The Ethics and Law of Contraception and Abortion - PowerPoint Presentation

1. The Ethics and Law of Contraception and Abortion&Reproductive JusticeDr. Munir Kassa (MD)

2. Conflict of InterestNone

3. Overview of the Presentation Ethical foundations for professional activities in the field of obstetrics and gynecology The role of OBGYNs as advocates for women’s rights Contraception and abortion: The Ethiopian Medical Association’s Code of Ethics Contraception and abortion: The International Federation of Gynecology and Obstetrics Code of Ethics Ethiopia’s abortion law Legality of conscientious objection in Ethiopia The components of reproductive justice

4. Part One: Foundations of the Codes of Ethics for OBGYNsESOG (in the process of writing one)EMA- medical ethics for doctors in Ethiopia- 2010FIGO, ACOG, AMALet us begin with ACOG’s Code of Ethics…

5. 1. The Patient-Physician Relationship The patient–physician relationship: The welfare of the patient (beneficence) is central to all considerations in the patient–physician relationship. Included in this relationship is the obligation of physicians to respect the rights of patients. The respect for the right of individual patients to make their own choices about their health care (autonomy) is fundamental. The principle of justice requires strict avoidance of discrimination on the basis of race, color, religion, national origin, sexual orientation, perceived gender, and any basis that would constitute illegal discrimination (justice).

6. 2. Physician Conduct and Practice The obstetrician–gynecologist must deal honestly with patients and colleagues (veracity). This includes not misrepresenting himself or herself through any form of communication in an untruthful, misleading, or deceptive manner. Furthermore, maintenance of medical competence through study, application, and enhancement of medical knowledge and skills is an obligation of practicing physicians. Any behavior that diminishes a physician’s capability to practice, such as substance abuse, must be immediately addressed and rehabilitative services instituted.

7. 3. Avoiding Conflicts of Interest Potential conflicts of interest are inherent in the practice of medicine. Physicians are expected to recognize such situations and deal with them through public disclosure. Conflicts of interest should be resolved in accordance with the best interest of the patient, respecting a woman’s autonomy to make health care decisions.

8. 4. Professional Relations The obstetrician–gynecologist should respect and cooperate with other physicians, nurses, and health care professionals.

9. 5. Societal Responsibilities The OBGYN has a continuing responsibility to society as a whole and should support and participate in activities that enhance the community. As a member of society, the OBGYN should respect the laws of that society. As professionals and members of medical societies, physicians are required to uphold the dignity and honor of the profession.

10. EMA’s Medical Ethics for Doctors in Ethiopia XII: AbortionArticle 54: The first moral principle imposed upon the doctor is respect for human life from its beginning. Article 55: An abortion is justified only when it is performed for the purpose of saving the endangered life or health of a woman. Article 56: Abortion is justifiable if performed by a doctor in health institutions where appropriate facilities are available. Article 57: It is mandatory to treat a patient who is suffering from the effect of an abortion induced by another person. Article 58: The doctor must never disclose the cause of her/his patient's condition to anyone else without the consent of the patient unless ordered to do so in court of law. Article 59: An abortion leading to death should be reported to the concerned authorities by the treating doctor.

11. EMA’s Medical Ethics for Doctors in Ethiopia XIII: Family Planning Article 60: It is ethical for a doctor if she/he informs, educates and communicates knowledge of family planning to individuals, families or the general public. Article 61: It is the duty of a doctor to prescribe scientifically acceptable means and methods of family planning to individuals or couples who have attained the age of 18 years and who freely and responsibly decide to postpone or prevent pregnancy.

12. FIGO Code of Ethics ETHICAL ISSUES IN OBSTETRICS AND GYNECOLOGY by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’s Health, OCTOBER 2015

13. The Role of OBGYNs as Advocates for Women’s HealthOur ethical obligation to be advocates:Our knowledge on sexual and reproductive health Women come to us first, so it is our duty to provide careA strong knowledge base and social standing is helpful for advocacy for policy changeWomen are uniquely vulnerable due to their reproductive function and role, social discrimination, GBV and lack of power, this increases our obligation!

14. The Role of OBGYNs as Advocates for Women’s Health Continued…Unequal exposure to violence, poverty, malnutrition and denial of opportunity for education and employment will lead to unjust SRH and access to health care.When possible, monitor and publicize RH data and suggest improvements.Wrong policies deleteriously affect the care that we provide.We should inform the community about the problems of SRH and promote a wide debate to improve policies and legislation.

15. Definition of Pregnancy Natural human reproduction is a process which involves the production of male and female gametes and their union at fertilization. Pregnancy is that part of the process that commences with the implantation of the conceptus in a woman, and ends with either the birth of an infant or an abortion.Verification of this is usually only possible at the present time at 3 weeks or more after implantation.WHO definition of a birth: 22 weeks’ menstrual age or more

16. Safe Moterhood Maternity is a social function and not a disease. Societies have an obligation to protect women’s right to life when they go through the risky business of this social function that ensures the survival of our species. Maternal health care is not only important for avoiding maternal mortality and morbidity, but is also crucial for reducing the high burden of perinatal mortality and morbidity.

17. Safe Motherhood: RecommendationsWomen’s mortality related to pregnancy remains unacceptably high, particularly in resource poor areas. Prevention of maternal death should be considered worldwide as a public health priority. Where abortion is not against the law, every woman should have the right, after appropriate counselling, to have access to medication or surgical abortion. The health care service has an obligation to provide such services as safely as possible. Family planning services and information should be made available for the timing and spacing of births.

18. Ethical Aspects of Induced Abortion for Non-Medical Reasons Induced abortion may be defined as the termination of pregnancy using drugs or surgical intervention after implantation and before the conceptus has become independently viable (WHO definition of a birth: 22 weeks’ menstrual age or more).

19. Abortion is Very Widely Considered to be Ethically Justified when…Undertaken or medical reasons to protect the life or health of the mother in cases of molar or ectopic pregnancies and malignant disease. Most people would also consider it to be justified in cases of incest or rape,when the conceptus is severely malformed, or when the mother’s life is threatened by other serious disease.

20. The Use of Abortion for Other Social Reasons Remains very controversial because of the ethical dilemmas it presents to both women and the medical team. Women frequently agonize over their difficult choice, making what they regard in the circumstances to be the least worse decision. Health care providers wrestle with the moral values of preserving life, of providing care to women and of avoiding unsafe abortions.

21. The Use of Abortion for Other Social Reasons Continued… Abortion should never be promoted as a method of family planning. Women have the right to make a choice on whether or not to reproduce, and should therefore have access to legal, safe, effective, acceptable and affordable methods of contraception. Provided that process of properly informed consent has been carried out, a woman’s right to autonomy, combined with the need to prevent unsafe abortion, justifies the provision of safe abortion.

22. The Use of Abortion for Other Social Reasons Continued… Most people, including physicians, prefer to avoid termination of pregnancy, and it is with regret that they may judge it to be the best course, given a woman’s circumstances. Some doctors feel that abortion is not permissible whatever the circumstances. Respect for their autonomy means that no doctor should be expected to advise or perform an abortion against his or her personal conviction. Their careers should not be prejudiced as a result. Such a doctor, however, has an obligation to refer the woman to a colleague who is not in principle opposed to inducing termination.

23. The Use of Abortion for Other Social Reasons Continued… Neither society, nor members of the health care team responsible for counseling women, have the right to impose their religious or cultural convictions regarding abortion on those whose attitudes are different. Counseling should include objective information. Very careful counseling is required for minors. When competent to give informed consent, their wishes should be respected. When they are not considered competent, the advice of the parents or guardians and when appropriate the courts, should be considered before determining management.

24. The Use of Abortion for Other Social Reasons Continued… The termination of pregnancy for non-medical reasons is best provided by the health care service on a non-profit-making basis. Post-abortion counseling on fertility control should always be provided In summary, the Committee recommends that after appropriate counseling, a woman has the right to have access to medical or surgical induced abortion, and that the health care service has an obligation to provide such services as safely as possible.

25. Permits medical providers to refuse to provide certain health services based on religious or moral objections. Conscientious Objection (CO)

26. Ethical Guidelines on Conscientious ObjectionThe primary conscientious duty of obstetrician-gynecologists is at all times to treat, or provide benefit and prevent harm to, the patients for whose care they are responsible. Any conscientious objection to treating a patient is secondary to this primary duty. Practitioners who find themselves unable to deliver medically indicated care to their patients for reasons of their personal conscience still bear ethical responsibilities to them.

27. Conflict of InterestWhen practitioners feel obliged to place their personal conscientious interests before their patients’ interests, they have a conflict of interest. Not all conflicts can be avoided, but when they cannot, they can be resolved by due disclosure; that is, practitioners must inform potential patients of the treatments in which they object to participate on grounds of their personal conscience.

28. Conflict of Interest2. Provision of Benefit and Prevention of Harm require that practitioners provide such patients with timely access to medical services, including giving information about the medically indicated options of procedures for their care and of any such procedures in which their practitioners object to participate on grounds of conscience.

29. Conflict of Interest3. Practitioners have a professional duty to abide by scientifically and professionally determined definitions of reproductive health services, and to exercise care and integrity not to misrepresent or mischaracterize them on the basis of personal beliefs.4. Practitioners have a right to respect for their conscientious convictions in regard to both undertaking and not undertaking the delivery of lawful procedures, and not to suffer discrimination on the basis of their convictions.

30. Conflict of Interest5. Practitioners’ right to respect for their choices in the medical procedures in which they participate requires that they respect patients’ choices within the medically indicated options for their care.6. Patients are entitled to be referred in good faith, for procedures medically indicated for their care that their practitioners object to undertaking, to practitioners who do not object. Referral for services does not constitute participation in any procedures agreed upon between patients and the practitioners to whom they are referred.

31. Conflict of Interest7. Practitioners must provide timely care to their patients when referral to other practitioners is not possible and delay would jeopardize patients’ health and well-being, such as by patients experiencing unwanted pregnancy 8. In emergency situations, to preserve life or physical or mental health, practitioners must provide the medically indicated care of their patients’ choice regardless of the practitioners’ personal objections.

32. Conscientious Objection Should it be universal? Does it apply to resource limited countries? When does it become unethical? Is it legal?

33. The Limits of Conscientious Objection to Abortion in the Developing World, Louis-Jaqcues van Bogaert, Developing World Bioethics 2 (2), 131-143 Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. This is because referral procedures are fraught with major obstacles. Therefore … the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.

34. Conscientious objection to abortion provision: Why context matters, Laura Florence Harris, Jodi Halpern, Ndola Prata Conscientious objection to abortion–a clinician’s refusal to perform abortions because of moral or religious beliefs–is a limited right, intended to protect clinicians’ convictions while maintaining abortion access As the only legal way to refuse to provide abortions that are permitted by law, conscientious objection can become a safety valve for clinicians under pressure and may be claimed by clinicians who do not have moral or religious objections.

35. Physicians, Not Conscripts — Conscientious Objection in Health Care The New England Journal of Medicine engl j med376;14 nejm.org April 6, 2017 1380 Ronit Y. Stahl, Ph.D., and Ezekiel J. Emanuel, M.D., Ph.D.

36. The Views of Professional SocietiesAll tend to accept rather than question conscientious objection in health care. The American Medical Association (AMA) is internally inconsistent on conscientious objection. In its Code of Medical Ethics, the AMA insists that “physicians’ ethical responsibility [is] to place patients’ welfare above the physician’s own self-interest” (Opinion 1.1.1). Physicians must treat HIV pts for example.AMA forbids discrimination in selecting or rejecting patients on the basis of “race, gender, sexual orientation, or gender identity, or other personal or social characteristics that are not clinically relevant to the individual’s care” (Opinion 1.1.2).

37. But… Conversely, it permits physicians to refuse to treat patients who are seeking care that is “incompatible with the physician’s deeply held personal, religious, or moral beliefs” But the authors argue that physicians are professionalsAMA argues that physicians should not participate in executions, even if they personally accept the morality of capital punishment (Opinion 9.7.3).Physicians also must care for wounded enemy soldiers and refuse to participate in torture, regardless of their personal political allegiance.

38. We Chose Our Profession No one is forced to be a physician, nurse, pharmacist, or other health care professional or to choose a subspecialty within their larger field. It is a voluntary, individual choice. By entering a health care profession, the person assumes a professional obligation to place the well-being and rights of patients at the center of professional practice. Thus the Jehovah’s Witness surgeon cannot refuse to allow blood transfusions during the surgery.The catholic nurse cannot refuse to treat alcoholics.

39. Remember: In a freely chosen profession, conscientious objection cannot override patient care! No matter how sincerely held, objections to treating particular classes of patients are indefensible — regardless of whether the objections are based on race, gender, religion, nationality, or sexual orientation. A health care professional cannot provide medical services for a white, Christian person and conscientiously object to providing the same services to a Hispanic, Muslim.

40. Health care professionals who are unwilling to accept these limits have two choices: 1. Select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, 2. If there is no such area, leave the profession.

41. Recognizes CO as a barrier to lawful abortion services, it can impede women from reaching the services for which they are eligible, potentially contributing to unsafe abortion. In its recent edition of guidelines on safe abortion, WHO notes that health services should be organized in such a way as to ensure that an effective exercise of the freedom of conscience of health professionals does not prevent patients from obtaining access to services to which they are entitled under the applicable legislation. It recommends the establishment of national standards and guidelines facilitating access to and provision of safe abortion care, including the management of conscientious objectionWHO and CO

42. While important, the right to conscience is not absolute. Article 18(3) of the International Covenant provides that: “Freedom to manifest one’s religion or beliefs may be subject only to such limitations as…are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others.” The right of conscientious objection is an important freedom, but those who invoke it must show the same respect for other’s rights and freedoms as they require for their own. Referral does not constitute participation in any discussions that referred physicians have with patients, or in any procedures upon which such physicians and patients agree. Limits of Conscience

43. Failure to provide referral, information Failure to provide service when referral is not possible Actively place additional obstacles to the provision of safe and legal abortion services Facilities cannot have CO Claiming conscientious objection to hide personal convenience as a reason for refusing to provide safe abortion careWhen CO Becomes Unethical

44. The Ethiopian Law in Abortion Articles 14, 15, and 16 under Section I (Human Rights) of the Constitution refer to the rights to life, liberty, and security of the person. Article 35 refers to women’s equality with men and their rights to information and the capacity to be protected from the dangers of pregnancy and childbirth.

45. Article 551 of the Penal Code Allows Termination of Pregnancy Under the Following Conditions:a. The pregnancy is a result of rape or incest; or b. The continuation of the pregnancy endangers the life of the mother or the child or the health of the mother or where the birth of the child is a risk to the life or health of the mother; or c. The fetus has an incurable and serious deformity; or d. The pregnant woman, owing to a physical or mental deficiency she suffers from or her minority, is physically as well as mentally unfit to bring up the child. e. In the case of grave and imminent danger which can be averted only by an immediate intervention.

46. Abortion: Technical and Procedural Guideline in Ethiopia, FMOH, 2014 Ethiopian women carry a disproportionately high morbidity and mortality as compared to their counterparts in other parts of the world. Although we are witnessing a slow but steady change in the reproductive health status of women, improvement in the status of women desires much more focused attention investments, political commitment, and intersectoral collaborations. Pursuant to its national and global commitments to improve the well being of its citizens and changing social and gender dynamics, the Government of Ethiopia had taken several policy and legal measures over the last decade. The revision of the Criminal Code of the Ethiopia that came after more than five decades is among such notable measures. As an instrument for change and a tool for the security of the individual and the society, the Criminal Code would undoubtedly contribute to the overall development intentions of the nation.

47. This Guideline Translates the Law into Actionable Measures And envisages to inform women, health professionals, law enforcement agencies and all sectors of the society who care for well-being of women and their families. It is worthy of note here that this Guideline follows the launch of the National Reproductive Health Strategy that provides the framework for all our RH services and programs.

48. Hence… Health care providers at all levels are expected to not only have a good grasp of this Guideline, but also prepared to discharge their professional responsibilities as outlined in the document. The FMOH provides unreserved support and guidance to the implementation of the Guideline as an essential component of the strategy to reduce maternal morbidity and mortality.

49. Details - needs reading it No need for consent for minors Three working days

50. The Ethiopia Law on Conscientious Objection FEDERAL NEGARIT GAZETTE 20th year No 11, Addis Ababa, 24th January, 2014 Regulation number- 299/2013 FMHACA council of ministers regulation

51. Part Six: Health Professionals Chapter two: health professional code of conduct Article 84 -የግል እምነትና አገልግሎት የመስጠት ግዴታ‘ማንኛውም የጤና ባለሙያ የግል እምነቱን ምክኒያት በማድረግ እንደ ወሊድ መቆጣጠሪያ፡ህጋዊ ውርጃ ና ደም ማስተላለፍ የመሰለ የህክምና አገልግሎት አልሰጥም ማለት አይችልም’

52. Hence… Conscientious objection is illegal in Ethiopia.

53. Successful Examples of Disallowing ‘Conscientious Objection’ in Reproductive Health Care Christian Fiala, Kristina Gemzell Danielsson, Oskari Heikinheimo, Jens A. Gumundsson Reproductive health care is the only field in medicine where health care professionals (HCPs) are allowed to limit a patient’s access to a legal medical treatment – usually abortion or contraception – by citing their ‘freedom of conscience.’ However, the authors’ position is that ‘conscientious objection’ (‘CO’) in reproductive health care should be called dishonorable disobedience because it violates medical ethics and the right to lawful health care, and should therefore be disallowed.

54. Countries that Prohibit ‘CO’ Three countries – Sweden, Finland, and Iceland – do not generally permit HCPs in the public health care system to refuse to perform a legal medical service for reasons of ‘CO’ when the service is part of their professional duties. The purpose of investigating the laws and experiences of these countries was to show that disallowing ‘CO’ is workable and beneficial. It facilitates good access to reproductive health services because it reduces barriers and delays. Other benefits include the prioritization of evidence-based medicine, rational arguments, and democratic laws over faith-based refusals. Most notably, disallowing ‘CO’ protects women’s basic human rights, avoiding both discrimination and harms to health. Finally, holding HCPs accountable for their professional obligations to patients does not result in negative impacts.

55. It is legal and ethical to do abortion in Ethiopia, and FMOH recognizes it as one method of decreasing maternal death. HCPs should ALWAYS prioritize the patient’s interest ahead of their interest.Summary

56. THANK YOUANY QUESTIONS?

57. Part Two: Reproductive JusticeDefinition: The complete physical, mental, spiritual, political, social, and economic well-being of women and girls, based on the full achievement and protection of women’s human rights(1) the right to have a child; (2) the right not to have a child; and (3) the right to parent the children they have, Necessary enabling conditions to realize these rights

58. The Reproductive Justice Framework Analyzes how the ability of any woman to determine her own reproductive destiny is linked directly to the conditions in her community—and these conditions are not just a matter of individual choice and access. Reproductive Justice addresses the social reality of the inequality of opportunities. Moving beyond a demand for privacy and respect for individual decision making to include the social supports necessary for women’s individual decisions to be optimally realized. This includes obligations from government for protecting women’s human rights to make options safe, affordable and accessible.

59. Reproductive Oppression The control and exploitation of women, girls, and individuals through their bodies, sexuality, labor, and reproduction. There are three main frameworks for fighting reproductive oppression defined:1. Reproductive Health, which deals with service delivery2. Reproductive Rights, which addresses legal issues, and 3. Reproductive Justice, which focuses on movement building.

60. The Reproductive Justice Analysis Offers a framework for empowering women and girls relevant to every family. Instead of focusing on the means—a divisive debate on abortion and birth control that neglects the real-life experiences of women and girls— The Reproductive Justice analysis focuses on the ends: better lives for women, healthier families, and sustainable communities

61. The Key Strategies for Achieving this Vision Include: Supporting the leadership and power of the most excluded groups of women, girls and individuals within a culturally relevant context. Directly addressing the inequitable distribution of power and resources within the movement Building the social, political and economic power of low-income women, indigenous women, women of color, and their communities so that they are full participating partners in building this new movement..

62. 10 Reasons to Rethink Overpopulation Central requirement for reproductive justice is not only for women to have the right not to have children, but to also exercise the right to have children. Women have been denied this right through population control programs that care more about reducing birth rates than empowering women to have control over their reproductive health and right.

63. Here is WhyThe population ‘explosion’ is over- the era of rapid growth is over. birth rates have fallen in almost every part of the world and now average 2.7 births per woman.A narrow focus on human number places the blame on the people with the least amount of resources and power rather than on corrupt governments and rich elites as a cause for poverty and inequality.Hunger is not the result of ‘too many mouths’ to feed. Global food production has consistently outpaced population growth. People go hungry because they do not have the land on which to grow food or the money with which to buy it

64. 4. Population growth is not the driving force behind environmental degradation. Blaming environmental degradation on overpopulation lets the real culprits off the hook. The richest fifth of the world’s people consume 66 times as many resources as the poorest fifth. 5. Population pressure is not a root cause of political insecurity and conflict. youth bulge’ of too many young men whose numbers supposedly make them prone to violence. Blaming population pressure for instability takes the onus off powerful actors and political choices.

65. 6. Population control targets women’s fertility and restricts reproductive rights. All women should have access to high quality, voluntary reproductive health services, including safe birth control and abortion.7. Population control programs have a negative effect on basic health care. Under pressure from international population agencies, many poor countries made population control a higher priority than primary health care from the 1970s on. Reducing fertility was considered more important than preventing and treating debilitating diseases like malaria, improving maternal and child health, and addressing malnutrition.

66. 8. Population alarmism encourages apocalyptic thinking that legitimizes human right abuses.9. Threatening images of overpopulation reinforce racial and ethnic stereotypes and scapegoat immigrants and other vulnerable communities. For example: Third world, Muslims…10. Conventional views of overpopulation stand in the way of greater global understanding and solidarity. Fears of overpopulation are deeply divisive and harmful.

67. Abortion Rights and Reproductive Justice Because a woman’s ability to control her reproduction is fundamental to her ability to control her life, reproductive autonomy is a core aspect of reproductive justice. Achieving this goal requires access to safe abortion, comprehensive sex education, freedom from coerced sex, and birth control appropriate to each woman’s health and life. It also requires that women have all that they need to have and raise children.

68. Abortion Rights and Reproductive Justice Continued… While abortion rights are central to women’s freedom, they are only part of the picture. Within the reproductive rights movement, there has been frustration over the mainstream pro-choice movement’s singular focus on abortion, and its use of the framework of individual choice. The inadequacy of “choice,” the failure to disassociate abortion politics from population control, and reducing reproductive rights to the issue of abortion, alone, have divided feminists for decades. In contrast, the framework of reproductive justice is rejuvenating the meaning and practice of reproductive rights with an expansive multi-issue perspective and agenda for action.

69. Abortion is a matter of…Racial inequityEconomic justiceYouth issuesViolence: When a woman is coerced into an abortion by her abusive husband or partnerReligious intoleranceRights for people with disabilitiesImperialism

70. Conditions of Reproductive Justice Reproductive Justice recognizes women’s right to reproduce as a foundational human rightWomen’s right to manage their reproductive capacity1. The right to decide whether or not to become a mother and when;2. The right to primary culturally competent preventive health care;3. The right to accurate information about sexuality and reproduction;4. The right to accurate contraceptive information;5. The right and access to safe, respectful, and affordable contraceptive materials and services; and6. The right to abortion and access to full information about safe, respectful, affordable abortion services;7. The right to and equal access to the benefits of and information about the potential risks of reproductive technology.

71. Women’s Right to Adequate Information, Resources, Services and Personal Safety While Pregnant 1. The right and access to safe, respectful, and affordable medical care during and after 2. The right of incarcerated women to safe and respectful care during and after pregnancy, including the right to give birth in a safe, respectful, medically-appropriate environment;3. The right and access to economic security, including the right to earn a living wage;4. The right to physical safety, including the right to adequate housing and structural protections against rape and sexual violence;

72. 5. The right to practice religion or not, freely and safely, so that authorities cannot coerce women to undergo medical interventions that conflict with their religious convictions;6. The right to be pregnant in an environmentally safe context;7. The right to decide among birthing options and access to those services.

73. A Woman’s Right to be the Parent of Her Child1. The right to economic resources sufficient to be a parent, including the right to earn a living wage;2. The right to education and training in preparation for earning a living wage;3. The right to decide whether or not to be the parent of the child one gives birth to;4. The right to parent in a physically and environmentally safe context;5. The right to leave from work to care for newborns or others in need of care;6. The right to affordable, high-quality child care.

74. Sexual Rights Embrace human rights that are already recognized in national laws, international human rights documents and other consensus statements. They include the right of all persons, free of coercion, discrimination and violence, to: the highest attainable standard of sexual health, including access to sexual and reproductive health care services; seek, receive and impart information related to sexuality; sexuality education; respect for bodily integrity; choose their partner; decide to be sexually active or not; consensual sexual relations; consensual marriage; decide whether or not, and when, to have children; and pursue a satisfying, safe and pleasurable sexual life.

75. Reproductive Rights Embrace certain human rights that are already recognized in national laws, international human rights documents and other consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents.

76. And… Further, the right to reproductive health requires that reproductive health care goods and services, as well as programs, are widely available, economically and physically accessible, culturally acceptable, and of high quality. The right to reproductive autonomy also includes the rights to information, privacy and confidentiality when making decisions about one’s reproductive capacity and life.

77.

78. Sayingsሴት አሉሽ ምን ይበሉሽ？ሴት ያመነ ጉም የዘገነሴት ሲበዛ ጎመን ጠነዛየ ሴት ልጅ

79. EDHS 2016 Polygyny: Eleven percent of currently married women report that their husband has multiple wives. Age at first marriage: Marriage is nearly universal in Ethiopia, although women marry about 6.6 years earlier than men on average. Median age at first marriage is 17.1 years among women and 23.7 years among men age 25-49. Trends: Age at first marriage has dramatically changed for women and girls. More than 30% of women born in the seventies married before age 15, while for those born in the nineties, this indicator is around 10 percent.

80. Teenage pregnancy: Among women age 15-19, 10% are already mothers and 2% are pregnant with their first child. Age at first birth: The median age at first birth among women age 25-49 is 19.2 years.

81. Women Empowerment Employment and earnings: Forty-eight percent of currently married women age 15-49 were employed in the 12 months before the survey, compared with 99% of currently married men age 15-49 Decision to marry: The majority (61%) of ever-married women say their parents made the decision that they would get married the first time.

82. Sexual Violence Experience of violence: Among women age 15-49, 23% have experienced physical violence and 10% have experienced sexual violence. Four percent of women have experienced physical violence during a pregnancy. Marital control: Sixteen percent of ever-married women have experienced at least three types of marital control behaviors by their husbands or partners. Forty-three percent have never experienced marital control behaviors by their husbands or partners. Spousal violence: Thirty-four percent of ever-married women age 15-49 have experienced spousal physical, sexual, or emotional violence. Physical and emotional violence were experienced by 24% each, and sexual violence by10%. Injuries due to spousal violence: Twenty-two percent of ever-married women who experienced spousal, physical, or sexual violence reported injuries, including 19% who reported cuts, bruises, or aches and 10% who reported deep wounds and other serious injuries. Help seeking: About one-quarter of women who have experienced physical or sexual violence has sought help.

83. Marital Control Percentage of women whose current husband/partner (if currently married) or most recent husband/partner (if formerly married) demonstrates at least one of the following controlling behaviors: is jealous or angry if she talks to other men; frequently accuses her of being unfaithful; does not permit her to meet her female friends; tries to limit her contact with her family; and insists on knowing where she is at all times.

84. Reproductive justice links reproductive rights with the social, political and economic inequalities that affect a woman’s ability to access reproductive health care services. Core components of reproductive justice include equal access to safe abortion, affordable contraceptives and comprehensive sex education, as well as freedom from sexual violence. Reproductive health care requires reproductive justice.In Summary

85. THANK YOUANY QUESTIONS?