Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-23T14:13:12.719Z Has data issue: false hasContentIssue false
  • English
  • Français

What is hindering progress? The marginalization of women's sexual and reproductive health and rights in Brazil and Chile

Published online by Cambridge University Press:  09 March 2020

Jasmine Gideon ,
Marianna Leite  and
Gabriela Alvarez Minte
Jasmine Gideon*
Affiliation:
Department of Geography, Environment and Development Studies, DBirkbeck Univeristy of London, Malet St, LondonWC1E 7HX, UK
Marianna Leite
Affiliation:
Department of Geography, Environment and Development Studies, DBirkbeck Univeristy of London, Malet St, LondonWC1E 7HX, UK
Gabriela Alvarez Minte
Affiliation:
Department of Geography, Environment and Development Studies, DBirkbeck Univeristy of London, Malet St, LondonWC1E 7HX, UK
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The paper draws on the cases of Brazil and Chile to consider the lack of progress towards securing better health outcomes for women in the field of sexual and reproductive health and rights (SRHR). At first glance, these poor outcomes for women appear surprising, given that both countries represent middle-income countries where significant developments have occurred towards ensuring universal access to healthcare services. Yet, a more nuanced analysis uncovers the historically constructed gender regimes and policy legacies within relevant institutions that act to limit progress. The discussion in the paper specifically focuses on the evolution of the health sector in the two countries, the role of the medical profession and the influence of the Catholic Church, which, we argue, have been key to constraining women's SRHR in Brazil and Chile.

Keywords

womenreproductive healthpolicy legaciesChileBrazil
Type
Research Article
Information
Journal of International and Comparative Social Policy , Volume 31 , Issue 3 , October 2015 , pp. 255 - 270
Copyright
Copyright © 2015 Taylor & Francis

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abu Sharkh, M., & Gough, I. (2010). Global welfare regimes: A cluster analysis. Global Social Policy, 10(1), 27–58.CrossRefGoogle Scholar
Alvarez, S. E. (1990). Engendering democracy in Brazil: Women's movements in transition politics. Princeton, NJ: Princeton University Press.Google Scholar
Barrientos, A. (2013). The rise of social assistance in Brazil. Development and Change, 44(4), 887–910.CrossRefGoogle Scholar
Barros, F., Victora, C., Barros, A., Santos, I., Albernaz, E., Matijasevich, A., … Vaughan, J. (2005). The challenge of reducing neonatal mortality in middle-income countries: Findings from three Brazilian birth cohorts in 1982, 1993, and 2004. The Lancet, 365(9462), 847–854.CrossRefGoogle ScholarPubMed
Béhague, D., Victora, C. G., & Barros, F. C. (2002). Consumer demand for caesarean sections in Brazil: Informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods. BMJ, 324(7343), 942–942.CrossRefGoogle ScholarPubMed
Bernier, N., & Clavier, C. (2011). Public health policy research: Making the case for a political science approach. Health Promotion International, 26(1), 109–116.CrossRefGoogle ScholarPubMed
Bitrán, R. (2013). Explicit health guarantees for Chileans: The AUGE benefits package UNICO studies series 21. Washington, DC: The World Bank.Google Scholar
Blofield, M. (2001). The politics of “Moral Sin”: A study of abortion and divorce in catholic Chile since 1990. Santiago: FLACSO Chile.Google Scholar
Blofield, M. (Ed.). (2011). The great gap: Inequality and the politics of redistribution in Latin America. Pennsylvania: Penn State University Press.Google Scholar
Brasil, Supremo Tribunal Federal. (2012). Arguição de Descumprimento de Preceito Fundamental n. 54 ajuizada pela Confederação Nacional dos Trabalhadores da Saúde. Brasília: Claim of breach of fundamental precept n. 54 filed by the National Confederation of Health Workers.Google Scholar
Brito Peña, A., Cid Aguayo, B. E., & Donoso Orellana, C. (2012). Ruling the womb: The sexual and reproductive struggle during bachelet's administration. Latin American Perspectives, 39(4), 145–162.CrossRefGoogle Scholar
Casas, B. L., & Dides, C. C. (2007). Objeción de conciencia y salud reproductive en chile: Dos casos paradigmáticos (Concientious objection and reproductive health in Chile: Two paradigmatic cases). Acta Bioethica, 13(2), 199–206.Google Scholar
Casas, L. (2008). ‘La saga de la anticoncepción de emergencia en Chile: Avances y desafíos’ (The ‘saga’ of the emergency contraceptive pill in Chile: Progresses and challenges). serie documentos electrónicos. Santiago: Programa Género y Equidad FLACSO, 2.Google Scholar
Casas, L., Vivaldi, L., Silva, M., & Bravo, M. (2013). ‘ La penalización del aborto como una violación a los derechos humanos de las mujeres’ (The criminalization of abortion as a violation of women's human rights). In T. Vial (Ed.), Informe anual sobre derechos humanos en Chile (pp. 69–120). Santiago: Universidad Diego Portales.Google Scholar
Casanova, J. (1994). Public religions in the modern world. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
Casanova, J. (2009). Religion, politics and gender equality: Public religions revisited. In UNRISD (Ed.), A debate on the public role of religion and its social and gender implications (pp. 1–29). Geneva: United Nations Research Institute for Social Development.Google Scholar
Cavagnero, E. (2008). Health sector reforms in Argentina and the performance of the health financing system. Health Policy, 88(1), 88–99.CrossRefGoogle ScholarPubMed
CEDAW Committee. (2012a). Concluding observations on Brazil, 51st sesssion, U.N. Doc. CEDAW/C/BRA/CO/7, March 23, 2012 (paras. 28–29).Google Scholar
CEDAW Committee. (2012b). Concluding observations on Chile, 53rd session, U.N. Doc. CEDAW/C/CHL/CO/5–6.Google Scholar
CEPAL. (2012). Social panorama of Latin America 2012: Briefing paper. Santiago: Comisíon Económica para América Latina y el Caribe (CEPAL).Google Scholar
CEPAL. (2013). Implementación del programa de Acción de la Conferencia Internacional sobre la Población y el Desarrollo en América Latina y el Caribe. Santiago: CEPAL.Google Scholar
Connell, R. (2012). Gender, health and theory: Conceptualizing the issue, in local and world perspective. Social Science and Medicine, 74(11), 1675–1683.CrossRefGoogle ScholarPubMed
Corrêa, S., Alves, J. E. D., & Jannuzzi, P. M. (2006). ‘Direitos e saúde sexual e reprodutiva: Marco teórico-conceitual e sistema de indicadores’ (Reproductive and sexual health and rights: A conceptual-theoretical landmark and indicator system). In Cavenaghi, S. (ed.), Indicadores municipais de saúde sexual e reprodutiva (pp. 29–62). Rio de Janeiro/Brasília: ABEP/UNFPA.Google Scholar
Costa, A. M. (2009). Participação social na conquest das políticas de saúde para mulheres no Brasil (Social participation in the achievement of health policies to women in Brazil). Ciência and Saúde Coletiva, 14(4), 1073–1083.CrossRefGoogle Scholar
Couttolenc, B., & Dmytraczenko, T. (2013). ‘Brazil's primary care strategy’, Universal Health Coverage Studies Series (UNICO) UNICO studies series no. 2. Washington, DC: World Bank.Google Scholar
Craske, N., & Molyneux, M. (2002). Gender and the politics of rights and democracy in Latin America. New York: Palgrave Macmillan.CrossRefGoogle Scholar
Cristi, R. (2000). El pensamiento político de Jaime Guzmán: Autoridad y libertad, (The political thought of Jaime Guzmán: Authority and freedom). Santiago: Lom Ediciones.Google Scholar
De Zordo, S. (2012). Programming the body, planning reproduction, governing life: The ‘(ir-) rationality’ of family planning and the embodiment of social inequalities in Salvador da Bahia (Brazil). Anthropology and Medicine, 19(2), 207–223.CrossRefGoogle Scholar
Dides, C., Benavente, M. C., Sáez, I., Nicholls, L., & Correa, T. (2011). Provisión de Anticoncepción de Emergencia en el Sistema de Salud Municipal de Chile Estado de Situación (The provisions of the emergency contraception in the municipal health system of Chile, state of affairs). Santiago: Universidad Central – UNFPA Chile.Google Scholar
Diniz, D., Madeiro, A., & Rosas, C. (2014). Conscientious objection, barriers, and abortion in the case of rape: A study among physicians in Brazil. Reproductive Health Matters, 22(43), 141–148.CrossRefGoogle ScholarPubMed
Diniz, S. G. (2010). Gender, maternal health and the perinatal paradox. Revista Tempus: Actas de Saúde Coletiva, 4(4), 49–59.Google Scholar
Diniz, S. G., d'Oliveira, A. F., & Lansky, S. (2012). Equity and women's health services for contraception, abortion and childbirth in Brazil. Reproductive Health Matters, 20(40), 94–101.CrossRefGoogle ScholarPubMed
ECLAC/UNFPA. (2010). América Latina: advances y desafios de la implementación del Programa de Accíon de El Cairo, con énfasis en el período 2004–2009 (Latin America: Progress and challenges in the implementation of the Cairo Programme of Action, with emphasis in the period 2004–2009). Santiago: Comisíon Económica para América Latina y el Caribe (CEPAL).Google Scholar
Erasmus, E. (2014). The use of street-level bureaucracy theory in health policy analysis in low- and middle-income countries: A meta-ethnographic synthesis. Health Policy and Planning, 29(suppl 3), iii70–iii78.CrossRefGoogle ScholarPubMed
Erasmus, E., & Gilson, L. (2008). How to start thinking about investigating power in the organisational settings of policy implementation. Health Policy and Planning, 23(5), 361–368.CrossRefGoogle Scholar
Ewig, C. (2010). Second-wave neoliberalism: Gender, race and health sector reform in Peru. University Park, PA: Pennsylvania State University Press.Google Scholar
Ewig, C., & Kay, S. J. (2011). Post-retrenchment politics: Policy feedback in Chile's health and pension reforms. Latin American Politics and Society, 53(4), 67–99.CrossRefGoogle Scholar
Ewig, C., & Palmucci, G. A. (2012). Inequality and the politics of social policy implementation: Gender, age and Chile's 2004 health reforms. World Development, 40(12), 2490–2504.CrossRefGoogle Scholar
Ferraz, L., & Bordignon, M. (2012). ‘Mortalidade materna no brasil: Uma realidade que precisa melhorar’ (Maternal mortality in Brazil: A reality that must improve). Revista Baiana de Saúde Pública, 36(2), 527–538.Google Scholar
Filgueira, F. (2011). Fault lines in Latin American social development and welfare regime challenges. In Blofield, M. (Ed.), The great gap. Inequality and the politics of redistribution in Latin America (pp. 21–57). Pennsylvania: Pennsylvania State University Press.Google Scholar
Fleet, M., & Smith, B. (1997). The Catholic Church and democracy in Chile and Peru. Notre Dame, IN: University of Notre Dame Press.Google Scholar
Fonn, S., & Ravindran, T. K. S. (2011). The macroeconomic environment and sexual and reproductive health: A review of trends over the last 30 years. Reproductive Health Matters, 19(38), 11–25.CrossRefGoogle ScholarPubMed
Franceschet, S. (2010). The gendered dimensions of rituals, rules and norms in the Chilean congress. The Journal of Legislative Studies, 16(3), 394–407.CrossRefGoogle Scholar
Freedman, L., & Schaaf, M. (2013). Act global, but think local: Accountability at the frontlines. Reproductive Health Matters, 21(42), 103–112.CrossRefGoogle ScholarPubMed
Frenz, P., & Vega, J. (2010, November 16–19). Universal health coverage with equity: What we know, don't know and need to know. Background paper for the global symposium on health systems research, Montreux Switzerland.Google Scholar
Galli, B., & Rocha, H. (2014, July 20). Direitos Sexuais e Reprodutivos, Autonomia Reprodutiva, Política e (des)respeito ao Princípio da Laicidade (Sexual and reproductive rights, reproductive autonomy, policy and (dis)respect to the secularism principle), IPAS.CrossRefGoogle Scholar
Gamble, J., Creedy, D., McCourt, C., Weaver, J., & Beake, S. (2007). A Critique of the literature on women's request for cesarean section. Birth, 34(4), 331–340.CrossRefGoogle ScholarPubMed
Gideon, J. (2014). Gender, globalization and health: Issues and challenges in a Latin American context. Basingstoke: Palgrave Macmillan.Google Scholar
Gideon, J., & Alvarez, G. (in press). Engendering health in Bachelet's Chile? In Waylen, G. (Ed.), Gender, institutions and change in bachelet's Chile. Basingstoke: Palgrave Macmillan.Google Scholar
Gideon, J., & Molyneux, M. (2012). Limits to progress and change: Reflections on Latin American social policy. Social Politics: International Studies in Gender, State & Society, 19(3), 293–298.CrossRefGoogle Scholar
Gilson, L., Schneider, H., & Orgill, M. (2014). Practice and power: A review and interpretive synthesis focused on the exercise of discretionary power in policy implementation by front-line providers and managers. Health Policy and Planning, 29(suppl 3), iii51–iii69.CrossRefGoogle ScholarPubMed
Guzmán, V., Seibert, U., & Staab, S. (2010). Democracy in the country but not in the Home? Religion, politics and women's rights in Chile. Third World Quarterly, 31(6), 971–988.CrossRefGoogle Scholar
Haas, L. (2010). Feminist policymaking in Chile. University Park, PA: Pennsylvania State University Press.Google Scholar
Hagopian, F. (2008). Latin American catholicism in an age of religious and political pluralism: A framework for analysis. Comparative Politics, 40(2), 149–168.CrossRefGoogle Scholar
Harrison, A., Montgomery, E., Lurie, M., & Wilkinson, D. (2000). Barriers to implementing South Africa's termination of pregnancy act in rural Kwazulu/natal. Health Policy and Planning, 15(4): 424–431.CrossRefGoogle ScholarPubMed
Huber, E., & Stephens, J. (2001). The Development and crisis of the welfare state: Parties and policies in global markets. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
Inhorn, M. C. (2006). Defining women's health: A dozen messages from more than 150 ethnographies. Medical Anthropology Quarterly, 20(3), 345–378.CrossRefGoogle ScholarPubMed
Instituto Nacional de Derechos Humanos. (2012). Informe complementario comité de la CEDAW 2012, Santiago: Instituto Nacional de Derechos Humanos.Google Scholar
Iriart, C., & Waitzkin, H. (2006). Argentina: No lesson learned. International Journal of Health Services, 36(1), 177–196.CrossRefGoogle ScholarPubMed
Keely, C. B. (1994). ‘Limits to papal power: Vatican inaction after humanae vitae’, supplement: The new politics of population: Conflict and consensus in family planning. Population and Development Review, 20, 220–240.CrossRefGoogle Scholar
Kulcycki, A. (2014). A comparative study of abortion policymaking in Brazil and South America: The salience of issue networks and policy windows. Journal of Comparative Policy Analysis: Research and Practice, 16(1), 62–78.CrossRefGoogle Scholar
Laurell, A. C. (2007). Health system reform in Mexico: A critical review. International Journal of Health Services, 37(3), 515–535.CrossRefGoogle ScholarPubMed
Lehmann, U., & Gilson, L. (2013). Actor interfaces and practices of power in a community health worker programme: A South African study of unintended policy outcomes. Health Policy and Planning, 28(4), 358–366.CrossRefGoogle Scholar
Lloyd-Sherlock, P. (2009). Social policy and inequality in Latin America: A review of the trends. Social Policy and Administration, 43(4), 347–363.CrossRefGoogle Scholar
Londoño, J., & Frenk, J. (2000). Structured pluralism. Towards an innovative model for health system reform in Latin America. In Lloyd-Sherlock, P. (Ed.), Healthcare reform and poverty in Latin America (pp. 21–56). London: Institute of Latin American Studies.Google Scholar
Luna, N. (2014). Aborto no Congresso Nacional: O enfrentamento de atores religious e feminists em um Estado laico (Abortion in National Congress: The struggle between feminists and religious actors in a laic State), Revista Brasileira de Ciêência Política, 14 (May–August), 83–109.Google Scholar
Macaulay, F. (2010). Trickling up, down, and sideways: Gender policy and political opportunity in Brazil. In Maier, E. & Lebon, N. (Eds.), Women's activism in Latin America and the Caribbean: Engendering social justice, democratizing citizenship (pp. 273–290). New Brunswick, NJ: Rutgers University Press.Google Scholar
Martínez Franzoni, J. (2008). Welfare regimes in Latin America: Capturing constellations of markets, families, and policies. Latin American Politics and Society, 50(2), 67–100.CrossRefGoogle Scholar
McGuire, J. (2010), Wealth, health, and democracy in East Asia and Latin America. Cambridge: CambridgeUniversity Press.CrossRefGoogle Scholar
Mesa-Lago, C. (2008). Reassembling social security: A survey of pension and health care reforms in Latin America. Oxford: Oxford University Press.Google Scholar
Molyneux, M. (2007). Change and continuity in social protection in Latin America: Mothers at the service of the state?. Gender and Development Programme Paper, 1, Geneva: UNRISD.Google Scholar
Mooney, J. P. (2009). The politics of motherhood. Maternity and women's rights in 20th century Chile. Pittsburgh: University of Pittsburgh Press.CrossRefGoogle Scholar
Murray, S. F., & Elston, M. A. (2005). The promotion of private health insurance and the implications for the social organization of healthcare: A case study of private sector obstetric practice in Chile. Sociology of Health and Illness, 27(6), 701–721.CrossRefGoogle ScholarPubMed
PAHO. (2012). Health in the Americas: Regional outlook and country profiles. Washington, DC: PAHO.Google Scholar
Pierson, P. (1994). Dismantling the welfare state? Regan, thatcher and the politics of retrenchment. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
Pribble, J. (2013). Welfare and party politics in Latin America. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Raczynski, D. (1994). Políticas sociales y programas de combate a la pobreza en chile: Balance y desafíos. Coleccíon estudios CIEPLAN. 39, 9–73.Google Scholar
Ravindran, T. K. S. (2012). Universal access: Making health systems work for women. BMC Public Health, 12(Suppl 1), S1–7.CrossRefGoogle ScholarPubMed
Rodríguez, J. (2011, July 21–22). High adolescent fertility in the context of declining fertility in Latin America. Paper presented at the United Nations Expert Group Meeting on Adolescents, Youth and Development. United Nations Expert Group Meeting on Adolescents, Youth and Development.Google Scholar
Rosemblatt, K. (2000). Gendered compromises: Political cultures and the state in Chile, 1920–1950. Chapel Hill: University of North Carolina Press.Google Scholar
Sandall, J., Benoit, C., Wrede, S., Murray, S. F., van Teijlingen, E., & Westfall, R. (2009). Social service professional or market expert?: Maternity care relations under neoliberal healthcare reform. Current Sociology, 57(4), 529–553.CrossRefGoogle Scholar
Santhya, K. G., & Jejeebhoy, S. J. (2015). Sexual and reproductive health and rights of adolescent girls: Evidence from low- and middle-income countries. Global Public Health, 10(2), 189–221.CrossRefGoogle ScholarPubMed
Schiappacasse, V., & Díaz, S. (2012). Chile: One step forward, one step back. In Foster, A. & Wynn, L. L. (Eds.), Emergency contraception: The story of a global reproductive health technology (pp. 107–122). New York: Palgrave MacmillanCrossRefGoogle Scholar
Schwindt-Bayer, L. (2006). Still supermadres? Gender and the policy priorities of Latin American legislators. American Journal of Political Science, 50(3), 570–585.CrossRefGoogle Scholar
Sen, G., & Govender, V. (2015). Sexual and reproductive health and rights in changing health systems. Global Public Health, 10(2), 228–242.CrossRefGoogle ScholarPubMed
Shiffman, J., & Smith, S. (2007). Generation of political priority for global health initiatives: A framework and case study of maternal mortality. Lancet, 370(9595), 1370–1379.CrossRefGoogle ScholarPubMed
UN. (2013). The millennium development goals report 2013. New York, NY: Author.Google Scholar
UNDP. (2010). Regional human development report for Latin America and the Caribbean 2010 – acting on the future: Breaking the intergenerational transmission of inequality. New York, NY: Author.Google Scholar
UNFPA. (2008). Making reproductive rights and sexual and reproductive health a reality for all. New York, NY: Author. Retrieved June 24, 2015, from http://www.unfpa.org/sites/default/files/pub-pdf/SRH_Framework.pdfGoogle Scholar
UNFPA. (2010). How universal is access to reproductive health? A review of the evidence. New York, NY: Author.Google Scholar
UN Women. (2013). A transformative stand-alone goal on achieving gender equality, women's rights and women's empowerment: Imperatives and key components. New York, NY: Author.Google Scholar
Vaggione, J. M., & Morán Faúndes, J. M. (2012). Ciencia y religión (hétero) sexuadas: El discurso científico del activismo católico conservador sobre la sexualidad en argentina y Chile. (Science and Religion (hetero) sexualized: The scientific discourse of conservative Catholic activism about sexuality in Argentina and Chile). Revista Semestral do Departamento e do Programa de Pós-Graduação em Sociologia da UFSCar, 2(1), 159–185.Google Scholar
Vargas, V., & Poblete, S. (2008). Health prioritization: The case of Chile. Health Affairs, 27(3), 782–792.CrossRefGoogle Scholar
Vega, J. (2013). Universal health coverage: The post-2015 development agenda. Lancet, 381(9862), 179–180.CrossRefGoogle ScholarPubMed
Vianna, A., & Lacerda, P. (2004). Direitos e políticas sexuais no Brasil: O panorama atual (Sexual rights and politics in Brazil: The current panorama). Rio de Janeiro: CEPESC.Google Scholar
Victora, C. G., Aquino, E. M. L., Leal, M., Monteiro, C. A., Barros, F. C., & Szwarcwald, C. L. (2011). Maternal and child health in Brazil: Progress and challenges. The Lancet, 377(9780), 1863–1876.CrossRefGoogle ScholarPubMed
Victora, C. G., Matijasevich, A., Silveira, M. F., Santos, I. S., Barros, A. J. D., & Barros, F. C. (2010). Socio-economic and ethnic group inequities in antenatal care quality in the public and private sector in Brazil. Health Policy and Planning, 25(4), 253–261.CrossRefGoogle ScholarPubMed
Waylen, G. (2014). Informal institutions, institutional change, and gender equality. Political Research Quarterly, 67(1), 212–223.CrossRefGoogle Scholar
WHO. (2010). Gender, women and primary health care renewal: A discussion paper. Geneva: Author.Google Scholar
Witz, A. (1992). Professions and patriarchy. London: Routledge.CrossRefGoogle Scholar
Zárate, M. (2001). ‘Notas preliminares sobre profesión médica y masculinidad, Chile, Siglo XIX’ (Preliminary notes on the medical profession and masculinity, Chile, XIX Century). In Olavarría, J. (Ed.), Hombres: Identidad/es y violencia, red masculinidad/es (pp. 73–84). Santiago: FLACSO Chile, Academia de Humanismo Cristiano.Google Scholar