TABLE OF CONTENTS I. INTRODUCTION 660 II. MODERN CONTRACEPTION 662 AS A REPRODUCTIVE RIGHT A. Health and Economic Benefits 662 of Modern Contraceptives B. Family Planning in International 664 Treaties C. Continuing Unmet Need and Regional 668 Disparities in the Access to Contraception III. THE COMMITTEE ON THE ELIMINATION OF ALL 671 FORMS OF DISCRIMINATION AGAINST WOMEN A. CEDAW Enforcement Mechanisms 671 B. Domestic Politics Theory of Treaty 673 Compliance C. CEDAW's Influence on Domestic 677 Abortion Laws IV. PROMOTING DOMESTIC ENFORCEMENT OF TREATY 679 OBLIGATIONS TO INCREASE ACCESS TO MODERN CONTRACEPTION A. CEDAW's Approach to Modern 679 Contraception B. Sierra Leone 685 687 V. CONCLUSION 689 I. INTRODUCTION
A mother of nine children, Zainabu was fully aware of the dangers of pregnancy and childbirth. (1) Sierra Leone, Zainabu's home country, has the highest maternal mortality rate in the world. (2) When a nonprofit provider of sexual and reproductive health care services visited her village, Zainabu decided to learn about the availability of family planning options. (3) After discussing condoms, the pill, and long-acting or permanent methods, she decided to undergo a tubal ligation, which is a twenty-five minute operation performed under local anesthetic. (4) "By stopping having children, we'll be able to give all our attention to the ones we have," Zainabu stated in explanation of her decision to seek contraception. (5)
As Zainabu's story demonstrates, access to modern contraceptive methods enables a woman to control the number and timing of her children. With this control comes health and economic benefits for the woman, her family, and her country. (6) Modern contraception is relatively inexpensive, and its power to benefit and transform the lives of the poorest and most vulnerable women is tremendous. The ability to delay or prevent pregnancies is truly lifesaving--approximately 800 women die each day from causes related to pregnancy or childbirth. (7) Access to contraception is especially important in areas of conflict, such as the refugee crisis of the war in Syria, and in regions plagued by infectious diseases, such as Zika. (8)
While women's rights advocates, health professionals, and economists recognize the importance of access to contraception, unmet need for modern contraceptives remains high in certain parts of the world, especially in developing regions. (9) This Note argues that international treaty monitoring bodies have not fully exercised their monitoring powers to ensure and encourage member states' compliance with treaty obligations regarding access to contraception. In particular, this Note contends that one treaty monitoring body, the Committee on the Elimination of All Forms of Discrimination Against Women (CEDAW), can and should do more to pressure its member states to increase access to contraception and reduce unmet need, in part by providing local advocacy groups with the information needed to create change in the member states' domestic policies.
In Part II, this Note explains the importance of access to modern contraceptive methods as a fundamental reproductive right and discusses the continuing unmet need for and regional disparities in the access to contraception. Part III then examines the role of CEDAW and its powers as a treaty monitoring body, analyzing the particular situations and circumstances in which CEDAW is most effective at ensuring member states' compliance with treaty obligations. The research suggests, and this Note argues, that CEDAW's efforts will be most effective within a country with engaged domestic actors, the presence of women's health-focused non-governmental organizations (NGOs), a degree of political liberalization, and high unmet need for contraceptives and family planning services. As an example of CEDAW's ability to shape the policies of its member states, this Note discusses CEDAW's efforts regarding abortion rights and access to abortion services. In Part IV, this Note argues that CEDAW should use similar efforts to put pressure on countries with low access and high unmet need for modern contraceptives to make national policies, laws, and investments aimed at increasing access to contraception. Additionally, CEDAW should require member states to include data on access to contraception in their annual reports, so that CEDAW, national advocacy groups, and NGOs can better understand where progress has been made and where access to contraception remains low. Drawing on the analysis in Part III, this Note additionally presents two country-specific situations, Sierra Leone and Haiti, where CEDAW might use certain treaty monitoring actions to effectively encourage an increase in access to family planning services and modern contraception.
MODERN CONTRACEPTION AS A REPRODUCTIVE RIGHT A. Health and Economic Benefits of Modern Contraceptives
Access to contraception has been linked to many health, societal, and economic benefits for women and for the societies in which they live. These benefits include safer pregnancies, (10) higher access to education for women and girls, (11) and greater financial security for women and their families. (12) Access to contraception has been proven to reduce maternal mortality rates, for example, by lowering excessive hazards associated with pregnancies that are "too early, too late, too many, or too frequent" and by reducing the number of deaths caused by complications from abortions. (13) Access to contraception or family planning methods is explicitly linked to lower rates of abortion, and in particular, lower rates of unsafe abortions. (14)
These effects are particularly potent in poorer and less developed countries where resources are scarce and women are likely to be living in poverty. Girls, often forced into marriage when they are still teenagers, can stay in school longer when they are able to delay pregnancy. (15) The children born to women who have access to family planning methods also benefit. (16) When women are able to control the number and spacing of their pregnancies, they are able to devote more food, time, and resources to the children they already have. For example, research has shown that these children are more likely to go to school and to do better in school. (17)
Further, access to modern contraception is a relatively inexpensive and cost-effective method of improving the lives of the most vulnerable women in the poorest regions of the world. (18) As discussed above, the benefits of modern contraception and the ability of a woman to control the spacing and number of her children are almost incalculable. The investment costs of providing these benefits are relatively low. (19) Modern contraception includes methods such as birth control pills or condoms, which are inexpensive to provide and to teach women to properly use. (20) Intrauterine devices (IUDs) are also particularly cost-effective and practical, because they involve a onetime insertion that provides months of birth control. (21) Additionally, organizations such as the Bill and Melinda Gates Foundation are currently working to create cheaper and more effective methods of contraception. (22) Overall, providing family planning services is extremely cost-effective, even for less developed and poorer countries, because the benefits that come with access to contraceptives are significant.
Access to modern contraceptive methods can be particularly important in the context of global epidemics and sexually transmitted diseases. (23) The ongoing spread of the Zika virus is one such example. The Centers for Disease Control and Prevention has determined that Zika can be spread through sex, (24) and the disease is also linked to severe birth defects in children born to women who have contracted the virus. (25) Health officials in countries where the disease is pervasive are warning women to wait until the epidemic is over to get pregnant. (26) However, in many of the Latin American countries hit hardest by the spread of Zika, millions of women lack the education and access to contraception needed to control pregnancies. (27) These women risk becoming pregnant while infected with Zika--a severe danger to both the mother and the child. (28)
Access to contraception is also crucial in areas of violent conflict, where women are particularly vulnerable to sexual violence and are particularly unable to have safe pregnancies. (29) For example, over half of the three million Syrian refugees fleeing the war or who are internally displaced within Syria are women and girls. (30) These refugees are estimated to include 200,000 pregnant women, of whom almost 15 percent are at risk of poor pregnancy outcomes. (31) Among refugees, sexual violence is pervasive, pregnancies are often unsafe, and access to contraception is low. (32)
Family Planning in International Treaties
The importance of family planning is reflected in international law. In 1979, the United Nations General Assembly adopted the Convention on the Elimination of All Forms of Discrimination Against Women (the Convention). (33) The treaty, which has been ratified by 189 countries, (34) entered into force on September 3, 1981, and has been described as an international bill of rights for women. (35) The thirty-article treaty touches on all aspects of women's economic, social, and political rights. (36) Several articles of the Convention specifically reference reproductive rights. Article 12 focuses on health. It states that parties to the treaty should take "all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care service, including those related to family planning." (37) Article 10 focuses on eliminating discrimination between men and women in the field of education, and specifically includes "[a]ccess to specific educational information to help to ensure the...