“We live in a patriarchal world where numerous social, political, cultural, ideological or religious barriers are placed in front of women, that deprives or hinders their ability to make decisions about their own bodies and health. For many women and girls in the world, the consequences of this are severe, because it directly affects their health and lives particularly their reproductive health. It is difficult to single out even one country in the world that has fully realized the fundamental reproductive rights of women and girls in their country”, tells Bhavya Joshi, PhD Candidate at the University of California in Berkeley. Joshi has been in Croatia for the past month working on her doctoral research focused on the reproductive health needs of women and girls in times of compound crisis. As a case study of complex crises, Bhavya Joshi investigates the reproductive health needs of Ukrainian women who have found refuge in Croatia since the beginning of the war. Interactions will be conducted with them, as well as with organizations working on the issue. From these stakeholders, qualitative data will be collected on how the crisis situation affected their rights and reproductive health. From expectations and needs to the provision of health service delivery necessary to preserve reproductive health. In her work, she cooperates with non-governmental organizations that focus on the reproductive health and rights of women and girls, so she is currently working with Roda in Zagreb.
“We are living in a time where crises are constant so I begin with the hypothesis that crisis is a continuum and that this will not change in the future. We face crises all the time, whether it is climate change, natural disasters, war, pandemics or political instability. At the moment we have the pandemic, climate change, and the Russian invasion of Ukraine affecting the Ukrainian women refugees in Croatia. All of this directly or indirectly affects them on a daily basis. What interests me in research is how all of these crises affect the reproductive health of women and girls. How the continuum of crises and the multiplication of crises threaten both health and rights. What consequences do women, girls and the communities in which they live face due to the unavailability of health services and the impossibility of realizing basic rights to preserve reproductive health and how to influence this to change“, explains Bhavya Joshi.
The reproductive health of women and girls is a crisis in itself
“The reproductive health of women and girls is a crisis in itself. We are always facing increased difficulties in types of treatment, availability of treatment and availability of other services geared towards protecting the reproductive health of women and girls. All of this increases the threat to their health and lives. I am therefore interested in getting answers to the questions of how, in what ways, crises affect the reproductive health of women and girls who come from the most vulnerable social groups. Especially when there are compound crises, like what we have now: a pandemic health crisis, a climate crisis, the Russian invasion of Ukraine”, explains Joshi, who has already done a series of studies on reproductive health and rights of women and girls, in which she investigates and analyzes intersectionality, the complex systems of discrimination at the root of which are different identity categories – from race, class, gender, sexual orientation. Most of them have been done in India, where she was born and educated. As she says herself, her constant focus is reproductive health and rights, especially in those areas and regions of the country where women and girls do not have access to basic hygiene conditions or health services, while experiencing discrimination on all levels due to their gender.
During crisis reproductive health care services are reduced and degraded by many governments, because this new crisis itself becomes a priority, and other services are pushed into the background. This happened during the Covid-19 lockdowns. What is clearly evidenced by the data of international organizations, is that women and girls and their reproductive health and rights have suffered the most. UNFPA (United Nations Population Fund) announced that 12 million women experienced disruptions in access to family planning due to the pandemic, which led to 1.4 million unwanted pregnancies. The World Health Organization (WHO) predicts that the disruptions caused by the pandemic could lead to 200,000 more stillborn children in the next 12 months, and the situation is already alarming: a stillborn baby is born in the world every 16 seconds.
Gender inequality has been normalized for centuries through patriarchy, colonization and racism
We have a history of social inequalities, which is reflected in the constant discriminatory laws and policies, the lack of political will to change the situation, the ever-present economic differences, discrimination in the cultural and religious context, that adds to the underlying causes of increased health inequities.
Gender inequalities manifest in systemic disadvantages for women throughout their life cycle, and it has been normalized by centuries of patriarchal, colonial, and racial discrimination. The gender inequalities and gender-based violence when layered with a sudden event of difficulty, danger, or threat, exacerbates the threat or danger for women and girls. For example, explains Joshi, for women in rural areas, where there are no basic hygiene conditions, no water, and no proximity to health services, upon emergence of a new crisis, such as the need to escape from the destruction of war the threat to the reproductive health of women and girls increases significantly.
Bhavya Joshi has a master’s degree in International Law and Human Rights where she focused on reproductive health and rights for her dissertation. After which she worked extensively in rural India on reproductive health.
“Access to all reproductive health services in rural contexts are slim due to availability of staff, or medical stocks, or the distance to the facility among other reasons. Sometimes purchasing menstrual supplies is a challenge, in some communities young girlsmenstruate in isolation because of the stigmatization and discrimination. I have worked in 18 states of India, a big country where the differences between the less and more developed parts are huge. This issue is also dependent on the religious communities that dominate in certain regions. Different religions have different attitudes towards reproductive rights. The women do not have the reproductive autonomy to make decisions about their bodies, or with respect to their marriage or in family planning. It is in the hands of other people, like her father, mother-in-law, or husband, but not in the hands of the woman herself. Girls who often get married before the age of 18, become teenage mothers and often receive training on how and what to do from their mothers or mother-in-law. The family decides which doctor to consult, when to visit the doctor, maternal nutrition etc. The husband often decides the method of contraception used.”
The quality of women’s reproductive health affects the entire society
Joshi explains how it is important to recognize what good reproductive health is and what impact it has on society as a whole. The whole community is then more powerful. Women themselves are more powerful. If we constantly maintain that half of the human population does not have the autonomy to decide for themselves about their sexual and reproductive health, that it is more inaccessible to them, and that in crisis situations women are the first to suffer the consequences precisely in terms of reproductive health and rights, we will never be able to say that we have created and we live in healthy societies. That is why it is important to be constantly present in that field, to research and publish data and facts, to look for mechanisms and tools for improvement and to initiate changes for the better. The goal is to make health care in the field of reproductive health accessible to women because it is one of the fundamental human rights. When researching, it is important to detect those who suffer the most when crises occur. And each of us has the opportunity and challenge to make positive changes, to act.
The issue of reproductive health is a holistic issue and that it concerns society as a whole. We who work in organizations focused on these issues are faced with many challenges and our job is to push governments to prioritize reproductive health in their policies. We create policies geared towards adolescents, which include education about menstruation and contraception, enabling access to healthcare and safe termination of pregnancy by abortion, and enabling healthcare and any other care for pregnant women and mothers. These are all connected to the effort of saving women’s lives, and they can only be solved if we look at reproductive health and rights holistically, because reproductive health follows us throughout our entire lifespan.
Women and girls in seek of refuge
Women’s rights are unavoidable issues in her research work, but also in the activism Bhavya Joshi is dedicated to as a collaborator of a number of international organizations. We asked her if, as part of the research she is conducting in Croatia with women and girls of refugees from Ukraine, she also investigates the quality of the policies and systems of the country where the refugees come and now live.
“I am working with Ukrainian women now because the pandemic as a global crisis was followed by a new war crisis, and women from Ukraine are now the ones most affected by these compounded crises. In the recent past, we had female refugees from other countries, Afghanistan, and Syria so at a certain stage of my work I will also do a comparative analysis. Has something changed there, in the provision of care, but also in terms of the political status of accepting refugees? Many countries today accept Ukrainian refugees better than they did when they came from Afghanistan or Syria, and I believe that in my research these different experiences will surface. Next year, I plan to come to Croatia again and continue my research, when I will also conduct interviews and conversations with refugees from Ukraine. It will be clear how much influence government policies have in a crisis, especially on the provision of health services, which is the focus of the issue. I am interested in how governments act when a crisis occurs regarding sexual and reproductive health. I am also interested in other stakeholders in this field, what non-governmental organizations do and in what way, how much influence they have, and what results they achieve.
Reproductive health and rights came into focus for the first time in 1994 at the UN ICPD conference
We asked Bhavya Joshi to assess how strong or influential certain international organizations dealing with the improvement of sexual and reproductive rights and health of women and girls (SRH – sexual and reproductive health) are. “All organizations and their policies are good in principle. We can recognize many local organizations as well as consortia of organizations that push the political agendas of SRH, like the Roda association in your country, which are doing a great job of improving women’s reproductive health. If we look at international organizations and bodies, UNFPA – UN agency working on sexual and reproductive health. The world conference on the topic of reproductive health was held for the first time in 1994, and since then the state of sexual and reproductive rights and women’s health was first systematically investigated on a global level. In the meantime, the ICPD produced a series of reports and recommendations as international standards that should be followed in order to solve, prevent, and overall change policies in the direction of improving women’s reproductive health throughout the world.
“Human rights and gender rights, and discrimination against women are a constantly open space for action and I would say that several global institutes organizations are advocating for intersectionality. There are human rights bodies under the Office of the High Commissioner of Human Rights (OHCHR) where women human rights activists can advocate for changes in the reproductive health policies of their countries. During my time here at Roda, I am also working on a submission to the Special Procedures at the United Nations highlighting the case of Mirela Čavada and denial to legal abortion services in Croatia”, Joshi told us.
Sex ed is important, even more important that it is carried out by experts
When it comes to the need to introduce sexual education into educational systems, which is lacking almost all over the world, Bhavya Joshi clearly emphasizes that sexual education, especially for women’s health, is extremely important: “Regardless of gender, everyone must have sexual education, to know how to recognize their reproductive rights and, ultimately, to empower women to fight for them. We know that many countries do not have it. We know that those countries that have included it in their educational programs have problems in implementation The most important questions here are who will do it and how it will be done, who will teach and how to ensure safe environments for children and young people to carry out that education, which, unlike other subjects, is always much more sensitive for numerous reasons. Firstly, those who teach sex education must first of all have the knowledge themselves, they must be trained because if you bring sex ed into the curriculum, and the teachers are not capable of teaching it properly, it could lead to a unwanted direction. Secondly, a safe environment should also be provided to avoid trauma and additional stigmatization. It is not enough to put one chapter in a textbook on the subject of sexuality and reproductive health and rights and act like the matter is solved. It is a responsible and serious job because sex ed is connected with other aspects of our live. Thirdly, it is very important to have parents directly involved. We should start with workshops for parents because these topics are dominated by stigmas, taboos, and religious ideologies, parents themselves may have traumatic experiences and will resist the sexual education of their children in order to prevent them. Parents should be involved as partners in the process of introducing sex education to children and young people. If we reach the parents and other key stakeholder, we will be able to reach the children as well.“
BHAVYA JOSHI: A PhD Candidate at UC Berkeley working at the intersection of public health and human rights. She collaborates on programs and projects for global public health and human rights, and the Bixby Center for Population, Health and Sustainability. She is also the founder of the research organization WomenSARRA, whose goals are to work on the full realization of sexual and reproductive health (SRH) as a human right and to empower women for reproductive autonomy and independent decision-making in health care about SRH. Her doctoral research postulates that we all live in times where ‘crisis is continuity’ and that it will continue to be so. This means that we are faced with crises at all times, be it climate change, natural disasters, wars and invasions, pandemics or political instability. Given that ‘crisis is a continuum’, there is a greater risk of complex crisis, which means the presence of two or more crisis events. And how they affect the reproductive health and rights of women and girls, especially the more vulnerable groups, is the subject of her scientific and ultimately activist interest.