Women's Rights are Human Rights: Global Challenges to Reproductive Health

December 14, 2016


JOEL ROSENTHAL: I'm Joel Rosenthal, president of Carnegie Council. I want to welcome our guests and welcome all of you to our program this evening. Many of you know the Carnegie Council, some of you may be new here. We do something like 40 to 50 of these kinds of events a year. It's a very busy place.

I want to tell my good friend, Professor Jim Ketterer, and also my students who are here, this is my favorite public event working with Bard Globalization and International Affairs Program, the BGIA Program, and we've been trying to do at least one of these public events with BGIA per semester. We're delighted to have this opportunity this evening.

I teach a course in BGIA. It's called "Ethics for a Connected World" and there are about a dozen people in the audience who can tell you all about that course. We had a great semester, and I'm delighted that we are able to finish up in this context with the rest of the BGIA program with this public event.

I'm going to turn it over to Professor Jim Ketterer, who is the director of the BGIA Program. He's doing a great job, and he'll tell you a little bit about the program and introduce our conversation this evening. Thank you all for coming.

JAMES KETTERER: Good evening, everyone. It's nice to see a full house for such an important topic. Many thanks to Joel and to everyone here at the Carnegie Council for having us back for this event, and we hope to have many more.

The Bard Globalization and International Affairs Program is run by Bard College—as you might have guessed—which is located in the Hudson Valley. Here in New York City, we have students come from Bard College; they come from Bard's international partner institutions in Russia, Kyrgyzstan; and we hope soon from Alqudsbard in the Palestinian West Bank; and from Bard Berlin, as well as other colleges across the United States and from all over the world. We have those students come to New York City to take courses from scholar-practitioners like Professor Rosenthal and also to intern at a wide variety of institutions here in the city of New York and to enjoy their time here in the city and find interesting cultural and other sorts of things to do.

One of the things that the students do as part of their study and that we open up to the public are these lectures, which are done in the name of James Chace, who was one of the co-founders of the BGIA program. He was a professor at Bard and was also the editor of the World Policy Journal and the editor of Foreign Affairs, who is a generous supporter of this lecture series.

With that as background on what BGIA is and what we do, I'm very happy to turn over the stage to Professor Terry McGovern, who is a professor of population and family health at Columbia University, and María Antonieta Alcalde, who is the advocacy director for the International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR).

One of the reasons I'm happy to see so many people here is that this is breaking new ground for us to do a topic that's like this. Too many, I think, of our lectures have been focused on a narrow gauge and a narrow definition of what we mean by "foreign policy" and what we mean by "international affairs." To take a hard look at issues of reproductive health, how they're affected by U.S. foreign assistance and perhaps changes in U.S. foreign assistance that might be coming up, I think is an important thing for us to do. I hope this is the beginning of many more lectures that we're going to have on topics like this.

With that, I turn it over to our guests.


MARÍA ANTONIETA ALCALDE: Thank you very much, and thank you very much for having us here. It's a real pleasure, especially sharing the stage with Terry, who is also a very dear friend of mine.

My first question to you, Terry, is: The issues of sexual reproductive rights, women's rights, are not new issues. We had the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and we had the Fourth World Conference on Women, and still we have not fulfilled those commitments. In sub-Saharan Africa, for example, 50 percent of the new infections in HIV/AIDS are in young women. In the region where I work the most, in Latin America and the Caribbean, even though a lot of advancement has been made on sexual and reproductive rights, still 20 percent of all births are from women under 18 years old. We see the Millennium Development Goals (MDGs). They haven't been fulfilled; MDG 5 was on women's health.

What's your perspective on that? Why is this happening?

TERRY MCGOVERN: That's quite a question, but first of all, thank you for having us here. Thank you to Bard and the Carnegie Council. We have been partners in advocacy for many years, so it's great to be on the stage with you as well.

I think if you look at the trajectory of global reproductive health, you see that unfortunately there is still a lack of availability of contraception in many places—still at a 24-percent level in sub-Saharan Africa. You see violence against girls and woman is at epidemic proportions; it's been that way a long time. You see lots of problems with laws that keep girls, adolescents, from being able to access contraception and say no to early marriage. There are lots of power issues between girls and young men that keep girls from being able to exercise their sexual and reproductive health and rights.

I think one of the things that has evolved over time—we've had these amazing activists and advocates who've gotten things like CEDAW, the Convention on the Rights of the Child (CRC), all of these different kinds of global systems that say: "You can't do certain things. You have to allow adolescent girls to access contraception. You have to allow girls to choose marriage or not."

What has evolved over time is that countries have figured out ways to evade those commitments. In the case of the Convention on the Rights of the Child, CEDAW, most of the international human rights commitments, what happens is a lot of countries take reservations around issues of sexual and reproductive health, i.e., "We agree to CEDAW, but we take reservation to the section that deals with access to contraception and freedom of choice in all of these areas." That is one way you might actually see that a country has ratified all of the relevant treaties. But then you wonder why there are really high maternal mortality rates or lack of access to contraception. When you look closer, you'll see they ratified the treaties with reservations.

Another part of this process is that if you ratify a treaty, you actually have to domesticate it and make it national law, so in some instances they never do that. In some instances, they domesticate it with exceptions for private law. I always like to say, "Eleanor Roosevelt said: 'Human rights need to attach in the smallest of places.'" A lot of countries, member states, have found ways to evade these commitments.

Those are the international commitments, but the Millennium Development Goals, of course, governments agree to these things, but there's no teeth to enforce what they've agreed to. As you pointed out, the agreements were quite basic around sexual and reproductive health. They weren't particularly sophisticated in measuring any of these issues: law, structural barriers, economic justice, etc.

MARÍA ANTONIETA ALCALDE: The MDGs just expired last year, and now we have a new set of commitments, the Sustainable Development Goals (SDGs), that are way broader; from the eight commitments that we had with the MDGs, now we have 17, and we have stronger language. We have the SDG triple incentive that says there should be universal access to sexual reproductive health and reproductive rights. So we have rights there. We have gender equality and reproductive rights in SDG 5. Do you have more hope for the SDGs? Do you think with these commitments we will be able to advance the women's agenda further?

TERRY MCGOVERN: I think that the advocacy community, including you, did an amazing job in advocating for the Sustainable Development Goals to be broader, to have gender integrated all over the place, to have targets that are more sophisticated, that take apart—the MDGs measured the top line of how a country was doing; they never looked at inequalities within a country. So we've made a lot of progress on the Sustainable Development Goals, at least in the formulation.

I will say that Columbia University, we were brought in to do the methodology around 5.62—sorry to be so technical but—

MARÍA ANTONIETA ALCALDE: I know what she's talking about.

TERRY MCGOVERN: You know what I'm talking about. That's the Sustainable Development Goal that is for the first time to measure the number of countries that have laws that guarantee access to sexual and reproductive health—very important. But immediately, these have to be negotiated by member states. Are you going to ask questions about abortion? Are you going to ask questions about an unmarried adolescent girl's ability to consent? Are you going to ask questions about a third party's ability to make decisions for women in certain countries?

We went in originally, and we took the International Conference on Population and Development (ICPD), which is the broadest kind of international agreement on sexual reproductive health, and asked questions that matched each section of it, and the United Nations was like: "We could never give this many questions to the countries."

So this is ultimately a political situation. The countries have to agree. Then, who fills out these questions at the country level is another big question. How do you guarantee that it's reliable? How do you guarantee that it's valid? We have these surveys, and they're helpful, but I think we really have to go much deeper in looking at what's really going on in a lot of these contexts.

Yes, I think they're an improvement, but I think they are going to have to be carefully watched.

MARÍA ANTONIETA ALCALDE: One of the challenges, as you were mentioning, is political will. I participated closely in the process of development of the SDGs, and I have to say it's not only the SDGs on health, whether it's SDG 3 or 5, like gender inequality. For the first time in history, we have a goal on inequalities at SDG 10 that is to reduce inequalities within countries, but as you were saying, Terry, among countries, and to think: How can we build a more equal world? But at the end, it comes back to the national level, and to ensure that we have political will at the national level.

Talking about the national level, I think that it's impossible to have this conversation without talking about the big elephant in the room, and that's the results of the U.S. elections. I really would like to have your input in terms of how do you feel that—I just will take for granted that globally women's rights and sexual reproductive rights will be affected by the results of the elections. But what's your take on how much it will be affected? What is your perspective on that?

TERRY MCGOVERN: Since the United States is a part of the globe, let me start with the impact in the United States. We have had, I think, 288 restrictions introduced at the state level on abortion. The president-elect is very clear that he wants to see Planned Parenthood de-funded, and there's lots of data that shows that Planned Parenthood really works with low-income women of color, communities of color, so there are some big problems in the United States to begin with.

Of course, part of the platform was to overturn Roe v. Wade, and that could happen either by passage of a law that is basically going to gut Roe v. Wade, or it can happen based on one of these state-restriction cases. Of course, the question is: How many Supreme Court justices will turn over? I just have to say in the context in the United States where we have a shockingly high maternal mortality rate, where we've seen some progress in reduction of teen pregnancies because of access, I'm very worried about the situation here.

But in terms of foreign assistance, there is a many-faceted potential impact. What President-elect Trump said was that he would reinstate the Mexico City Policy, otherwise known as the "abortion gag rule," which is that any organization getting U.S. assistance, U.S. aid, cannot even counsel or make referrals about abortions, or they lose their funding. This is a policy that has come and gone with different administrations. It was repealed in the last administration, but there is a lot of evidence that shows that that actually just leads to a whole lot of unsafe abortions, more pregnancy, because you're shutting down services that are really promoting health. That's one thing.

Another thing is that we see these kind of requirements or programming around abstinence and whether you can talk about sexuality, whether you can't talk about sexuality, how much you'll touch law issues—all of these things are actually impacted by the political viewpoint of the leadership. That also goes to the UN. In effect, the United States, because we're such a huge donor, pretty much helps select the head of the United Nations Children's Fund (UNICEF). That's where the Convention on the Rights of the Child and all the adolescent issues sit. We are a major donor of the United Nations Population Fund (UNFPA), which is the global agency looking at sexual and reproductive health. You can go down the list. I think people don't really know yet, but there could be profound impacts on global health.

Just quickly to say one other thing, there is the whole issue of conflict. We at Columbia have a huge forced migration program, and we look a lot at sexual and reproductive health of women in forced migration situations. That is already so tenuous, the lack of services. There are no abortion services; there is very little access to justice in the context of sexual violence. The imposition of more restrictions in this area is really, to me, very sad.

MARÍA ANTONIETA ALCALDE: I think we're living in a very scary time in terms of what's ahead of us because this is a—you were mentioning the global gag rule. For me, the United States has been in general an important donor on family planning. Even during the Bush administration, the United States was providing—I think right now it's around 40 percent of the international funding for family planning. There are some countries and some organizations that without U.S. support wouldn't be able to provide basic services like delivery and family planning services.

What is devastating about the global gag rule is that it prohibits organizations to do any work related to abortion, not only with U.S. money, but with any resources that they have. If 90 percent of your budget is from other sources, and 10 percent is from the United States, then you cannot do anything, and that anything is not even services—it's information, it's referrals. That really creates a big problem for organizations that are aware. IPPF is one of those organizations. We have clinics in the field, and we are aware.

We are torn in the middle between knowing the needs of women and having to respond to the needs of women in the field, and some of those needs are abortion services or abortion counseling, and having to refuse that service is a huge problem—I cannot even give you information about it—or losing an important donor. It's a choice like Sophie's Choice in terms of what to do as an organization. This is what the scenario looks like with the United States, and as you said it's a prominent player in the field.

TERRY MCGOVERN: I think also where abortion is legal, it's safe; where it's illegal, it's unsafe. I think people maybe don't realize that 50 percent of the deaths related to abortion are in young women—women younger than 25—so there are devastating impacts on all of this to young people—not just young people, but that is pretty prominent.

MARÍA ANTONIETA ALCALDE: As you said, it's not only abortion. What we know prevents abortion is comprehensive sexual education and access to family planning. The problem is that conservative groups, including what seems to be the next U.S. government, do not just have very regressive policies on abortion, they're going to have regressive policies in the things that we know can actually prevent abortion, like having abstinence-only programs and denying women access to contraceptives or making emergency contraceptives unavailable. We will then increase the number of women who then will need access to some services that we won't be able to provide, so that's very scary.

I want to have some time for audience questions, so I don't want to end the conversation on a sad note or with a gloomy feeling, so I would like to ask you: With this scenario, do you have hope? Do you see some lights in terms of hope, in terms of sexual reproductive health and women's rights?

TERRY MCGOVERN: In the last 20 years, we've seen a huge 50-percent decrease in maternal mortality around the world, we've seen an uptake on contraceptive availability, we've seen safer abortions in more places. There are some improvements, for sure.

I guess what gives me the most hope is working with young women around the world. There's activism all over the place, and whatever shock and dismay some people may be feeling here about some of this, people are certainly feeling and organizing around the world.

I always like to say that when I first became a lawyer I worked as a lawyer doing legal work with the AIDS Coalition to Unleash Power (ACT UP). Reagan was president, and all these young men were dying of AIDS, and they taught me about creative resistance and joyful creative resistance. I think we're going to have to start thinking about strategies that are a little bit different than those we've used in the past. We're in a whole new landscape, but I do take a lot of inspiration from what I see in the field.

MARÍA ANTONIETA ALCALDE: I fully agree with you. I have the privilege of working with a lot of young people globally, in Latin America and the Caribbean, and you're right. I think that these struggles and these setbacks really bring together large numbers of people marching in the streets here in the United States, but also overseas, trying to think about how to ensure that their values and their perspectives really prevail.

I think that as a movement it's in these moments of struggle when we get together and work through our differences and really strengthen. It can be very challenging. We're seeing it also as an opportunity to bring new voices and to have the opportunity to listen to people and to incorporate their concerns into our work.



I got out of this talk so far that the opposition, at least to some of the advocacy that you've been doing, seemed to be conservative governments in our country and the men in power in sub-Saharan Africa. I was just wondering: How do you deal with people who feel that their religion is the driving force behind why they're fighting against abortion or why they're advocating for gender inequality and they're not accepting of consent for young women, and use that as the driving force and not necessarily their independent ideological beliefs?

MARÍA ANTONIETA ALCALDE: That's a very good question. Within all the religions, I think we see voices claiming for women's rights and gender equality, and of course there is a spectrum. You see within those spectra more conservative voices. I am from Latin America, as I think I already said a couple of times, and the Catholic Church is very strong in Latin America, and the Catholics' values are really strong. But within the religion, there are priests and nuns who are working for gender equality. I think what we are trying to do—and we at IPPF have worked closely with a lot of faith-based organizations that care about health, that have been working with HIV patients knowing that maybe they don't agree with some of the lifestyles of the gay community but that they are there to help them.

So I think that there are certain values that we all share within the religious community and within the sexual reproductive rights community in terms of caring for the well-being of people. With the communities that we work with, like faith communities, we use those values to create common ground, knowing that we may not agree on everything, but working on the issues that we agree on.

I think there are more extreme voices, and it's hard to find common ground with them, but I feel that if we work with those people, that the vast majority are really the ones who care about the well-being of people and are willing to work in that common ground. That's the way that we approach it, and that's the way that we do it.

TERRY MCGOVERN: Absolutely. I think there's really also some very interesting work going on around culture, and women and girls' rights to participate in culture. Farida Shaheed from Pakistan and Sylvia Tamale from Uganda are very much taking on what they call the "patriarchal version of what culture is." They are using all kinds of techniques, unearthing history, versions where women had different roles. They're actually challenging what they're saying is the "patriarchal interpretation of culture." It's this movement for the right to participate and make culture whether you're a girl or you're LGBT (lesbian, gay, bisexual, transgender) or whatever, which I find really interesting because it's always been kind of culture versus rights oppositionalized, but they're interrogating who owns culture.

QUESTION: I just want to say thank you again for being here tonight. I'm Olivia. I'm with the BGIA program.

I suppose my question is about the advocacy piece and how in certain societies it's dangerous to be an advocate—you're putting your life at risk—and how International Planned Parenthood, for instance, would empower and support women and advocates to pursue their agenda in a safe way and what that might look like; for instance, in certain regions of Central America, how that changes country to country, and what are some of the methods that IPPF would suggest.

MARÍA ANTONIETA ALCALDE: I think that's a very good question, and that's something that we are very concerned about as part of the human rights movement. Being a human rights activist is very dangerous, being a women's rights activist, being a gay activist, working on climate change—I think at every point where there's someone fighting out there in that struggle, it is jeopardizing the interests of the powerful and the wealthy, and that's a point where people could be in danger.

The way that we approach it in terms—and this is a huge diverse group. I was a youth activist a long time ago. Within the small group that I was working with, we did a lot of self-defense, but not only physical defense, like training as part of being part of the activists—not only training, but also creating a safe space in terms of how do you react when suddenly you are in an event and people start shouting horrible things at you, like "you are a murderer," or "you are a slut." How can you hold on while that is happening?

I think that the type of violence that human rights activists and gender equality activists face is very broad. There are several programs, as I said, in terms of helping you to cope with this.

We are a very tight community, too, so most of the time it's not that there is one person out there. It's an organization that is supported, there is an international community. There is a sense I think now with the Internet and with social media of protection in terms of—we just had a case in Nicaragua doing a march on September 28 for abortion legalization. A group of women were taken by police, and we didn't know where they were taken. Suddenly a whole chain of social media responded. In a matter of minutes I think we all received messages. Everyone started mobilizing, people who knew people in Nicaragua, making phone calls, and they were released.

We don't have just one program for protection, and I have to say that it is very important that we raise the cases. We just had a case in Honduras with Berta Cáceres. So it is important that we know about it, that we are part of this network of protection of human rights defenders, and that we raise those cases, because honestly it is impossible to keep them safe unless we keep them visible.

QUESTION: Hi. My name is Sidney. Thank you both for being here.

My question is related to the fact that I think the United States is very well known for typically being a fairly progressive country. I think it's really interesting how when you look at reproductive health care, especially in the United States, access is becoming dependent on a woman's zip code, and access in New York is very different from access in other states. I'm very lucky to be a resident of New York, but when you go to states like Alabama or Mississippi or Louisiana that currently only have one abortion clinic, it's almost like another world.

My question for you guys is: How does that compare when you look at those specific states or other states like Texas or Ohio that are currently in the news for very restrictive laws being passed there? How does that compare to the work that you do in Latin America or sub-Saharan Africa?

TERRY MCGOVERN: It's frankly very similar. First, in many countries around the world abortion is illegal, two-thirds, I think, of countries in Africa and Asia. We're talking very similar situations.

I think we'll find that the spike in maternal mortality has to do also with lack of access to abortion in places. People have to travel great distances. People are doing things that are unsafe. There's a perception that you can use other methods, but you still need to have some form of supervision in using other methods, so to me it's very similar. I've actually worked a lot in the U.S. South.

MARÍA ANTONIETA ALCALDE: I think it is very interesting about this perception about the United States—and I may be very politically incorrect here. When I moved to the United States, I lived in Brooklyn, but I was very surprised to see how this idea of a really progressive country—it's not really it. It depends on where you live, but you see, for example, that things we are fighting for are things that we have already achieved in most of the countries in the world. Most of the countries in the world already have ratified CEDAW, for example—not the United States; the CEDAW protocol, we're aiming for that.

When it come to inequalities, this country is one of the most unequal countries in the world. When it comes to teenage pregnancy, in many countries we're really aiming to reduce teenage pregnancy. Teenage pregnancy in the United States is going even higher when in most countries it's really reducing.

If you see the sexual education programs in schools, some countries, like in Latin America, stopped using them in the 1970s because they knew they were not working. I think that many times there is a kind of mask: You are in the front of the world, super-progresssive, but this is hiding all the inequalities, all the regressions that are really in the United States.

I think it is really important to show this. It is really important for American people to point at those inequalities. Again, I've been very involved in the Sustainable Development Goals, so I'm biased, but I think the Sustainable Development Goals in a way gives you a different opportunity from the Millennium Development Goals. The MDGs were an agenda that was kind of funded by the North and implemented in the South. It was a poverty-reduction agenda, mostly with this idea.

One of the big negotiation points when the SDGs were being negotiated was to say: This is a universal agenda that needs to be implemented everywhere, and every country must come back to this stage or that stage of the UN and report what they are going to reduce maternal mortality, to reduce poverty. That gives everyone an opportunity, especially the countries in the North, like the United States, for civil society to go and ask your government: "What are you doing to reduce SDG 10 inequalities? What are you doing to reduce inequalities in the United States? What are you doing to reduce maternal mortality in the United States?"

I think that is a possibility to bring to an international forum the reality of the United States that is, as you were saying, a very uneven reality. I think that's a very good question, and American people have an opportunity to use that space to really out or make more visible the reality in the United States.

TERRY MCGOVERN: Even that question I was working on: Do we have laws that guarantee access to sexual and reproductive health? Do we? What's your definition of "sexual and reproductive health?" Is abortion in it? Does it exist for girls 15 and above? You'd really have to answer that question probably "No," if you look at the majority of states and you include abortion.

MARÍA ANTONIETA ALCALDE: I remember during the discussions on the inclusion or not of contraceptives on insurance—I was already living here—I was surprised. I was completely shocked.

I'm Mexican. In Mexico, we have a different type of system. We have social security and the government provides a lot of services. Contraceptives are free for everyone. You go to the clinic. It's a system like in many countries. The social system is in crisis, they have a lot of needs, they're under-funded, but one discussion that we are not having is whether women have the right to practice contraception. There are many other discussions.

I was very surprised how strong and violent the question about access to contraception was. Again, how is it that the most progressive country in the world is having this discussion when we have had access to free contraceptives for everyone, even people under 18, for free since, I don't know, the 1980s.

QUESTION: Hello. My name is Sofia Villalon.

This topic is very familiar with the UN, and there has been a topic around: Is the Security Council being reformed? That begs the question of CEDAW and the UN, and then you have the five permanent members that hold the veto power, and the United States is one of them.

It baffles me what you just said, that Mexico has programs available readily. The United States is very progressive, and it holds this veto power. I know you said that maintaining activism is very important. What else can we do besides just marching on the streets, something that's loud, something that's proud, something that says we want change in the United States, not only like in progressive, liberal-type states, but also everywhere in the country, like abroad, everything that encompasses global women's rights, global reproductive rights?

TERRY MCGOVERN: I work at a school of public health. We're trying to actually make a plan right now to measure immediate impacts of some of the things that we're afraid are about to happen. It's very important to actually show what has happened. Some people say we're now living in a post-fact world. We're not giving up yet on that. So we need to measure, actually, what these changes are going to cost in terms of human lives.

I do think you're raising, though, a very important issue, which is the limitations of the UN system when it's kind of built upon member state agreement and negotiation. I think it is a really important discussion to be having: What are the limitations of the UN given that so many member states may not be representing the people in their country when they are doing what they do at the UN?

MARÍA ANTONIETA ALCALDE: For me, the UN is a system that has been reforming since the second day that it was created. It is going through different reforms, the Security Council, [inaudible] because I think people recognize that it's an institution with flaws, with a huge mandate like human rights, social development, economic development, security, etc.

Knowing that, it is the best institution because it's the one that we have. Again, living in the United States, I have been very concerned about the conversation about the UN and how young people in the United States are like: "We don't believe in the UN; it's not useful. We can police the world ourselves."

I'm really concerned about that because the UN—and I agree, having five countries that have all this power is really dangerous—is an institution that helps us to have those global conversations. It's a forum for smaller countries to really amplify their voices. It's a forum for civil society to bring our own voices. I think we need to talk about reforming the UN and those type of things without throwing out the baby with the bathwater because it is important to protect it.

In the sense of what we can do in terms of mobilization, as I was saying before, we have at least four years of strong struggle. This is the time to be creative. We are relying on you, the younger generation, to let us know creative ways. I think right now we're all like, "Yeah, what will happen," and we're kind of excited and want to do something. We're going to get tired.

I didn't do any international advocacy for a while, and I had to do UN work during the Bush era, and it was amazing how in the first year and the second year, a lot of people were coming. The last year, or the last maybe three or four years, there were maybe two of us sitting in the basement of the UN, holding the ground, because you get tired of not winning.

So I think it is important that we maintain the spaces, the communications, and that we are informed. Even if we cannot fully advance the agenda we would like to hold ground. As I was saying, we are really relying on younger generations to come up with bright and funny ideas on how to communicate our message and on how to mobilize people because at the end that's what we need.

QUESTION: I have two questions, and they go together. The first is: If the policies that we were talking about that we are afraid of with Trump's presidency actually end up being followed through on, who ends up taking that position of leadership in reproductive health if America suddenly stops funding every organization that supports abortion?

The other part of the question is: Especially if these policies change so often as when we elect a new president, what are some ways that we can stabilize our progress?

TERRY MCGOVERN: I want to point out that the United States President's Emergency Plan for AIDS Relief (PEPFAR), which is the big HIV initiative, was created under a Republican administration, so not everything goes. Unfortunately, abortion is always in the cross-hairs; family planning, I would say, does better. You can see certain components of sexual and reproductive health exist and go on in Republican times and Democratic times.

It is the abortion issue. I think, to answer, a lot of other donors try to step in and cover. A lot of private donors try to step in and cover. In fact, there is a lot of involvement of private donors in the whole issue of providing contraceptive coverage, etc. But I also think that there are lots of people trying to make inroads so that there is some stability around some of these programs. I think people are still hoping that everything won't just go.

To go back to the point about the UN: The UN was created after World War II to elevate human dignity and prevent preventable suffering, so the UN has to—even in the face of member states that actually want to violate human rights—stand the ground. We have a lot of agencies that actually know all about these issues. They're not able to implement them on the ground, but they know what they are, and I think will work to try to prevent complete and total disaster in this whole area. Ultimately you can do an economic analysis—an investment analysis—of why you don't want to stop providing this support in the world. There's lots of reasons to do it.

MARÍA ANTONIETA ALCALDE: I think that when George W. Bush took the presidency, he reestablished the global gag rule, and then the European countries got together and created what was called at the time the "decency fund," to cover that gap. Right now, looking at the landscape, it doesn't look like the Europeans, with the refugee crisis and the debt crisis, will be able to make that happen. But I think people are already thinking some big individual donors and private foundations will do that.

But at the end, many organizations will have to take the gag rule and will continue providing family-planning services and HIV services, but not abortion services. At the end, who's going to pay the bill is all of the women who don't have access to abortion.

Here it comes again, the issue of inequality: It's not the wealthy women who will suffer, because if you have the means, you can pay to have an abortion in any country, even the countries that have—Latin America has the countries with the most restrictions on abortion. There are six countries in the world that fully ban abortion, even when the life of the woman is in danger. Even if you're having an ectopic pregnancy and your fallopian tube will explode if you don't have an abortion, the doctor cannot intervene. Those countries are: Nicaragua, El Salvador, Dominican Republic, Chile, Honduras, and the Vatican—but they don't have women, so they don't have that problem. They do have women, sorry, but they don't get pregnant, or they do get pregnant, but that's another story. 

The other countries have a certain means to have access to abortion. So in countries like Chile, El Salvador, and Nicaragua, if you have money, you can have access to an abortion.

That is why abortion is, although we talk about it as a reproductive rights issue, a justice issue. Also it's a development issue. If women cannot access contraceptives, if women have high maternal mortality, at the end the economy suffers if you have a big part of your workforce who is not even able to participate in that.

Who's going to pay for this in terms of who is going to cover the gap? We hope that some private foundations and some governments will do that, but at the end, who's going to pay for it? It's women.

QUESTION: Vincent McGee.

I have a comment and then a question. One of the things that we have to focus on more and more going forward is that we have to find ways to have these conversations at home, not only in New York City or at school or in our workplaces. If we learned anything from this election, it's that many of us are out of touch with what a majority, for whatever reason, voted, and we have to think about that.

Look at the history of gender and sexual diversity. AIDS was a scourge, but it created the opportunity, and it forced people to talk about sexuality, and it changed a lot of thinking. We need to find opportunities and to remind people that reproductive health isn't only about abortion, although abortion is a key point.

Another thing is to have simple statistics that can open the door to conversations. In reading all of the coverage about Fidel Castro's death, there was almost no mention of the positive health situation and structures in Cuba and the fact—I think I'm correct—that Cuba has about the lowest infant mortality and maternal mortality rates in the world and the highest literacy rates in the world, higher than the United States. We have to find ways to look for those kinds of statistics and to bring them not into people's faces, but into the conversation in a way that opens the possibility of change of opinions and activation.

MARÍA ANTONIETA ALCALDE: Yes. I think engaging in conversation is important, and not only talking to the people who will agree with you but engaging in an open conversation to understand the value. The results of the U.S. election is one opportunity. We can just take it as: "We're right, we're superior because we're smarter, and you made a mistake because you're ignorant and you don't know what you're doing," or we can try to engage and try to understand the values and the principles and why so many people decided that this was the best thing.

I think we need to engage in those conversations and find the common ground. I've been talking a lot like a foreign person who moved to the United States, but I've been really surprised to see how the abortion discussion—I think that there is no country in the world where the abortion conversation is so polarized like in the United States. I haven't seen in other countries doctors being murdered because they perform abortions. I think finding common ground, finding dialogue is important, although it's hard.

Also, as you said, looking at the cases with good outcomes, like in the case of Cuba, like zero maternal mortality for abortion. In the case of Uruguay that decriminalized abortion a couple of years ago, there is zero maternal mortality due to unsafe abortion. This is huge.

One final note: Sexual reproductive human rights is not only about abortion. There are many other things—access to contraception is still an issue; fistulas, sexually transmitted infections, HIV. There are many things. At the end, what we're talking about is people being able to make decisions about the most basic and fundamental elements of life: who you love and who do you want to be; if you want to have kids or not, and when. These are really fundamental things, and it shouldn't be a privilege to be able to make these decisions. Right now, with the world as it is, it is a privilege. At the end, it's a social justice issue.

TERRY MCGOVERN: I totally agree. I do think we need to really kind of reset and think about how we talk in our conversations, but also how in this election certain issues were just kind of—the whole sexual and reproductive health issue collapsed around abortion. There are real health outcomes that are linked to all kinds of health outcomes, to closing, to de-funding Planned Parenthood, for example. I think we really have to take back the discussion and have it in many more places, and also publicize exactly how bad the health outcomes are in this country around these issues comparatively.

MARÍA ANTONIETA ALCALDE: Thank you very much. I think we need to close now.

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