerced and violating procedures included people of color , immigrants , disabled people , and poor people , as well as women working in the sex industry and girls who transgressed gender and sexual norms ( 2020 ) The initial wave of support for eugenics was eventually quelled when Nazi Germany adopted similar , causing a shift in public opinion among US citizens and eventually leading to the 1942 Oklahoma Supreme Court decision to reject forcible . Nevertheless , forcible again gained traction here after World War II owing to sentiments and population growth . The situation decades later was eerily reminiscent of that at the turn of the century Indigenous , people of color , immigrants , and the poor were again the targets ( 2020 ) As laws to justify these procedures were lacking after World War II , those in power often used surreptitious means to these groups to patients were obliged to sign consent forms they couldn read or

POLITICS OF HEALTH I 131 stand but that nonetheless permitted medical professionals to sterilize them ( doctors compelled their patients to undergo these procedures for fear of losing medical or welfare ily medicated women who could not understand English had their tubes tied after childbirth ( gal 12 . These practices happened from coast to coast and to various racial minorities ( 2020 ) Such practices have been compared to Nazi sterilization campaigns , which were in fact modeled after eugenic sterilization laws in the United States in the early twentieth century ( 2020 ) In 1970 , a whistleblower leaked evidence of rampant sterilization abuse at the University of Southern California Medical Center , where hospital staff repeatedly approached women whose primary language was Spanish for consent for sterilization while they were in active labor and with English consent forms they could not understand . And in 1974 , in the case of . two Black sisters , aged 12 and 14 , were by a federally funded family planning clinic in Alabama after their mother signed a consent form that she was unable to read ( 2020 ) These atrocities were and continue to be widespread across the United States . Eugenics programs were also enacted within a colonial social context , once again with the belief that some people are more to reproduce . In Puerto Rico , fertility control was developed and fostered under colonialism after the United States seized the Caribbean archipelago in 1898 ( 2020 ) Rich , white were encouraged to reproduce while poor people of color in developed nations were labeled as to reproduce ( 2020 ) In 1937 , Law 116 was passed , sterilization was subsidized and promoted by the US federal government , and the policy became so well known and normalized that it was referred to as 14 ( 2020 ) By the , Puerto Rico had the highest rate of sterilization in the world , with of Puerto Rican women having undergone the procedure . Additionally , US eugenicist Clarence Gamble , heir to the Proctor and Gamble fortune , enacted another method of reproductive violence by using his facilities on the archipelago to test contraceptives that had not been approved by the US Food and Drug tion on hundred women , many of whom lived in in impoverished neighborhoods ( 2020 ) None of the deaths caused by the trials were investigated . Currently , in Puerto Rico , almost half the lives below the poverty line , further complicating any sort of reproductive freedom . Some birth control methods , such as intrauterine devices , can cost more than , and other options such as the patch or the pill range from 10 to 150 a month ( 2020 )

132 I OF HEALTH The testing of contraceptives on and forced of marginalized Communities represents a form of eugenics in 2020 US history over the past hundred years , where people who have been deemed undesirable , girls , people of color , people with disabilities , and people who have been convicted of considered to have children and are subject to horrendous medical ( 2020 ) There are many forms of violence that the United States has inflicted on Black , Indigenous , and other communities of color , including genocide , enslavement , and family . These forced represent reproductive violence that is the implementation of racist and eugenic practices executed by the federal government . Tragically , a new wave of forced in the United States arose in 2020 . Dawn , a blowing nurse from the Irwin County Detention Center in Georgia , detailed how officials and medical professionals have been violating the rights of countless immigrants at this facility . described how women were frequently subjected to forced and other unwanted gynecological , and informed consent was lacking ( 2020 ) Without professional interpreters , some nurses attempted to use cursory tools such as Google Translate to communicate with their patients nonetheless , many of these patients could not understand what was happening to them . Again , for at least the third time in US history , these practices target particularly vulnerable groups , solidifying just how perilous it is to be an immigrant , a person of color , or poor in the United States ( 2020 ) Violence and Trans Care Transgender , and people experience high rates of health disparities and . A total of 350 known trans and people were murdered globally in 2020 , indicating a

OF HEALTH I 133 percent rise from 2019 ( Clifton 2020 ) Trans women or people accounted for 98 percent of those killed , and 79 percent of trans people murdered in the United States are people of color ( Clifton 2020 ) It is also important to remember that many cases of trans murders aren known to the public , as they are or . Trans people of color , particularly Black trans people , are more likely to experience discrimination and violence in housing , employment , and health care , while also being times more likely to experience police violence and more times likely to experience physical violence ( SPARK Family 2015 ) The trans community is a diverse population with a high prevalence of adverse health outcomes ( et al . 2016 ) Though , overall , most aspects of health remain understudied and lacking , the most outcomes among trans communities include HIV and other , mental health distress , and substance use and abuse . The lack of resources invested in minimizing health inequities in the trans munity implies a dire need to acknowledge the complex ways that institutional systems operate to create these inequities in health outcomes in the place . Our institutional systems have stigmatized trans people for decades . In 1975 , gender transition processes were as a mental disorder within diagnostic manuals , including the International of Diseases ( The and and Manual of Mental only recently removed this . Nevertheless , trans people still suffer the daily repercussions of laws and practices , social discrimination , and violence , both inside and outside the medical community . In several countries , they are still required to undergo psychiatric treatment to access trans health care and are often subject to reparative therapies . literature has also historically trans people ( 2020 ) Efforts are being made to address these inequities . The Human Rights in Patient Care Framework helps to prevent abuse within the health care system and hold governments accountable . The , published in 2007 and updated ten years later , establish a basis of human rights laws to protect people from discrimination based on gender expression , sexual orientation , and sex characteristics . the situation has by no means been made right , as trans people still suffer widespread tion in health care and employment , and they are highly exposed to a spectrum of human rights violations ( 2020 )

134 OF ) HEALTH March by Ahmed Since 2018 , organizations across Pakistan have been taking to the streets on national Working Women Day , under the banner March ( which means Women Freedom ) or They demonstrate for the liberation of ( people ) transgender people , people , and women , and for the abolition of patriarchy and all forms of gender oppression and exploitation . Ahead ofits 2021 demonstration , March Lahore issued a comprehensive Feminist Manifesto on The manifesto calls for universal access to health care for all people regardless of gender identity , social class , religion , sexual orientation , race , ethnicity , ability and Staunchly opposed to the privatization of health care in Pakistan , it advocates transforming the health care system to fully and equitably meet the needs of communities , transgender people , disabled people , women , people living with HIV , survivors of abuse , drug users , sex workers , and incarcerated women and children . demands include access to hormone therapies , drug recovery programs , medical care for disabled people and For sex workers , and an end to forced on intersex people . Similarly , the March Charter of Demands , titled Feminist Care in the Time of the For 2021 , addressed health care , disability justice , patriarchal violence , labor rights and protections , welfare , affordable housing and land redistribution , militarized state violence , students oppression , justice for religious and ethnic minorities , and environmental justice . Select demands from this charter include free health care for people with mental and physical disabilities , taxation and environmental regulation of corporations , universal basic income , land redistribution , an end to enforced disappearances , demilitarization of educational institutions and reinstatement of dent unions , legislation against forced conversions , and an end to police brutality , harassment , and der .

POLiTiCS OF HEALTH i 135 As Loretta Ross explains , through a reproductive justice lens is crucial to address vulnerabilities . She writes , Not only biologically women experience reproductive oppression . By highlighting the distinction between biological sex and socially constructed gender , our analysis includes , and individuals . For example , trans and intersex people are frequently coerced to undergo gender reassignment surgery that results in involuntary in order to obtain vital documentation such as driver licenses that match their preferred identities . Such policies limit their reproductive options as a form of covert reproductive control by the state . Reproductive justice addresses the essentialism of accounts that neglect how differences shape people material realities , leaving undiscovered reproductive vulnerabilities shaped by white supremacy and . White supremacy as used in this article is a lethal body of ideas comprised of racism , Christian nationalism , phobia , nativism , settler colonialism , misogyny , and authoritarianism . Ross 2017 , 292 ) Ross words demonstrate the need for an intersectional framework to understanding health inequities and an approach to reproductive justice that is inclusive of all people and centers the experiences , needs , and power of those who are most marginalized . In the words of Lorde , There is no such thing as a struggle because we do not live lives ( 2007 , 131 ) All forms of oppressions affect reproductive lives , so marginalized groups , who experience multiple layers of structural oppression , need to be at the forefront of conversations on justice . Disability Justice The pandemic has focused attention on the health disparities experienced by people with disabilities . Individuals with disabilities have historically been erased and mistreated by the institutional systems of white supremacy , colonialism , and capitalism . Before the disability rights movement , public places were inaccessible , and people with disabilities were mistreated without legal repercussions . This movement critically established civil rights for people living with disabilities through the creation of organizations and movements such as service provision agencies , centers , academic spaces , and advocacy organizations ( Sins Invalid 2020 ) Nevertheless , while the disability rights movement was important in raising awareness and demanding civil rights , both its context and content lacked in several regards . For one , its approach often based ability rights on a single issue rather than considering the disabled person as a whole ( immigration status , race , gender , sexuality ) the importance of should be noted here . Furthermore , the leadership of the disability rights movement was based on white experience and privilege , and a more diverse framework is necessary to comprehensively serve all disabled people . The mainstream disability

136 i POLITICS OF HEALTH rights framework also historically focused on people with mobility , with other disabilities being relatively neglected . Achieving justice through this movement has often hinged on pursuing a legal pathway , but this option is not always available or appropriate ( Sins Invalid 2020 ) In response to these shortcomings , queer disabled persons and people of color spearheaded a movement for disability justice in 2005 , with activists like Patty Berne and Mia leading many of these and conversations . Central to the tenets of this movement is the idea that disability justice work is largely done by individuals within their respective settings ( Sins Invalid 2020 ) Also pivotal is the fact that leadership is composed of disabled persons that offer diverse perspectives ( queer , forming , people of color ) Through these efforts , the disability justice movement seeks to create a world that values and celebrates us in all our beauty , with a focus on the principle that we move together , with no body left behind ( Sins Invalid 2020 ) Ten Principles of Disability Justice from Sins Invalid . Simply put , this principle says that we are many things , and they all affect our lived experience . We may be not only disabled , but we also each come from a experience of race , class , sexuality , age , religious background , geographical location , immigration status , and more . Depending on context , we all have areas where we experience privilege as well as oppression . The term was introduced by feminist theorist Crenshaw in 1989 to describe the experiences of Black women , who experience both racism and sexism in ways . We gratefully embrace the nuance that this principle brings to our lived experiences and the ways it shapes the perspectives we offer . Leader ' When we talk about , racism , sexism and , colonization , police violence , and the like , we are not looking to academics and experts to tell us what are lifting up , listening to , reading , following , and highlighting the ofthose who are most impacted by the systems we against . By centering the ship of those most affected , we keep ourselves grounded in problems and creative strategies for resistance . Politics Capitalism depends on wealth accumulation for some ( the white ruling class ) at the expense of others and encourages competition as a means of survival . The nature of our disabled minds means that we resist conforming to normative levels of productivity in a capitalist culture , and our labor is often invisible to a system that labor by ,

OF ) HEALTH 137 white supremacist , standards . Our worth is not dependent on what and how much we can produce . Disability justice can only grow into its potential as a movement by aligning itself with racial justice , reproductive justice , queer and trans liberation , prison tion , environmental justice , terror , Deaf activism , fat liberation , and other movements working for justice and liberation . This means challenging white disability communities around racism and challenging other movements to confront . Through ity , We create a united front . Each person is full of history and life experience . Each person has an nal experience composed of our own thoughts , sensations , emotions , sexual fantasies , and quirks . Disabled people are whole people . We learn to pace ourselves , individually and collectively , to be sustained over the long term . We value the teachings of our bodies and experiences and use them as a critical guide and reference point to help us move away from urgency and into a deep , slow , transformative , unstoppable wave of justice and liberation . Commitment to Cro We value and honor the insights and participation of all of our community members , even and especially those who are most often left out of cal conversations . We are building a movement that breaks down isolation between people with physical , people who are sick or chronically ill , psych survivors and people with tal health disabilities , people , people with intellectual or developmental disabilities , Deaf people , Blind people , people with environmental injuries and chemical sensitivities , and all others who experience and isolation that undermines our collective liberation . Interdependence Before the massive colonial project of Western European expansion , We stood the nature of interdependence within our communities . We see the liberation of all living systems and the land as integral to the liberation of our own communities , as we all share one planet . We work to meet each other needs as we build toward liberation , Without always ing for state solutions that inevitably extend state control further into our lives . Collective Access As Black and brown and queer crips , we bring and creative nuance to our engagement with each other . We create and explore ways of doing things that go beyond and norms . Access needs aren all function differently depending on context and environment . Access needs can be articulated and met privately , through a collective , or in community , depending upon an individual needs , desires , and the capacity of the group . We can share responsibility for our access needs , we can ask that our needs

138 I OF HEALTH be met without compromising our integrity , we can balance autonomy while being in , we can be unafraid of our vulnerabilities , knowing our strengths are respected . 10 . Collective We move together as people with mixed abilities , multiracial , mixed class , across the sexual spectrum , with a vision that leaves no mind behind . This is disability justice . We honor the legacies of resilience and resistance that are the inheritance of all of us whose bodies and minds will not conform . Disability justice is not yet a popular movement . Disability justice is a vision and practice of what is yet to be , a map that we create with our ancestors and our onward , in the width and depth of our and histories , a movement toward a world in which every body and mind is known as beautiful . Transnational Engagements and Health Equity A Way Forward Throughout the world , women are addressing inequalities that deny their human rights , endanger their health , keep them from productive opportunities , and threaten them with violence . This happens in ious settings within the family , in schools , and in commercial and political institutions . Women social , economic , and political status undermines their ability to protect and promote their own physical , and mental health , including their effective use of health information and services . Women deserve better . The inequities ingrained in the daily lives of women have been exacerbated by . With more time spent at home during the pandemic , the hours devoted to domestic work such as meal preparation , cleaning , and child care have increased dramatically , and the brunt of this labor has fallen upon women . This division of household labor was already severe before the pandemic , with 42 percent of women unable to maintain a paid working position because of their domestic responsibilities , in contrast to percent of men . The unpaid and domestic workload also increased for men during this time , but it has increased more for women ( Bolis et al . 2020 ) The effects of this disparity can not be neglected . Among women surveyed about the changes to their lives and workload during the pandemic , 43 percent reported heightened levels of anxiety , depression , and isolation they also noted ing overworked and becoming physically ill due to these unpaid responsibilities . Furthermore , this ity is more rampant in countries , with women there shouldering even more responsibilities

OF HEALTH 139 and lacking the means that might make their labor less onerous ( equipment , water , Bolis et al . 2020 ) Gender equality is a goal in its own right , and it is central for the attainment of social policies in a wide range of areas , including the improvement of health . As this chapter emphasizes , we must address based on gender , race , ethnicity , caste , sexual orientation , migrant status , nationality , and other and health care practices by using an intersectional framework to ensure that interventions in health those who have the least resources . Changes are occurring , but not quickly enough . A woman dies in pregnancy or childbirth every minute . One in three women experience violence in their lifetimes . In 2020 , million women were diagnosed with breast cancer , resulting in deaths ally . Trans people experience high levels of violence , discrimination , and stigma that also limit their access to much needed health care . Armed disproportionality affects the and health of women and children ( Singh et al . 2021 ) And too many women are not receiving the of their productive labor . Women want a different future . Change must take place at the local level as well as within international policy . In other words , it is to realize the importance of and grassroots approaches to health issues that are inclusive of marginalized voices . These efforts require collaborative action by a wide range of actors side the government and development agencies , such as people organizations , underrepresented and marginalized women groups at the local and national levels , the media , and all others concerned with building a fair and just society . To obtain health equity , we must call out and dismantle the systems that perpetuate inequality . Such collective action creates pressure for ability and puts social change onto the political agenda . Activist Peggy ( 2004 , 25 ) the common difference that links us all in a political struggle for recognition and redistributive She explains that its difference from other social movements lies not only in the absence of homogeneity . but in the value it places on diversity , its commitment to solidarity with women everywhere , its , politics , and its method of And , as Reddock states , sexuality and reproductive rights and health , including freedom from violence , are the foundation of women ability to engage in the political struggle against inequality and injustice , not just for women but for everyone ( 2006 , 1375 ) Recognizing the connections between individual health and community health makes it vital that all research , policies , and projects are committed to achieving health equity in a systematic and manner . Such goals can not be achieved through isolated actions by any one group of society , no matter how committed . The root causes of these problems and power relations must be , and a feminist , human rights perspective must be employed to understand health in the context of wider social , cultural , and economic issues . Thus the priorities for equity should be and based on the munity struggles with colonialism , imperialism , and national and oppressive policies within

140 OF ) HEALTH global and transnational . The challenges to eradicating health inequities and ing the distribution of power across all social institutions can not be addressed merely through technical or managerial interventions , but instead require an emphasis on social justice and health equity through intersectional practices and policies .

POLiTiCS OF HEALTH I 141 Learning Activities . begins the chapter by arguing that health and adequate health care are a human right . What should the right to health and health care include , according to and the sources she cites ?

discusses the ways that , environmental changes and disasters , and war have continue to negatively outcomes for women and girls around the globe . Working alone , with a partner , or in a small group , choose one of the three topics listed above . How does support her argument about the way , environmental changes and , and war negatively affect health outcomes for girls and women ?

What do you learn about your chosen topic that you didn previously know ?

One chapter heading asks , Why Do Women Still Die Giving Birth ?

How does answer that question ?

What is the global gag rule ?

How does this US foreign policy negatively affect women around the globe ?

What is reproductive justice ?

How does the concept of reproductive justice broaden the conversation about reproductive rights beyond a framework ?

What is the way forward to health equity , according to ?

How do transnational feminist and principles serve as the foundation for the way forward ?

Working in a small group , add these key terms to your glossary Sustainable Development Goals ( Majority World Minority World , global gag rule , medical racism medical apartheid , justice , disability justice .

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148 OF HEALTH , and . 2020 . Health Employing an Equity and Em Debate 44 , no . Image Photo by Tim on une 2009 Protect Women Health ! by is licensed under BY Photo by on Photo by Claudio Schwarz on Reproductive justice by is available under Photo by Reproductive Health Coalition on