Susana T Fried is a Visiting Fellow at the Yale University Global Health Justice Partnership. Her work focuses on sexual rights, public health, gender equality, and social justice, including as the lead researcher on a global project on human rights and criminal law in the context of sexuality, sexual conduct, and sexual and reproductive health.
To force women to have children they do not wish to have is a form of violence against women. Similarly, there are strong linkages between HIV and violence and more broadly to the denial of women’s control over their bodies. Lack of access to quality sexual and reproductive health and lack of ability to exercise rights, mixed with gender inequality, stigma, and discrimination, plague women living with and at risk of HIV as well as women with unwanted pregnancies. Today, despite decades of advances in treatment, care, and support, HIV is the leading cause of death among women of reproductive age in the developing world. Maternal death is the second biggest killer of such women. Complications related to pregnancy and childbearing among 15-19-year-old young women, including from an estimated 3 million unsafe abortions each year, contribute significantly to maternal mortality and morbidity.
Deaths of women from HIV and unsafe abortion aren’t simply biomedical problems. The science and technology of preventing and treating HIV, and the technical capacity to provide safe abortions, are well established. Safe and legal abortion and HIV prevention are relatively inexpensive to deliver. Moreover, there is a wealth of experience with successful pregnancy and HIV prevention programming. However, the criminalisation of abortion, along with the criminalisation of non-heteronormative sexuality, sexual conduct, and sexual and reproductive health choices, continues to circumscribe the lives of many women, men, and trans people.
A number of factors contribute to the higher HIV risk experienced by girls and young women, including harmful gender norms resulting in early marriage, intimate partner violence, early pregnancy, and discriminatory laws and practices. These factors combine to prevent girls from being able to stay in school and become economically independent, and impede access to social and health services. Even when health services are accessible, they are rarely designed for, and often unfriendly to, adolescents. In sub-Saharan Africa, for instance, only 15% of adolescent girls and young women aged 15–24 are aware of their HIV status. For those who have tested positive for HIV, a lack of youth-friendly HIV treatment and insufficient linkages between sexual and reproductive health services and HIV testing, treatment, support and care services prevents many young women from accessing antiretroviral therapy (ART) and from accessing sexual and reproductive health services more generally.
The same structural drivers that increase young women’s vulnerability to HIV also lead them to seek unsafe abortions. The same systems of discrimination and gender inequality that directly and indirectly increase diverse women’s and girls’ HIV risk also increase the likelihood that adolescent girls and young women will turn to unsafe abortion. These structural and political drivers include poverty, gender inequality, sexual violence, and a lack of education. They combine with other factors of marginalisation (for example based on race, ethnicity, language, migrant status, disability, sexual orientation, gender identity, engagement in sex work, health status, use of drugs, etc) to create toxic conditions for the lives of adolescent girls and young women worldwide.
The past decade has seen increasing linkages across movements in the HIV orbit – linking decriminalisation of sex work, same sex conduct, non-binary gender identity, and of HIV itself. These links are based, first and foremost, on the common experience of vulnerability to, and risk of, HIV. Another commonality is the experience of being the target of stigma, discrimination, and violence. Such human rights violations put the victims’ health at risk. Criminalisation of abortion puts women with unwanted pregnancies at a similar risk.
In some cases, the connections are even more direct. Sex workers, for example, may find themselves turned away from clinics where legal abortions are performed. Indeed, it may well be as difficult to find sex-worker-friendly sexual and reproductive health services as it is to find adolescent-friendly health services or for a gender-non-conforming woman to find lesbian-friendly health services, even in countries where same sex conduct is not criminalised. Transmen may have as much difficulty accessing safe abortion services as adolescents. And across the board, it is those with the fewest resources who face the most arduous barriers to HIV and abortion prevention, services, care, and support.
Despite these linkages and common sources, movements to address the various forms of criminalisation of sexuality and sexual and reproductive health remain, for the most part, disconnected. Yet even some campaign slogans lend themselves powerfully to the linkages. For instance, the International Campaign for Women’s Right to Safe Abortion claims that “Consent to sex is not consent to pregnancy” – nor is it consent to be put at risk of HIV.
Given these common experiences of criminalisation, stigma, and discrimination, it is time to construct a larger umbrella to contest these human rights violations. This is, then, a call for groups representing HIV, sexual orientation and gender identity, and sex worker rights to join with women’s health and rights organisations to demand action on access to safe and legal abortions.