At the 2012 International HIV/AIDS Conference, presenters stressed the importance of sexual and reproductive rights. Starting with Secretary of State Clinton’s opening speech, where she said “every person deserves to decide the number and spacing of children, including HIV positive people,” the necessity of sexual and reproductive rights became a defining mantra of the Conference. This reveals a skewed understanding of international law. Whereas the right to found a family is a fundamental right that corresponds to the inherent dignity of every person, so-called “reproductive rights” represent a term that has been co-opted by abortion activists and is not recognized in international law.
Numerous sessions, workshops, and panel discussions dealt with these topics, using the terms “sexual health,” “reproductive health,” and “sexual and reproductive rights.” But rather than presenting a clear picture of what these terms mean under international law, presenters at the conference use these terms as synonyms. Reproductive health, reproductive health services, and reproductive rights are not synonyms. At the International Conference on Population and Development, States agreed to specific and nuanced definitions to these terms. When international actors and international conferences misuse these terms, they undermine the consensus definitions.
A number of conference participants stressed the importance of promoting the sexual and reproductive rights of women with HIV. Every human being, regardless of their HIV status, has inherent dignity, and a manifestation of that dignity is the ability to decide whether and when to have children. However, the right to found a family should not be conflated with “reproductive rights.” At the AIDS Conference, reproductive rights activists stressed “community sensitization and normalization of abortion” and call for legalization of abortion in international law as a means to “ensure protection of vulnerable young women.” Citing the dangers of back alley abortions procured by women in countries where abortion is illegal, speakers at the Conference advocated for the legalization of abortion. Speakers also commented on the danger of mother-to-child transmission, which is a risk borne by HIV-positive women who become pregnant. A representative from ICW and Ipas said in a panel on Tuesday afternoon, “HIV-positive women who become pregnant are making a responsible choice for themselves and their children by ending the pregnancy early.”
The call for abortion rights ignores international law and the guidelines established by the ICPD Programme of Action. International law does not include abortion as a component of reproductive health or reproductive rights. Rights to abortion are not included in any human rights treaty, and reproductive health services have never been defined to include abortion. In fact, the Programme of Action casts abortion as undesirable, confining its inclusion in reproductive health care and services to States where already legal, and saying “governments should take appropriate steps to help women avoid abortion, which in no case should be promoted as a method of family planning.” Abortion has never been an international human right. Participants at this conference who assert an international human right to abortion misstate international law.
The call for abortion rights ignores recent scientific developments that prevent mother-to-child transmission. Initiation of antiretroviral drugs during pregnancy can reduce transmission probabilities to almost zero, regardless of how advanced the mother’s HIV is. Continued antiretrovirals, administered to the mother while she is breastfeeding and to the baby during the first few weeks of life, are also highly effective at preventing transmission. A panel discussion hosted by AVSI on Wednesday morning explained how prevention of mother-to-child transmission (PMTCT) programs have been effective in reducing mother-to-child transmission in Uganda. Abortion does not address the situations of women who want to have children, and does not protect mother and baby throughout pregnancy and childbirth. It sends the message that HIV-positive women should not have children, undermining the very right abortion supporters purport to promote: the right to freely decide the number and spacing of children.
The call for abortion rights ignores the specific problems of the AIDS pandemic. In many countries, particularly those in Sub-Saharan Africa, AIDS is a generalized epidemic and is most commonly passed through heterosexual intercourse. Legalization of abortion will do nothing to curb this. Legalization of abortion will also be of no use in countries where HIV/AIDS is a concentrated epidemic among drug users and sex workers because it does not address the root causes of these behaviors.
A better response to the problem of HIV/AIDS is based on a holistic understanding of the person’s needs in prevention, treatment, care, and support. It would focus on the inherent dignity of the human person, and respond to that person’s capacity to make responsible choices. It would include measures for risk avoidance, such as antiretroviral therapy for mother and child.
Abortion is an inherently risky and destructive procedure and it does not address the drivers of HIV in a generalized epidemic: multiple concurrent partners, infidelity, and early initiation of sexual activity. It does not respect human dignity: neither the dignity of the life of the unborn child nor the dignity and right of the mother to bear children. HIV is a complex disease, so it is important that any response to the pandemic focus on the science of transmission, rather than the politics of the sexual and reproductive rights agenda.