“Towards a just economic order for sexual and reproductive health”, Cai Yiping at the 9th APCRSHR

Presentation delivered by Cai Yiping at 9th Asia Pacific Conference on Reproductive and Sexual and Health and Rights held on November 27 to 30 2017, in Halong Bay, Vietnam.
 
Dear colleagues and friends, Good Morning!
 
It is my honor to speak in this panel to share with some of my thoughts on such an important topic – towards a just economic order for sexual and reproductive health.
 
My original topic is Economic Development and Women’s Health in China. I meant to look closely at China’s ranking and performance in the three sets of widely used gender indicators – UNDP’s Gender Development Indicators (GDI) /Gender Inequality Indicators (GII); OECD’s Social Institutions and Gender Index (SIGI) and World Economy Forum’s Global Gender Gap Index (GGGI) in comparison of China’s health indicators in its national gender equality and women’s development indicator framework. I would examine the correlation between economic development, gender equality and women’s health in China, especially women’s sexual and reproductive health.
 
After drinking a nice cup of Vietnamese coffee last night, I stayed awake to prepare my PPT till this morning at 5am and I decided to throw away my previous presentation to talk about something completed different. Because I do not want to bore you with something you already knew about China: China’s Human Development Index increases significantly in the last three decades and made significant accomplishments in health and education. Meanwhile, China has experienced an increase in social inequality during over 30 years of rapid economic development. You all know well about this. What more important is what we can learn from this China case, especially from the perspectives of interlinkage of economic justice and gender justice and ecological justice for sexual and reproductive health.
Let me begin with clarifying three myths around this.
 
The first myth is about the dominating narrative on the concept of “womenomics” or the notion of “smart economics”. It refers to the idea that women´s economic advancement will improve the economy and that this should be "the" reason to promote pro-gender equality policies. Also, from this perspective, it is understood that gender discrimination and the violation of women´s human rights, including their sexual and reproductive rights, are economically inefficient. For example, there are economic costs on gender based violence (in the form of income loss, lower productivity, etc.) and that is why it should be overcome. It sounds very logical and convincing especially as the tactics for policy advocacy, but it is based on the false value. If economic efficiency is "the" reason to promote gender equality and improvement of women’s sexual and reproductive health can catalyse women´s economic advancement, what would happen if it does not prove to be this way? For example, evidence prove that the cost of violence against women is not that high? Or the cost of implementing public policies to narrow gender gaps in the labour market, prove to be more expensive than the economic gains? It is important to reaffirm the human rights at the centrality of sexual and reproductive health, as fundamental principle and underlying value, prior to the argument on economic efficiency.
 
The second myth is about the private-public partnerships (PPPs). In the 2030 Agenda, two targets under SDG 17 explicitly promote multi-stakeholder and public-private partnerships (targets 17.16 and 17.17) and endorses the private sector as the key “development actor”. Within this framework, multi-stakeholder partnerships are being promoted, not only by governments but by the UN, with no accountability mechanism attached. There are concerns on bilateral or multilateral public-private partnerships (or PPPs) are promoted for both infrastructure and sectors such as education and health and other public services.
PPPs are promoted with the assumption that (1) governments are unable to pursue the required public investment to basic public goods, and (2) PPPs can introduce technology and innovation to improve the efficiency. However, there is contrary evidence of the negative effects of PPPs, especially fiscal risks (overcharges and fiscal unsustainability), as well as failure to provide the needed and high-quality public good and services.
 
The European Commission’s Expert Panel on Effective Ways of Investing in Health adopted an opinion in 2014, based on a review of 15 PPP cases in European countries by an independent consultant, that “public disclosure of data and analyses behind PPP investments is very poor, inconsistent and not standardized. The Expert Panel has not found scientific evidence that PPPs are cost-effective compared with traditional forms of public financed and managed provision of health care.” Another case study by Oxfam in 2014 about the PPP on health sector in Lesotho found that three years after the hospital opened in 2011, governments’ expenses grew 64%, and the budget for this hospital represented half of the entire health sector public budget.
 
The third myth is about the science and technology as the fixer or easy solution. The rapid and revolutionary development of science and technologies, such as big data, artificial intelligence, artificial reproductive technology (ART) and surrogacy, among others, catalyses the transformative way of thinking around human bodies, sexuality, production and reproduction and rights. Growing influence of business sector and pharmaceutical companies poses the new challenges on SRHR, in terms of ethics, accessibility, quality and inequality, as well as depoliticizing the human rights based agenda. How to dismantle the corporate power and market-driven solution and fight for the transformative and structural change remains the biggest task in front of us.
 
The most important question is -- how we can move forward from here despite of all these challenges and difficult environment. There is no easy answer to this question. Maybe we can start with the following three actions:
 
First, we must ground our analyses, critics, advocacy and mobilization deeply in reality and address real issues. More than 20 years ago, feminist activists and human rights advocates have strived to expend the space in the multilateral platform like UN and make the paradigm shift during 1990s from population control to sexual and reproductive health and rights, to gender equality and women’s empowerment. Today, many of us are really trying very hard and not always succeed to hold the line to prevent the regression on the human rights, where many of this norms and values are severely challenged.  We continue to fight in every space where the decisions on SRHR are made to make sure voices of women and marginalized groups are heard and the reality of their every life is counted.
 
Second, to build broader alliance across progress social movements. Current SRHR advocacy overwhelmingly focuses on sexuality and reproduction. It often overlooks the broader and profound linkages between body and sexuality, production and reproduction, nature and livelihood. Therefore, it may miss the opportunity to challenge the corporate power that defines body -- both women’s and men’s bodies and gender non-confoming bodies-- as the labor and consumer that to be extracted and instrumentalized for the profit. As a result, it often leaves women and feminist groups or LGBTQI community alone at the frontline of the battle, as sexuality and reproduction are perceived as pure “women’s issues” and related to women’s bodies only, or imperfect, gender non-conforming bodies. It makes it difficult to build broader alliance across progressive social movements.
 
Lastly in conclusion, let us work together to reclaim the body as source of empowerment, for wellbeing and sustainability of planet and human being, and to make human rights framework truly work!