David P. Fidler, Gender Politics, Gender Paradox: Establishing and Implementing Global Standards for the Promotion and Protection of Women's Health

• Citation: Vol. 22 No. 1
• Publication year: 2008

GENDER POLITICS, GENDER PARADOX: ESTABLISHING AND IMPLEMENTING GLOBAL STANDARDS FOR THE PROMOTION AND PROTECTION OF WOMEN'S HEALTH

David P. Fidler^*

The Global Gender Paradox

The organizers of this conference have provided us with a rich assortment of issues to consider in the relationship between policy, law, and women's health. I have been asked to focus my remarks on conceptual concerns associated with establishing and implementing global standards for promoting and protecting women's health, with a particular eye on the challenges these objectives face in developing and least-developed countries. Thomas Murray said yesterday that generalities are the refuge of scoundrels, so perhaps I am the designated scoundrel given my mandate to focus on conceptual issues rather than on-the-ground practicalities.

Thinking about my assigned task in relation to the issues addressed at this conference raised for me two implications. First, as we learned from yesterday's proceedings, women's health around the world faces serious problems. As one leading expert argued in 2006, "The great dreams of the international conferences in Vienna, Cairo, and Beijing have never come to pass. It matters not the issue: whether it's levels of sexual violence, or HIV/AIDS, or maternal mortality, or armed conflict, or economic empowerment, or parliamentary representation, women are in terrible trouble.

And things are getting no better."¹

Second, these problems raise the need to implement existing standards for women's health more effectively and, where necessary, to develop more and better promotion and protection standards. Thus, the formulation and implementation of global standards for women's health are key challenges for gender politics in the early 21st century.

In thinking about these challenges, a paradox of sorts appeared in my mind. In my work on international law and global health, I frequently find gender- specific analysis of public health problems, and this analysis is tied to existing normative standards about women's health, most frequently emanating from international human rights law. In fact, these gender-informed analyses typically do the following: (1) they describe empirical data showing that a health problem significantly, and sometimes disproportionately, affects women; (2) they analyze this data in ways that connect it to political, economic, cultural, or medical problems women face; (3) they apply existing norms or standards that support betterment of women's health; and (4) they propose recommendations, principles, or guidance for improving the health of women. These gender-informed analyses appear with sufficient frequency that I have heard them referred to as the "gender boilerplate."

The paradox that I want to unpack is this: We perceive that problems concerning women's health worldwide, but particularly in developing and least-developed countries, are growing at the same time that gender-informed analysis of global health issues has become more pervasive. Now, immediately, two explanations for this paradox jump to mind, neither of which is comforting. First, our heightened awareness of women's health problems flows from the increased use of gender-informed analysis of public health problems. Put another way, we are only now beginning to understand how bad things are for women in many parts of the world. Second, the increased application of existing norms and standards on women's health reflects a worsening situation for women's health in many parts of the world. In other words, reality on the ground bears little resemblance to the standards found in policy and legal documents.

Many presentations at this conference highlight this gap between norms and reality with respect to specific health problems, such as maternal health, domestic violence, cultural discrimination, and sexual trafficking. I am going to focus conceptually on the challenges the effort to improve women's health faces in terms of standard development and implementation. I want to break down the conceptual components that go into the formation of standards for women's health, map the development of such standards using these components, and finally consider the difficulties standard-setting for women's health faces in the current context of global health governance. Through these steps I hope to communicate something about the structure and dynamics of gender healthcraft in the early 21st century and probe the difficulties gender healthcraft will face in the foreseeable future.

Behind the Gender Boilerplate

This audience needs no education in terms of the seriousness and sophistication of gender-informed analyses of global health problems, but let me connect this important phenomenon to my conceptual mandate. The depth and breadth of gender-aware examination of both specific disease threats, such as HIV/AIDS and malaria, and social determinants of health, such as education and poverty, that we see today is historically unprecedented and is the result of the development of the process through which standards for women's health form. In analysis and advocacy for improvements in women's health, standards emerge from the combination of three things: the development of epidemiological or empirical evidence, the application of human rights principles, and the process of gender mainstreaming.

By empirical evidence, I mean the data that provides insight into how a particular disease, threat to health, or social determinant of health affects the health of women. By human rights principles, I refer to the rules and norms found mainly in the international law of human rights. By gender mainstreaming, I mean the processes of "assessing the implications for women and men of any planned action, including legislation, policies or programmes, in all areas and at all levels" with the ultimate goal of achieving gender equality.²

Let me illustrate how these three things developed sequentially to work together in terms of the development of standards for women's health. My example is maternal health, one of the oldest international health issues focusing specifically on women. Epidemiological data on maternal morbidity...