Abstract
Caren Grown explores the linkages between trade liberalization and the provision of and access to sexual and reproductive health services.
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Notes
As Lipson (2006) states, ‘In most countries, trade in health-related goods and services is a relatively minor factor affecting the availability, cost and quality of health services. The ways in which each country organizes, finances, and regulates health services are usually much more important determinants of whether countries are able to ensure the delivery of basic health care to their people, without financially burdening the poor. But trade can influence some particularly critical health goods, such as life-saving pharmaceuticals, or the availability of certain services if they are only offered by foreign-owned companies. It is these situations where trade and rules governing such trade come into play’.
Most indicators cover the medical and demographic aspects of reproductive health. Indicators are being developed to capture the socio-political dimensions of reproductive health but they are not available for a large number of countries. There are few indicators for reproductive rights that are agreed upon and available across countries.
Although there are distinct country trends and modes of transmission, many analysts highlight gender inequality – especially the rules governing sexual relationships and sexual violence – as a major factor driving the increase of the epidemic (Rao Gupta, 2000; UNAIDS, 2004).
For example, concentration of certain medical procedures in urban areas when most of the population is rural or the imposition of user fees that most cannot pay illustrate the misfit between problems (needs) and services.
Other agreements, such as the Agreement on Agriculture, may also affect reproductive health outcomes via changes in food consumption and nutritional status.
As of 2003, 54 countries, nearly half of the World Trade Organization members, have made commitments to at least one of the trading modes under GATS.
Prior to the TRIPS Agreement, a substantial number of developing countries did not adequately cover intellectual property rights for medicines and pharmaceutical products. In addition, patent coverage was highly inconsistent between some developing countries, ranging from as little as three years (Thailand) to as long as 16 years (South Africa). These conditions generally favoured the local production of less-expensive generic medicines where possible. See Williams (2001).
Some reproductive health products – like certain forms of contraception – are off patent so TRIPS will not apply. It should also be noted that even if technology is available and affordable to women, other barriers in the health care system may prevent women from having full access to prevention and treatment of reproductive health problems. For instance, a study conducted on clinical practices related to sexually transmitted diseases (STDs) in gynecological and antenatal programs in Rio de Janeiro, Brazil, where drugs are wildly available, revealed that doctors found it difficult to disclose to married women they had an STD, and to discuss how they contracted the infection. See Giffen and Lowndes (1999).
Another indirect pathway is through the household. For instance, changes in husband's status or in the status of other earners in the household may affect women's reproductive health and her access to services (if it is through another earner's health insurance).
In Taiwan, Hong Kong, South Korea, and Singapore, as well as in Mexico's maquiladoras, women's share of manufacturing employment first increased and then fell in later stages of industrialization.
In some countries, such as in Latin America, economic restructuring and globalization have led to the feminization of agriculture as women seek remunerative employment to supplement declining family income (Deere, 2004). Countries that export unprocessed primary products (e.g., ores) do not fit the stylised fact for agriculturally based economies.
The sex trade is also one of the fastest growing and most profitable service industries; see UN (1999).
It is important to recognize that apart from women's own employment, changes in husband's employment status or that of other earners in the household may affect women's reproductive health and access to services, for example, if husbands’ lose health insurance that covers all family members. However, these will not be considered further here.
It is important to note that these studies do not control for selection bias; it may be that other characteristics of workers in the horticultural industry are responsible for this outcome.
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Explores the linkages between trade liberalization and sexual and reproductive health
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Grown, C. Trade Liberalization and Reproductive Health: A framework for understanding the linkages. Development 48, 28–42 (2005). https://doi.org/10.1057/palgrave.development.1100198
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DOI: https://doi.org/10.1057/palgrave.development.1100198