In about the same time as it takes you to read the next couple of paragraphs, somewhere in the world a woman will have died because there were complications with her pregnancy, childbirth or unsafe abortion. Another 190 will face an unplanned or unwanted pregnancy. Five girls will have endured female genital mutilation. In Nigeria — where women in their twenties have the highest risk of HIV infection of any other group — another person will have contracted the virus. In Canada, a woman or child will be sexually assaulted. A lot can happen in a minute.

It seems those of us with ovaries still don’t necessarily get a lot of say in what happens to them. Women’s reproductive rights — or lack of them — in Canada and internationally, continue to be subject to political, economic and social whims as we head into the year 2003.

âeoeReproductive rights” means more than having contraceptives at the ready. (Although that is really important.) According to the United Nations Population Fund, ensuring full reproductive rights involves “information, counselling and education, especially for women; basic health care and equipment; safe motherhood practices especially during childbirth; gender equality; and the power to make the choices that determine one’s reproductive life. But a supply of the necessary equipment and other essentials is required if such choices are to have meaning.”

Or, as Madeline Boscoe, executive director of the Canadian Women’s Health Network puts it, “We shouldn’t be treating just their ovaries and their uterus.âe

Despite years of activism around the world, full rights over their own bodies are still not the reality for many women. A study by the International Planned Parenthood Federation found that only 64 of the 148 countries it looked at were able to access a variety of contraceptives, and only 44 had “numerous” family planning services. It’s estimated that, globally, 350 million women and men have little or no access to these services.

Even those who have gained reproductive rights aren’t guaranteed them. In Canada, for example, abortion has been decriminalized since 1988; however, not all women are able to access services. “It’s pretty uneven and very sparse in some areas,” says Cynthia Wilson, director of outreach programs for the Canadian Abortion Rights ActionLeague (CARAL), which co-organized a conference on reproductive freedom and social justice in Ottawa this September. “Seventeen per cent of hospitals have abortion services in Canada. Anywhere outside of major metropolitan areas, it’s pretty bad.”

There’s more bad news. A year-old study by Population ActionInternational and CARE found that in Ethiopia, which ranked last in their 133-country survey, women have a one in seven chance of dying from a pregnancy-related cause. Overall, women in developing countries are thirty times likelier than women in the developed world to die this way. Sexually transmitted infection (STI) is another problem. By this time next year, one million more women will have become infected with HIV and more than 165 million will have contracted other STIs. Women and girls who endure female genital mutilation are left more at risk for infection. In Canada, a recent study by the Atlantic Centre of Excellence for Women’s Health found that the number of new HIV infections has gone down twenty-five per cent since 1995, but the infection rate for women has gone up twenty per cent since 1997.

Of course, where you live and who you are still determines to a great extent what kind of risks you face. “We think we have a certain level of services in this country,” says Boscoe, “but there are various barriers for different populations.” Assisted reproductive technologies, for instance, present a financial barrier for some women while access to emergency contraception is not a reality for women living in remote areas.

Will the recommendations in the Romanow Report help foster reproductive health for Canadian women? “The report is a very important line in the policy sand,” says Boscoe. “We need to enrich that vision with a gendered approach.” In other words, a drug plan is fabulous, but if you still can’t get, say, condoms and foam (which aren’t covered), you’re still at risk.

What is being done about these problems depends on national and international politics. As Michele Landsberg pointed out in a recent column, Bush fils has already caused incredible hardship with his global gag rule, which bans funding to international agencies that so much as mention the word abortion. He has also reneged on $34 million for the U.N. Population Fund, which supports developing countries wanting “to improve access to and the quality of reproductive health care,” and is gearing up to take away support from the 1994 Cairo Program of Action, an agreement between 170 countries to address gender issues and aid socio-economic development.

The effects of these decisions can be seen around the world. Take what is happening in Nepal. Many women in the country were dying because of unsafe abortions, and after a long battle it was recently decriminalized. “The government of Nepal is now facing a situation where they are unable to get funding for family planning, sexual and reproductive health, because they included among the services that they would provide abortion and information about abortion,” says Zonibel Woods, director of government relations for Action Canada for Population andDevelopment. “It’s quite tragic.”

Reproductive rights aren’t cheap. In 1994, the InternationalConference on Population and Development tagged the cost of meeting global reproductive health needs at U.S. $17 billion per year by 2000 and over $21 billion by 2015. But the money isn’t coming. The United States paid about $394 million in 2000, less than half of what it promised. One would expect a good explanation for this lack of support, but no. “Often,” says Woods, “sexual reproductive health and rights tends to fall off the table in terms of priorities.”

This lack of cash has consequences. Every $1 million that doesn’t come through for contraceptives means about 360,000 unwanted pregnancies, 150,000 abortions, and the deaths of 800 women and 25,000 children under five. In Saharan Africa, for example, only three condoms are available per man per year.

Women’s health can have a lot to do with men’s willingness to don a rubber. Demand for condoms is growing, but the stigma around their use is one of the problems society has to deal with to protect women’s rights. According to a report by Dr. Rachel Jewkes published on the International Planned Parenthood Federation Web site, “In many cultures suggesting condom use is tantamount to implying or admitting infidelity, as condoms are associated with prostitution, promiscuity and disease. A suggestion of condom use can be perceived as an implicit challenge to a male’s right to have many women.”

Even when condoms are widely available, many won’t use them. According to stats published on the Canadian Centre for Adolescent Research Website, fifty-one per cent of sexually active girls age fifteen to nineteen had sex without a condom; for boys in the same age group, the number dropped to twenty-nine per cent. Add to this the fact that domestic violence, rape and sexual abuse are major factors in the spread of HIV/AIDS and other diseases. Young women, in particular, are susceptible to sexual exploitation and trafficking and are least able to negotiate condom use. As a result, thirty per cent of Cambodia’s sex workers aged thirteen to nineteen are HIV-positive. In western Kenya, one in four girls aged fifteen to nineteen lives with AIDS.

âeoeIt’s an ongoing, exhausting process,” says Boscoe of the reproductive rights quandary. There are still plenty of groups — like CARAL — that are active. The question, she says, is how to develop that into a coherent strategy.

Here’s one idea. In September at the World Summiton Sustainable Development, U.N. agreements about women’s rights were included in the agreement, despite opposition from the U.S., the Vatican and some Islamic countries. How about celebrating by resisting the temptation to become complacent about reproductive rights, yours and others’?

“They’re fairly fragile,” says Woods. “We have to be very vigilant; we can’t turn away for a moment. I think there are many forces out there who want to control women, to control their sexuality, and to control their sexual rights. It’s not a battle that has been won.”