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Discussion: Women Global Health Discussion: Women

Discussion: Women Global Health Discussion: Women Global Health Discussion: Women Global Health ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Women Global Health Every year 22 million women undergo unsafe abortions worldwide- the vast majority of these occur in developing countries and they account for 13% of all maternal deaths in these regions (Ipas, 2014, Okonofua, 2006). Unsafe abortions are procedures performed “without the necessary skills or in an environment that does not conform to minimum medical standards, or both” (Grimes et al., 2006). These occur more commonly in countries where abortion is restricted by law and thus, can be considered as a largely preventable public health and human-rights issue (Ipas, 2014, Grimes et al., 2006). Sri Lanka presents a case-study with prohibitive legislation that is worth consideration; here, abortion is illegal except when a mother’s life is under threat (Kumar, 2013). By all accounts, Sri Lanka is a South Asian country to which others can aspire- enormous efforts have been made to improve health and education for all citizens (Arambepola and Rajapaksa, 2014, Gill and Stewart, 2011). Consequently, one might assume that gender equality is advancing in strides, irrespective of current abortion laws. Indeed it appears this assumption has been adopted by the Government, undermining any impetus for change. In this essay we will examine the current approaches to abortion laws in Sri Lanka, their validity within a national and international context and consequences of unsafe abortions for the health and well-being of Sri Lankan women. It will become apparent that despite superficial appearances, abortion laws- rather than being irrelevant to current progress in gender equality- are a symptom of a disconcerting double standard; where the rights of women are respected only within the limits of culture, religion and a predominantly patriarchal power structure. Ultimately, allowing women to have control over their own bodies “is a fundamental prerequisite to the achievement of sexual and reproductive health and rights” (Sri and Ravindran, 2015), and the Sri Lankan Government must recognise this critical issue if they are to continue to improve gender equality now and into the future. Gender inequality in Sri Lanka Discussion: Women Global Health Discussion: Women Global Health Gender inequality is comparatively more pronounced within Sri Lanka than in 71 other countries in the world, according to the gender inequality index; this score is based on reproductive health, empowerment (political participation and education) and labour market participation (Social Institutions & Gender Index, 2016). Whilst an improvement upon previous years- particularly in light of two decades of conflict and a tsunami disaster (Gill and Stewart, 2011)- this intermediary rank also indicates that substantial barriers to equality remain. Progress has largely been attributable to an improving economy, the provision of “free health for all” and universal education (Asian Development Bank, 2015, Gill and Stewart, 2011). Maternal mortality rates have declined significantly, health service utilisation- such as antenatal care- is enviably high and girls have higher enrolment and retention in secondary and higher education compared with boys (Asian Development Bank, 2015). Despite this, women are still perceived as natural reproducers and nurturers who must “obey and respect” their husbands (Jayatilleke et al., 2011). Controlling a wife’s behaviour is commonplace and acceptable (Bourke-Martignon, 2002) and for those women who transgress cultural norms, they are at significant risk of intimate partner violence (Jayatilleke et al., 2011). Indeed, lifetime prevalence of such violence is estimated at around 40% (Kuruppuarachchi and Wijeratne, 2005). Outside of the home, unemployment gaps between men and women have been narrowing, yet averages conceal the “unconscionably high” rates among younger or well-educated women relative to their male counterparts (Jayaweera et al., 2007). There are also horizontal and vertical gender divisions- women are excluded from higher income positions and of those thatareemployed, this largely occurs in the informal sector with low-skill jobs or even unpaid family labour (Asian Development Bank, 2015, Gill and Stewart, 2011). Female representation in parliament has failed to exceed 6% (Asian Development Bank, 2015) and legally the elimination of gender-based discrimination in inheritance rights has not occurred (Social Institutions & Gender Index, 2016). Thus, despite the relatively satisfactory position of Sri Lanka compared to other South Asian countries, there are clearly lingering barriers to equality that permeate everyday life, let alone controversial issues such as abortion. Current approaches to abortion in Sri Lanka The primary means by which the Sri Lankan Government impedes access to abortion services is through legal restriction, however this essentially amounts to sexual discrimination- given that these services are only required by women- and ultimately does little in the way of actually preventing terminations. Sri Lankan abortion laws are based on arachic colonial legislation from 1883 and state that abortion is legal only to save a woman’s life, and those who do not obey this law will be “punished with imprisonment” (Walatara, 1998, Government of the Democratic Socialist Republic of Sri Lanka). Simultaneously, the 1978 Constitution guarantees women fundamental rights as well as protecting against discrimination on the grounds of gender (Asian Development Bank, 2015). Sri Lanka has further ratified the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), a document that considers access to safe abortion services as a necessity for gender equality (Gomez, 2004). Thus clearly current legislation is antithetical to sentiments in both the national constitution and international treaties, and infringes upon basic human rights. Nor is this transgression founded on inaction, but rather active opposition; recent attempts to amend the law in instances of rape, incest, and fetal abnormalities were unsuccessful (Kumar, 2013). Resolving this conflict, one is left to assume that the Ministry of Health places enormous significance on the imperative to save lives by criminalising abortion, above and beyond any ramifications on human rights or the law. Ironically however, this hard-line stance does little in the way of actually preventing terminations and instead, promotes unsafe practices and places women’s lives at risk. Clandestine services and abortive medications (although unregistered) are widely available and whilst there are no national level statistics, it is estimated that over 500 abortions occur per day (Ban et al., 2002). Therefore Sri Lankan women are not only facing unlawful discrimination- despite national sentiment supporting gender equality- the Government is also compromising their health and wellbeing through the consequences of inevitable unsafe practices. Remaining defiant on the issue of legalisation, the Sri Lankan Government instead favours primary prevention and tertiary management of the consequences of unsafe abortions (Family Health Bureau, 2009); however even these services are implemented through a gender lens that emphasises traditional roles and responsibilities for women. Primary prevention is the provision of health services to minimise the risk of unwanted pregnancies. This largely encompasses family planning programs- accepted into national policy in the 1960s (Asian Development Bank, 2015)- as well as sexual and reproductive health education. These programs are well-established and expansive, increasing contraceptive use to 70% and causing a decline in the national fertility rate to 2.3 (Asian Development Bank, 2015). National averages such as these however, overlook district variations as well as the inconsistent impact on vulnerable and marginalised women. Barriers to contraceptive use include inaccessibility, privacy concerns, social barriers and financial costs, and for some women abortion becomes the predominant method of family planning (Perera et al., 2004). It is also worth noting that contraceptives are largely targeted to married women, whom historically have constituted the majority of individuals seeking terminations (Abeyasinghe et al., 2009). Even so, this underestimates changing societal norms within Sri Lanka; premarital sex appears to be increasing along with urbanisation, internal and external migration, increased marital age and a shift from arranged marriages towards “love marriages” (Jordal et al., 2013). Persisting cultural barriers- see above- and a lack of sexual education for adolescents has led to notably poor contraceptive use among unmarried couples (Kumar, 2012). This highlights how the current system is failing women- failing to afford them with equal sexual and reproductive health services in the first place and then failing to give them control over choices to manage the ensuing consequences. The reason why this occurs is likely the same mechanism as for discrepancies in the employment and political sectors. Were the Sri Lankan Government truly committed to gender equality and simultaneously opposed to abortion, one would anticipate efficient and effective primary preventative services for all women, not the deficiencies described here. Thus abortion laws are merely a symptom of an ongoing disease of discrimination. Tertiary management of unsafe abortions, involving the “integration and institutionalization” of post-abortion care into the Sri Lankan health care system, also fails to adequately meet the needs of women (Okonofua, 2006). For the most part, tertiary management has been achieved through “free health for all,” rather than specific directives. Indeed, the most recent Reproductive Health Policy of 1998 and the National Strategic Plan on Maternal and Newborn Health (2012-2016), both failed to include provisions for post-abortion care (Kumar, 2012). This passive stance endangers the health and well-being of women, particularly given the ongoing rate with which abortions occur. This is compounded by fear and stigma. In one small study, many women delayed seeking help from a Government hospital following an abortion because they were concerned about legal ramifications, as well as discrimination from health care providers (Thalagala, 2010). These women claimed that they had few opportunities to ask questions regarding their health upon admission and more than 10% experienced verbal abuse from staff (Thalagala, 2010)- women who have had abortions are often subject to “social ridicule, reprimand and exclusion from both family and society” (Jordal et al., 2013). This is particularly true for unmarried women, who are seen to be violating sexual norms and proper behaviour, with a woman’s virginity closely linked to the dignity of a family (Jordal et al., 2013). Thus clearly a more direct approach to managing the consequences of unsafe abortion is required, and one that adequately addresses privacy and legal concerns. The situation described above reflects not only a failure to manage medical consequences of terminations, but a disregard for the wide-reaching ramifications of abortion laws; it appears that “free health for all” has a caveat- so long as women conform to rules and regulations placed upon their behaviour (Gill and Stewart, 2011). ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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