Journal of Clinical Research & Bioethics

African Women’s Diminished Reproductive Autonomy as an Issue of Public Health Ethics

Chitu Womehoma Princewill^* National Biotechnology Development Agency, Umaru Musa Yar’Adua Expressway, Federal Capital, Abuja, Nigeria
^*Correspondence: Chitu Womehoma Princewill, National Biotechnology Development Agency, Umaru Musa Yar’Adua Expressway, Federal Capital, Abuja, Nigeria, Tel: +234(0)8037236069, Email:

Received: 21-Jun-2022, Manuscript No. JCRB-22-17197; Editor assigned: 24-Jun-2022, Pre QC No. JCRB-22-17197(PQ); Reviewed: 15-Jul-2022, QC No. JCRB-22-17197; Revised: 26-Jul-2022, Manuscript No. JCRB-22-17197(R); Published: 04-Aug-2022, DOI: 10.35248/2155-9627.22.13.420

Introduction

Over twenty-one years after the International Conference on Population and Development (ICPD) held in Cairo, Egypt, 1994, and twenty years after the Beijing Conference in China, women’s reproductive autonomy is still largely a matter of concern, especially in most developing countries. Globally, there is an increased interest in women’s reproductive autonomy [1-6]. Women’s reproductive autonomy which is part of the International Human Right Law is defined as the ability of a woman to decide whether to have children or not, when to have children, how to have children, It also includes her right to information, her right to attain the highest standard of sexual and reproductive health, her right to make decisions concerning reproduction, and free from discrimination, coercion and violence.

The culture of gender Inequality

The culture of gender inequality and discrimination of women exit in every society but varies from one society to the other. This inequality and discrimination of the woman begins from birth to the grave and is a hinder to women’s reproductive autonomy [7-9]. Women are socialized into respecting and referencing men in the family [10,11]. As young girls, in some families, when family finances and resources are scarce, the girl child is told to drop out of school; asked to hawk or is forced into early marriage in some extreme cases so as to raise money for her brother to attain education [12]. As a married woman, she is expected to be submissive and obedient to her husband in all matters including her reproductive autonomy. In her matrimonial home, she is not expected to make and act on her made decisions without her husband’s consent [13].

In most African countries where the societies are patriarchal, the payment of bride price or dowry as the case may be, is seen to commodify the woman and this in turn strips her of her reproductive autonomy. It is believed that once she consents to getting married, it is assumed that she has automatically consented to her body being used for the sexual fulfillment by her husband. Hence rape is not recognized in the African marital setting. Associating African married women’s diminished autonomy to the payment of a bride price is a misconception on the part of those who think that the payment of the bride price is the reason for married women’s diminished reproductive autonomy. In African patriarchal countries, sexual discussions are viewed as a taboo and women (married and single) who involve in sexual discussion are usually viewed as being irresponsible and of bad influence to other women. For this reason, issues of sex are left solely for the men [14,15].

Women’s lack of reproductive Autonomy

Women’s reproductive autonomy is central to the woman’s health and welfare because childbearing is naturally her responsibility and she is expected to primarily be responsible for child-rearing. Women’s lack of reproductive autonomy makes them a vulnerable group essentially because sometimes, their access to critical resources is through men. This is true in patriarchal society like the African society where gender inequality exist in the family and in the society [16]. Lack of women’s reproductive autonomy could expose them to a lot of health issues such as HIV/AIDS, health outcome relating to domestic violence, genital mutilation, Vesicovagina Fistula which in time past used to be considered as personal tragedy but has now become public health issue with increasing girl child marriage and in some extreme cases death [17-19]. The African woman tolerates constant battering in marriage because the society expects her to remain married because the society frowns at divorce [20]. More so, the process of divorce if initiated by a woman is made difficult by the courts due to delayed court proceedings [21]. A woman who is not able to exercise her reproductive autonomy faces the challenge of not being in the best position to adequately take care of herself and rear her children properly [22]. There have been several researches linking women’s good exercise of their reproductive autonomy to better health, educational outcomes, higher rates of infants and child survival and well-being [23,24]. Previous researchers have also shown that women who have freedom to exercise their reproductive autonomy contribute to the well-being of the family which in turn impacts on the community as well as the society [25-27]. According to Dickens and cook, countless families are devastated by the maternal mortality especially in the resource poor countries and this reduces the chances of dependent children and also compromises the health of victim’s children. Also, lack of women’s reproductive autonomy could lead to maternal morbidity and may weaken families, communities and societies resulting to issues of public health. Limiting women’s autonomy invariably limits her freedom to act as she so wishes in matters that concern her.

Universalist Ethical Stand

The Universalist ethical stand demands that the first step to achieving women’s reproductive autonomy is the protection of women’s right and the promotion of those rights over the promotion of culture [28]. Respect for cultural diversity does not imply support for wrong doing against women, cultures that promote gender inequality and reduce the dignity of some individuals [29]. In general, the Universalist ethical stand demand that “the protection of individual right is based on the presupposition that individuals are to be considered as autonomous moral agents who should have a chance to decide for themselves” and this includes women. This means that all human beings are equal and should be treated as equals irrespective of their differences like gender, race, ethnicity, their values, culture or their way of life.

Autonomy In Africa

In Africa, communitarian type of living is practiced and this promotes collective rights in order to preserve culture. This mode of communitarian living sometimes challenges the Universalist approach to women’s reproductive autonomy. Thus in alleged attempt to preserve culture, women’s reproductive autonomy is branded as western culture and a threat to African patriarchal culture [30]. Africans do not believe in acting individually, they believe in community decision making. They feel responsible for each other, especially the women and so the question of having individual autonomy is somewhat difficult.

But then, it is pertinent to note that any form of interference in someone else’s life is a violation of that person’s autonomy irrespective of whether the interference is for the good or bad of the person. At the heart of an individual’s autonomy is liberty. Liberty which invariably could be used as freedom is the ability to be free from oppressive restrictions imposed by authority on one's behavior or views. These restrictions sometimes could be from within one. Freedom is a matter of individual rights in so far as it does not infringe on the rights of others and the society. The right to be free is a moral claim that is made against others who are in a position to impede, impeding or destroy one’s freedom and who thereby have a correlative of non-interference [31-33]. Public health emerged from the realization by state that it had an interest in the health of its citizens and a possible duty to promote the welfare of its citizens for the benefit of the larger society. From the perspective of freedom on the ground that it is a moral right of every individual and the interference of women’s freedom by patriarchal culture is a public health issue worth looking into for the greater good of the society to which women belong.

Looking at the justice fairness of John Rawls’s theory, the concept of justice according to him is that all resources or primary good should be distributed equally amongst everyone unless these goods are to the advantage of the least favored in the society and this should be applied behind the veil of ignorance; that is, everyone should agree that the society should favour those in exposed positions [34-36]. In other words, looking at the African society where the women are subordinate to men, John Rawls is saying that men should put themselves in the position of the women and see if they the men would love to be treated (removing their reproductive autonomy and reducing them to incompetent individuals who cannot make decisions for themselves) the way these women are being treated by the same society they all belong to.

Public Health Strategy

Public health strategies are ethically mandated to contain the incidence of maternal mortality and morbidity arising from the issues mentioned above. This could be done by directing individual states to advance women’s welfare by respecting their reproductive autonomy. This would prevent many deaths and disease conditions associated with reproduction (including sexual relationships). As women’s reproductive autonomy increases, public awareness of the importance of a woman in the society will increase and be acknowledged. Acknowledging that there is an intimate relationship between women’s reproductive autonomy, the wellbeing of the children and family by public health experts will promote women’s reproductive autonomy. Furthermore public health experts in the states could include the following steps in their policy to improve women’s reproductive autonomy:

• African customary laws that promote gender inequality should be abolished or reformed to suit both genders. Belief systems that devalue the reproductive autonomy of the African woman should not be encouraged.

• Implementation of compulsory girl child education and abolishing of girl child marriage will help promote women’s reproductive autonomy.

• Awareness creation and education of all (including men) from the grass root on the importance of women’s reproductive autonomy.

• Empowering women for income generation to be free from over dependence on their male counterparts will also enhance women’s autonomy.

• Promotion of gender equality at all levels is critical to enhancing women’s reproductive autonomy.

Discussion

Equality in reproductive health includes access, without discrimination, to affordable, quality contraception, including emergency contraception. The decision as to whether to continue a pregnancy or terminate it may shape a woman’s entire future personal life as well as family life. The decision has a crucial impact on women’s enjoyment of other human rights. The decision is therefore fundamentally and primarily the woman’s decision.

Conclusion

Gender inequality and diminished women’s autonomy is an aspect that every society has to look into. Discrimination of one gender will not only set a nation backward, it will also stagnate a nation. Therefore, cultures and traditions that support gender discrimination should be abolished, and both genders should be treated equally with respect to their biological differences.

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