Modern challenges, modern responses.

Where Human Rights Begin: Health, Sexuality and Women in the New Millennium Edited by Wendy Chavkin & Ellen Chesler (Rutgers University Press, 2005, 309pp) 0-81535-3657-X, $62.00

"Where, after all, do universal human rights begin? In small places, close to home--so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person.... Unless these rights have meaning there, they have little meaning anywhere."

--Eleanor Roosevelt at the United Nations, March 27, z958

CONTINUING IN MRS. ROOSEVELT'S tradition of striving for equality in "small places," Where Human Rights Begin, edited by Wendy Chavkin and Ellen Chesler, examines evolving advocacy strategies and offers contextual insights into the advancement of sexual and reproductive health and rights. In focusing on the local while never losing sight of the global, this collection of essays by the Soros reproductive health and rights fellows offers diverse frameworks through which to engage with the historical, political, religious, cultural and legal contexts in which men and women are situated.

This collection comes at a critical historical moment. As Mary Robinson states in the foreword, "We find ourselves at a crucial juncture in the struggle to realize fully women's rights as human rights." A decade after the Beijing world conference and declaration, basic principles of women's human rights are once again contested ground amid rising religious extremism, increasing hostility and military conflict and the growing dominance of U.S. conservatism. It is essential that collections such as this respond to these political and social trends in a way that can promote women's health and rights locally and globally.

Ellen Chesler's introduction sets the tone for what is a very accessible collection of essays. Setting out the "historical trajectory of women's rights as human rights," Chesler recounts women's agency in striving for inclusion in the post-World War II human rights agenda. Chesler draws particular attention to the role of women from developing contexts in pressing for change. Refuting accusations that "the U.N.'s ambitious women's rights agenda is solely a recent product of European and American feminism," Chesler notes the early and continued advocacy of diverse nongovernmental organizations from India, New Zealand, the Dominican Republic and beyond.

This attention to historical counter-narratives is buttressed by the collection's attention to counter-narratives within religious and cultural traditions. As Jessica Horn's discussion of female genital mutilation/cutting in Egypt illustrates, context-specific advocacy strategies that address the underlying social conditions of harmful traditional practices are essential. In what she terms "empowerment as an antiviolence strategy," Horn outlines the importance of activism that works "to deliberately transform understandings of tradition and culture that limit the rights and actions of women and girls."

This idea of religious, cultural and traditional norms as contested and fluid notions becomes imperative when one considers the importance of these norms in women's lives. Ayesha Imam's discussion of women's reproductive and sexual rights and the offense of zina, unlawful sexual intercourse, in Muslim laws in Nigeria considers the integral role that internal challenges to dominant religious interpretations can play in advancing women's rights and health. Rather than relying solely on universal and external rights-based challenges, Imam highlights the legitimacy that "local structures and discourses" can bring in "really address[ing] the local political power struggles that are behind the political use of religions and ethnicities." This local contestation of dominant religious and cultural interpretations in turn leaves room for complementary legal and secular rights-based initiatives, as Wendy Chavkin emphasizes in her conclusion to the collection:

   [It] is profoundly important to refute
   the notion that respect for culture and
   religion is necessarily in opposition to
   reproductive and sexual rights....
   Those who work 'inside' to develop
   alternative interpretations of religious
   and cultural practice, and those who
   work in secular and legal arenas can
   complement, rather than clash with,
   each other.

This combination of "insider" reform and secular and legal advocacy offers great, and as yet unfulfilled, potential for advancing sexual and reproductive health and rights.

A tangible example of the combination is examined by Adriana Ortiz-Ortega in her chapter, "The Politics of Abortion in Mexico: The Paradox of Doble Discurso." By tracing the dominance of the Catholic church in Mexican political and legal policies on access to contraception and abortion services, Ortiz-Ortega contextualizes present-day Mexican abortion policies within a historical trajectory. Reforming Catholicism itself becomes important for advancing women's sexual and reproductive health and rights. Collaborative efforts among Mexican feminist groups Teologia de la Liberacion and Catolicas por el Derecho a Decidir in the 1990s exemplified the potential of combined efforts to engage religious norms while advancing a broader agenda of legal and health systems policy reform.

Beyond providing theoretical and pragmatic insights into the fluidity of culture, religion, and tradition, the authors also challenge deeply embedded political and social norms around gender and sexuality. Lamentably, it has taken the catastrophe Of HIV/AIDS to start frank discussions of sexuality and gender relations in many contexts. As Rhadika Chandiramani notes in her chapter, "Mapping the Contours: Reproductive Health and Rights and Sexual Health and Rights in India," such discussion still remains all but muted in the political and social Indian mainstream. Chandiramani's decision to separate the terms "reproductive health and rights" and "sexual health and rights" is clearly a deliberate one. Decoupling reproduction from sexuality is essential to addressing the lived reality of sexual diversity, in particular sexual activity outside the restricted bounds of heterosexual marriage. Challenging dominant heteronormative perceptions of sexuality and gender is essential to improve women's and men's ability to negotiate safer sexual practices and leave high-risk relationships. As Chandiramani notes, the de facto use of Indian criminal law to target same-sex sexual activity, for example, often leads to furtive and unsafe sexual encounters.

Similarly, patriarchal norms of sexuality that promote masculine sexual dominance and feminine passivity limit women's ability to negotiate terms of sexual contact. It is here that the role of men in advancing sexual health and rights is perhaps most crucial. Benno de Keijzer's aptly titled chapter, "Sexual-Reproductive Health and Rights: What about Men?" points to the often missing, but essential, half in discussions of gender, sexuality and reproductive choice. The inclusion of men in projects such as ReproSalud in Peru, an initiative "devoted to improving the reproductive health of low-income indigenous women," has proven vital to advancing concepts of gender equity and reproductive health. As masculine identities in Latin America move away from the traditional machismo model, social discussion and inclusion of male perspectives ensure that fathering, same or opposite-sex partnering and gender roles more generally evolve in a way that improves men's and women's health.

IN OTHER CONTEXTS, THE DRIVE to curb the spread of HIV has overshadowed the need to protect women's agency in the context of reproductive health. Lisa Ann Richey's analysis of HIV/AIDS and reproductive health in Uganda illustrates why "treating AIDS and reproductive health as separate agendas is counterproductive to the promotion of women's reproductive health and rights." With Uganda often upheld as the model for addressing AIDS in the African context, Richey stresses the importance of allocating adequate national and international donor resources to all elements of reproductive health. The fact that "infant mortality, child mortality and maternal mortality have remained high and stagnant over the last 5 years in Uganda, in spite of good economic growth," is indicative of the health systems challenges that emerge where HIV/AIDS and reproductive health strategies are treated separately.

Understanding context also includes understanding the political and development needs of a population. Nowhere is the complexity of population policies and development needs greater than in China, where restrictive birth policies have drawn international ire for decades. As Edwin Winckler argues in his discussion of the impact that the i994 U.N. conference in Cairo had on China, however, there are few easy answers for states concerned with the deleterious effects of overpopulation. Winckler forces readers to engage with the difficult conceptual challenge of drawing the line between individual reproductive choice and freedom and public policy interests in addressing overpopulation. While draconian measures adopted at various stages of China's one-child-policy campaign have clearly violated women's integral bodily autonomy, including through forced abortions, other, educationally driven aspects of the campaign appear, according to Winckler, to have reshaped public perceptions of fertility.

This notion of balancing development needs with individual reproductive choices is contrasted by the more cost-cutting approaches to reproductive policy in the U.S. context, as alluded to in Martha Davis' chapter, "International Human Rights from the Ground Up: The Potential for Subnational, Human Rights-Based Reproductive Advocacy in the United States." "Family cap" legislation adopted in more than 20 U.S. states, for example, denies welfare benefits to children born to mothers already on welfare. The notion of discouraging mothers on social assistance from having more children through financial punishment operates as a form of economic discrimination by depriving lower-income women of reproductive choice and freedom. Davis concludes that reproductive choice and freedom must be viewed in such instances through a broader lens that accounts for social determinants of choice. As activist Cheri Honkala argues, "The right to choose includes the right to have children, intertwined with literacy, housing, domestic violence, you name it. All of these go into her choice."

Where Human Rights Begin brings together a thought-provoking collection of essays to which Wendy Chavkin and Ellen Chesler provide clear thematic introductory and concluding analyses. For advocates, scholars and all those interested in the advancement of sexual and reproductive health and rights, this collection will prove to be an invaluable resource for years to come.

LISA KELLY is a fellow of the International Program on Reproductive and Sexual Health Law and a recent graduate of the Faculty of Law, University of Toronto.

REBECCA COOK is professor and faculty chair in international human rights and co-director of the International Program on Reproductive and Sexual Health Law in the Faculty of Law, University of Toronto.