1. Policy Forum
The African Women’s Protocol: Bringing Attention to
Reproductive Rights and the MDGs
Liesl Gerntholtz1, Andrew Gibbs2*, Samantha Willan2
1 Human Rights Watch, New York, United States of America, 2 Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South
Africa
Lack of Progress on All The Forgotten Millennium Goal: referring to them, it was in Cairo in 1994
Millennium Development Goals Improving Women’s at the International Conference on Popu-
lation and Development (ICPD) [9], and
for Women Reproductive Rights
again in 1995 at the Fourth World
The international community recently Underlying the failure to meaningfully Conference on Women in Beijing [10],
reviewed 10 years of progress towards the progress towards achieving MDGs 3, 5, that reproductive rights and their relation-
Millennium Development Goals (MDGs). and 6, particularly in Africa, is the failure ship to women’s rights and development
The outcome document of the High Level to protect and promote women’s human broadly was firmly established. The ICPD
Plenary Meeting of the General Assembly, rights, including their reproductive rights. Programme of Action remains a founda-
adopted by a consensus of the General The United Nations Population Fund [6] tional vision for women’s reproductive
Assembly of the United Nations on 22 outlines the three components of repro- health, committing the 179 participating
September 2010, recognised the signifi- ductive rights: the right to control sexual nations to the achievement of universal
cant steps made towards achieving many and reproductive lives, the right to non- and equal access to reproductive health by
of the goals, but also emphasised the discrimination, and the right to reproduc- 2015. The definition of reproductive
uneven progress and that more must be tive health care. This creates a framework health in the ICPD Programme of Action
done to ensure that the MDGs will be met that supports women’s rights to insist and was broad and inclusive and included
in 2015 [1]. engage in safer sex (including the right to family planning services and counselling,
Significantly, the fifth goal—to improve be free from unwanted sex) and to access comprehensive sexuality education, and
maternal health—has made the least comprehensive and accurate information maternal and child health services. The
progress, with 350,000 women still dying on HIV/AIDS and family planning and Beijing conference further amplified links
annually of pregnancy-related causes [2]; comprehensive reproductive health care, between women’s ability to participate
the MDG outcome document expresses which includes termination of pregnancy fully in all spheres of life and their re-
‘‘grave concern over the slow progress and post-abortion care. Furthermore, re- productive rights, and reiterated the im-
being made on reducing maternal mortal- productive rights are critical in ensuring portance of achieving the goal of universal
ity and improving maternal and repro- that women can control their fertility and access.
ductive health’’ [1]. While greater progress in supporting their participation in social, More recent international treaties, such as
has been made with regard to MDG 6, to economic, and political life. the Convention on the Rights of People with
combat HIV/AIDS, malaria, and other While earlier international treaties such Disabilities [11] and the Convention on the
diseases, and MDG 3, to promote gender as the Convention on the Elimination of Rights of the Child [12], have built on and
equality, progress in these two MDGs Discrimination of Discrimination Against reaffirmed a global commitment to achiev-
Women (CEDAW) [7] and the Interna- ing reproductive rights. In 2010, the UN
remains limited.
tional Convention on Economic, Social Human Rights Council passed a second
The lack of progress across MDGs 3, 5,
and Cultural Rights [8] supported aspects resolution on maternal mortality that reaf-
and 6 is linked; failure to progress in any of
of reproductive rights without explicitly firmed the need to protect women’s human
these three MDGs undermines progress in
the other two. Despite global progress in
reducing maternal mortality, the impact of Citation: Gerntholtz L, Gibbs A, Willan S (2011) The African Women’s Protocol: Bringing Attention to
Reproductive Rights and the MDGs. PLoS Med 8(4): e1000429. doi:10.1371/journal.pmed.1000429
HIV/AIDS has slowed reductions in
maternal mortality and in some countries Published April 5, 2011
increased maternal mortality [2]. One Copyright: ß 2011 Gerntholtz et al. This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
estimate suggests HIV contributed an provided the original author and source are credited.
additional 64,100 maternal deaths globally
Funding: This work has been funded through a Joint Funding Agreement (JFA) for the Health Economics and
in 2008 [3]. Furthermore, both AIDS- HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, South Africa. The JFA comprises of
related morbidity and mortality and ma- SIDA, Irish Aid, RNE and UNAIDS. The funders had no role in study design, data collection and analysis, decision
ternal mortality undermine women’s abil- to publish, or preparation of the manuscript.
ity to realise their equality by excluding Competing Interests: The authors have declared that no competing interests exist.
women from education and employment. Abbreviations: CEDAW, Convention on the Elimination of Discrimination Against Women; ICPD, International
While all women are ill-served by this lack Conference on Population and Development; MDG, Millennium Development Goal; OAU, Organisation of
African Unity
of progress, women in Africa, who are
especially vulnerable, will bear a dispro- * E-mail: gibbs@ukzn.ac.za
portionate burden of these failures [2,4,5]. Provenance: Not commissioned; externally peer reviewed.
PLoS Medicine | www.plosmedicine.org 1 April 2011 | Volume 8 | Issue 4 | e1000429

2. Summary Points out such a right, women living with
HIV/AIDS have a reduced ability to
make reproductive decisions.
N Despite overall progress on the Millennium Development Goals (MDGs), Goal 3
(promote gender equality), Goal 5 (reduce maternal mortality), and Goal 6 The many barriers to the promotion
(combat HIV/AIDS, malaria, and other diseases) significantly lag behind other
and protection of women’s reproductive
goals, with women in Africa bearing the burden of this failure.
rights in Africa undermines women’s abi-
N Underlying this lack of progress is the failure to protect and promote women’s lity to take control of their sexual health,
reproductive rights. fertility, autonomy, and participation in
N The Protocol to the African Charter on Human and Peoples’ Rights on the Rights social and economic life. Technical, dis-
of Women in Africa (or, the African Women’s Protocol) provides a strong, crete interventions to promote women’s
African framework for women’s reproductive rights that goes beyond other health, tackle HIV/AIDS, and reduce
binding international treaties in supporting and promoting reproductive rights.
maternal mortality are unlikely to work if
N Only 29 out of 52 countries in Africa have signed and ratified the African wider laws and policies continue to
Women’s Protocol thus far, and there remain significant barriers to translating undermine women’s reproductive rights.
the Protocol into national legislation and implementing its provisions.
N If fully implemented and integrated into national legislation, the African The African Women’s Protocol
Women’s Protocol offers a significant tool to support women’s reproductive
rights in Africa, thereby supporting the attainment of MDGs 3, 5, and 6. The Protocol to the African Charter
on Human and Peoples’ Rights on the
Rights of Women in Africa [23] (the
rights as part of a comprehensive strategy to to disclose their HIV status to sexual African Women’s Protocol), which was
address maternal mortality and morbidity partners for fear of violence and adopted by the African Union in 2003
[13]. abandonment. Criminalisation also and became legally binding for countries
Despite recognition of the key role that reduces access to reproductive health that had signed and ratified the protocol
reproductive rights plays in advancing services, especially for vulnerable on 25 November 2005, corrects the
women’s health and empowerment, the groups of women such as sex workers weaknesses in the African Charter on
MDGs originally failed to include a and adolescents; Human and People’s Rights (African
specific goal on access to reproductive
health care or reproductive rights. Partly
N Anti-abortion legislation [17]. Such Charter) [24] with respect to women’s
legislation limits women’s ability to rights. While the African Charter pro-
in response to lobbying by women’s determine whether and when to have vides an important human rights frame-
rights activists, access to reproductive children; work, including reinforcing the right
health was added as one of the targets
in MDG 5 at the 5-year review meeting
N High levels of violence against women, to life, liberty, security and freedom
often in contexts of weak or limited from discrimination, it is silent about
of the MDGs in 2005. Indeed, target 5B legislative frameworks to support wo- women’s rights in general and reproduc-
reaffirms the commitment made at the men’s rights [18,19]. Violence against tive rights specifically [25]. The protocol
ICPD to achieve universal access to women limits their autonomy and promotes women’s rights and equality
reproductive health by 2015. That the ability to make decisions about their broadly, including in marriage and
importance of women’s reproductive body and sex. Furthermore, violence divorce, land tenure, inheritance rights,
rights to women’s health, autonomy, places women at greater risk of and in relation to ‘‘traditional’’ practices.
and ability to participate fully in society acquiring HIV, and may make them The protocol contains specific protec-
has been recognised for decades makes weary of accessing reproductive health tions for older women, disabled women,
the absence of significant attention to services and HIV testing. The failure and women in distress, but fails to
these rights in the MDGs even more to criminalise marital rape in many include similar provisions for girls and
deplorable. African counties has increased the risk young women.
of HIV transmission for married The African Women’s Protocol
An Enabling Environment for women and undermines their access emerged through extensive lobbying of
Women’s Reproductive Rights to post-exposure prophylaxis; government by women’s rights organisa-
in Africa N Limited rights to comprehensive sexu- tions across Africa and around the world.
ality education and access to male and Since 1995, African women’s rights activ-
Currently, there are a range of issues
that undermine women’s reproductive female condoms, particularly for ists have recognised the limitation of the
rights in Africa. Specific issues include: young people [20]. The failure to African Charter and called on the Orga-
provide comprehensive sexuality edu- nisation of African Unity (OAU) to
N Criminalisation of HIV transmission cation and access to male and female
condoms undermines women’s abili-
address the rights of women with a specific
instrument. In response, the OAU man-
[14,15]. At present, in Africa and
globally, a number of countries have ties to make fully informed reproduc- dated the African Commission on Human
either passed legislation, or are con- tive choices and act on these decisions; and People’s Rights to develop a protocol.
sidering legislation, that criminalises and A draft was circulated to non-governmen-
the transmission of HIV. Criminalisa- N Failure in many national policies to tal organisations for comment in 1997 and
tion does little to reduce HIV trans- realise the reproductive rights of wom- the Commission later endorsed the ap-
mission [14,15] and disproportionately en (and men) living with HIV [21], pointment of a special rapporteur on
affects women, who are often unable seen most explicitly in the emergence women’s rights to finalise the protocol.
to decide how and when sex occurs of coerced or forced sterilisation of Following consultations with civil society,
[16]. Women may also be less willing women living with HIV [22]. With- the text was revised and adopted in 2005.
PLoS Medicine | www.plosmedicine.org 2 April 2011 | Volume 8 | Issue 4 | e1000429

3. The African Women’s Protocol is par- Table 1. African Union countries and the signing and ratification of the African
ticularly strong on women’s reproductive Women’s Protocol.
rights, and is a tool for ensuring universal
access to reproductive health and the
creation of an enabling environment. It Not Signed or Ratified Signed Onlya Ratified
goes beyond other binding treaties, such as
CEDAW, in outlining reproductive rights Botswana Algeria Angola
[25]. It contains the first references to Egypt Burundi Benin
HIV/AIDS in an international treaty, and Eritrea Cameroon Burkino Faso
the first expression of a right to abortion, Tunisia Central African Republic Cape Verde
albeit limited to where a pregnancy is the
Chad Comores
result of sexual assault, rape, or where it
endangers a woman’s mental or physical Cote d’Ivoire Dijbouti
health. It specifically recognises marital Equatorial Guinea Democratic Republic of Congo
rape as a form of gender-based violence. Ethiopia Gambia
Moreover, the protocol ‘‘identifies protec- Gabon Ghana
tion from HIV and AIDS as a key Guinea Guinea-Bissau
component of women’s sexual and repro-
Madagascar Kenya
ductive rights’’ [25].
Articles 14(1&2) of the African Wo- Mauritius Libya
men’s Protocol set out three major com- Niger Lesotho
ponents of women’s reproductive health Sahrawi Arab Democratic Republic Liberia
rights: Sierra Leone Mali
1. Reproductive and sexual decision mak- Somalia Malawi
ing, including the number and spacing Sao Tome & Principe Mozambique
of children, contraceptive choice, and Sudan Mauritania
the right to self-protection from HIV; Swaziland Namibia
2. Access to information about HIV/ Nigeria
AIDS and reproductive health; and
Rwanda
3. Access to reproductive health services,
South Africa
including antenatal services and abor-
tion-related services. Senegal
Seychelles
Unfortunately, the vision offered by the Tanzania
African Women’s Protocol is still to be
Togo
realised across Africa. Only 29 out of 52 of
the African Union countries have current- Uganda
ly signed and ratified the protocol (see Zambia
Table 1). While ratification is a significant Zimbabwe
step, it is, however, only the first step in
a
utilising the African Women’s Protocol to The signature of a treaty is evidence of the state’s intention to ratify the instrument at some time in the
future, but is not legally binding for a state.
realise women’s reproductive rights.
doi:10.1371/journal.pmed.1000429.t001
Countries must domesticate the proto-
col—that is, translate the protocol into
national (domestic) legislation. This would Protocol and guaranteeing that they are Through the ratification, domestica-
require a comprehensive legal review of replicated at a national level is crucial. tion, and transparent reporting on the
the provisions of the protocol in relation to Upon ratification, countries are bound to African Women’s Protocol, a framework
current legislation. Countries’ failures to report on steps taken to fulfil their can be implemented in Africa that creates
sign, ratify, and domesticate the protocol obligations when they report more widely contexts that support women’s reproduc-
are major barriers in utilising this legisla- on the African Charter. Yet reporting by tive rights. In so doing, a significant step
tion. Countries frequently raise concerns governments lacks transparency and is can be made towards rolling back HIV
about the cost of reviewing legislation and limited. and maternal mortality and thereby
implementing reproductive rights. A fur- Learning from CEDAW, civil society supporting the attainment of MDGs 3,
ther barrier is continued tension between has a crucial role to play in ensuring 5, and 6.
human rights and customary laws. accountability and implementation, in-
Finally, legislative change is meaningless cluding production of shadow reports Author Contributions
if it is not implemented, monitored, and and active lobbying of governments to
ICMJE criteria for authorship read and met:
enforced to ensure real change for women encourage further implementation. Civil LG AG SW. Agree with the manuscript’s results
in Africa [26]. Strengthening and ensuring society may, however, remain constrained and conclusions: LG AG SW. Wrote the first
the utilisation of accountability mecha- without significant resources being allocat- draft of the paper: AG. Contributed to the
nisms contained in the African Women’s ed to this specific role. writing of the paper: LG SW.
PLoS Medicine | www.plosmedicine.org 3 April 2011 | Volume 8 | Issue 4 | e1000429

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