For most people living in countries with a stable welfare system, services like free health insurance, flexible sick leave regulations, and paid maternity leave might seem like a given. But in reality, this is far from a global standard and even inside of individual countries there are vast differences to who gets to make use of these kind of services.
Women’s bodies have been a domain of control and debate for centuries. Feminist movements of the present and past have achieved numerous milestones: Legalising abortion, establishing the right to vote and work, criminalisation of sexual abuse and harassment, and many more. Looking at these accomplishments, they demonstrate not only the importance of raising awareness about these issues, but also about the systemic structures that challenge and hinder the improvement of women’s health and lives. Furthermore, it is clear that these achievements are far from global. There are no universally accepted frameworks in place that assure the adoption and implementation of certain rights. International institutions such as the UN aiming towards these goals do possess some level of global recognition, but they have little to no legal authority over individual country’s jurisdiction. Therefore, policies and established guiding principles concerning women and their well-being vary widely across nations. Additionally, over the last few decades it has been increasingly made clear that changing laws and introducing new policies is not the ultimate goal to improving women’s lives. Emerging intersectional approaches address the fact that there are multiple aspects that affect a person’s health and well-being. Acknowledging that while gender does play a central role, one’s position and ability to access certain infrastructures and knowledge is largely enabled or inhibited by a range of other aspects, such as socioeconomic background, ethnicity, and nationality.
In this project, I want to focus on one specific field of women’s health: sexual and reproductive health (SRH). In 1994, SRH became recognized as a universal human right by the United Nations and defined as the following:
“The right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care (…). [Reproductive health] also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.” (UN 1994)
Based on this definition, SRH includes not only the existence and access to proper health services but also the education and knowledge about related topics like (sexual) relationships, consent, and bodily autonomy. Another field of interest that is certainly relevant to SRH is menstrual hygiene management (MHM). The majority of people born with female sexual organs menstruate for several decades of their lives. In many Western countries the debate regarding MHM is currently focusing on menstrual products being taxed as luxury goods. However, for millions of women worldwide access to safe and affordable options for MHM is still a major issue. Whereas the existence of appropriate hygiene facilities and availability of period products are important steps, there is no “one-size fits all” solution. Practices linked to MHM are context-specific, hence varying depending on local customs, availability of resources, and personal preferences (Noreluis 2017:19).
As mentioned before, the intersectional aspects of contemporary societal structures play an important role in the difficulty of accessing specific services and knowledge. One field where this is especially apparent is migration. There are structural barriers to who is able to safely and legally cross borders that have little to do with the person’s particular situation and more with existing political, economic, and social circumstances external to the individual. Women that experience or have experienced forced migration are thereby facing multiple challenges and disadvantages, especially concerning their health. For this reason, the Committee on the Elimination of Discrimination against Women (CEDAW) further developed the UN’s definition of SHR in 1999 to include vulnerable groups such as “migrant women, refugee and internally displaced women” (par. 6) among others.
The barriers of accessing health care and SRH care in particular can materialize in various different forms. Social and cultural customs and narratives might reproduce a stigmatisation of some phenomena surrounding health and bodies. Menstruation in particular is highly enclosed by shame in many societies around the world. This leads not only to lack of information and opportunities to openly talk about related issues but can also have direct negative effects on women’s state of health (Norelius 2017). Access to funds and the economic situation of the person can stop them from making use of certain services. Poverty is among the main threats for migrant’s health (Padovese et al. 2013:373) and usually exacerbated by the difficulty of finding legal and safe sources of income in the host country. More systemic barriers include the lack of (professional) interpretation services, cultural competency of practitioners, as well as legal hurdles (Kopin/Integra Foundation 2016). Additionally, limited mobility of refugee women poses a physical challenge to accessing health care and support. Prevalent discourse surrounding migration across Europe regularly portrays refugees as criminals and as a (economic and social) burden or even threat. These dehumanising narratives cause an antagonist attitude within the population and are often utilized by politicians or policymakers to justify discriminatory acts including the poor conditions under which refugees are living (Pisani 2012:188).
One group of migrant women that is particularly affected by this is sex workers. The overlapping and multiple factors of marginalisation, like poverty, legal status, and gender, act in a “multiplicative” fashion whereby they have increasingly negative implications for women’s health and well-being (Platt et al. 2018:3). Sex work is as such not a determinant for ill sexual and reproductive health. However, structural factors such as stigmatisation, criminalisation, and strict immigration policies pose further barriers to accessing health care and support due to fear of prosecution and lack of legal protection (Goldenberg et al. 2021:122). A great number of studies demonstrate the positive effect decriminalisation of sex work has on the health of sex workers, for example as a result of safer working conditions and increased negotiation power due to a more formalized setting (ICRSE 2017:10)