Sex workers and allies march together for a march in Vancouver in June, 2016. Pictured here is the red umbrella, whichis the symbol of the global sex workers rights movement. Sally T. Buck/(CC BY-NC-ND 2.0)

Over the past two decades,globaladvancement of sexual and reproductivehealth andrights(SRHR)has been patchwork at best.While internationalhuman rightstreatiesespousea constellation ofrights related to sexuality and reproduction,manynationscontinue todefy their legitimacy.Thepromisesofinternational human rights law(IHRL)arethusundercut bythe realitiesofpersistently-highmaternal mortality,thecontinuedcriminalizationof sex work,thedisenfranchisementofpeople of various sexual orientations and gender identities,andthe denigration ofabortionandcontraceptionrights and access.Perversely, the very fact of international treaty support for SRHR in many countries cancause advocates tolose ground, ascriticslevelattacks on an over-weaning international regime.We categorize those countries thatflagrantlydisdain and floutIHRLwith respect tosexual and reproductiverightsasscofflaw,toco-opta colloquial term used in the US in the early 20thcentury to denote law breakers.

In thispiece,we illustrate the continued usefulness of international human rights concepts, frameworks, and principles in challenging regression on SRHR in scofflaw countries,work that is possible evenwithout citing international treaties directly.We arguethatrightsconcepts canbolsterSRHRclaimsbyhoningourcritical analysis of harmsandexpanding our imaginative capacity asscholars andadvocates.Werelyonexamples from theUS, one of the leadingscofflawcountries, whichparadoxicallyparticipated in draftinginternational human rights treatiesbywhich it has sincerefused to be bound.Our argumentconsidersbothstrengths andsomedangersin using rights in atreaty-freeway.

First, a brief meditation onwhat we mean by rights talk in this context.When we discuss thehumanrightsmostuseful for advancing SRR incountries like the US,werefer tothe newerversionof rightsbuiltover the lastthree decadesfrom within international treaty obligations.This version understandsdomains of sexual and reproductive life, and the linked but distinct domains of gender and race,as constitutedbysystems ofpowerthat rightshavea rolein dismantling.This versionof rightsalsosupportsthe capacity todetermine oneslifeacross publicandprivate domains,andtoextend state accountability tonon-state actors,fromthe husbandtothe trans-national corporation.Understood this way,rightstalkmovesbeyondliberal theorysabstract individualismand grappleswith thestructural conditions (inmarkets, housing, education, labor, scientific knowledge, etc.) necessary to realizeSRHR.

This version of human rightsbuiltthroughtheorization and practice globallyfunctions in two ways: it isat oncea law-based practiceand an act ofradical political imagination.These functionshelp us to identifythecontinued instrumentality ofhuman rightsinthe face of regression.Internationalhuman rights concepts, frameworks, and principlescan be mobilizedwithout invoking IHRL explicitlyin order to1)clarify acute and systematic failures to protect SRHRand 2)imagine and articulate a differentvision for theaffirmativefulfilment ofhealth and rights.

Two examples serve to illustrate thistreaty-freeapproach; while we rely on examples from the USdrawn fromourwork withGlobal Health Justice Partnership(GHJP),we recognizethat there aremany other ways and strategies for doing this kind ofunder-the-radaryetsubversive human rights workaround the world.

In 2017, GHJP collaborated with theBlack Mamas Matter Alliance(BMMA) andCenter for Reproductive Rights(CRR)to support advocacy on maternalhealth and racial justiceinthe state ofGeorgia.Ourfinal reportidentifiedstate-levelpolicies and institutionalpracticesperpetuating devastating and racially-inequitablerates ofmaternal mortality.We used the now-establishedrights framework of respect, protect, and fulfill to flag sites of state (in)actionlegislative, fiscal, administrativewhich led to the abrogation of the rights of pregnant womenof color.We mobilized the concepts of state obligation and accountability, along withreproductive justice frameworks,to developnew andempirically-grounded analyses thatlinkedstate policy decisionsonhealthcare funding and Medicaid expansion tomaternalhealth outcomes.

Another more recent US examplewasGHJPs collaborationwith theSex Workers and Allies Network(SWAN) in New Haven,Connecticutto develop apeer-led surveyon the experiences of street-based sex workers seeking social services.Our jointanalysishighlights structural barriers to adequate services, including but not limited to criminal legal system surveillance.TheAAAQ (availability, accessibility, acceptability, and quality)assessmentmodel, established by the Committee on Economic, Social, and Cultural Rightsin 2000, framedourevaluation ofservices and helpedrevealbarrierssuch asad hocclinichours, abusive treatment, and substandard care.The reportuses the AAAQ model totiesuchfailurestospecific state and city legislativepolicies, funding decisions, andgaps inmonitoring/accountability.

Mobilizingthe language ofinternational human rightsin analyses onstate and municipal SRHR outcomes ina country like the USmay not seemparticularly useful. In our Georgia report, weacknowledge outrightthat manydomestic policymakersare not necessarily concerned with whether or not state practices adhere to human rights principles.So whydid weneverthelessinject them intoouradvocacy?

First and foremost, internationalhuman rights conceptsuniquelybolstered ouranalysisof state practices: theyclarifiedconnections betweenupstreampolicy decisionsanddownstreamhealth outcomesfor pregnant womenof colorin Georgia and sex workers inConnecticut.Althoughthe obligations we attached to the statewere not framed with reference toUNtreaties,global human rightsallowedfor theidentificationand systematization ofharmsthat may otherwisehavebeen difficult to catalogueand attribute toroot causes.

Human rights frameworks didnt just help organize our critiques of broken systems; they also provided the glue for us as researchers to collaborate with advocate partners and imagine affirmative fulfilments of SRHR. For instance, human rights frames helped GHJP to continue engaging with SWAN in crafting demands for city policymakers, such asthis AAAQ-informed analysison the COVID-19responsein New Haven. The imaginative capacity of human rights language enables discussions of radically different futures characterized by welfare and well-being in scofflaw countries where preventing harm is usually the (minimalist) primary focus.

Weseehuman rights asa powerful waytotranslateinternationalprinciples into transformative, empirically-supported,measurabledomesticpolicydemands.However,the choice to wield human rights in somewhat covert fashionwithoutdirectreference to international legal obligationsadmittedlyhas its downsides. Whatisgainedinlocal political tractioncomes witha potential loss inhuman rights awareness:domesticpolicymakersinlaggardcountriesget no exposure to the idea of legally-binding international human rights nortoreflecting ontheiracts as part of acommonglobalcommitment.

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Advancing sexual and reproductive rights in scofflaw countries - OpenGlobalRights