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Gender, sexuality, health and human rights in Latin America and the Caribbean

In October 2006, after more than a century of guaranteeing the right to therapeutic abortion in the case of obstetric emergencies, the Nicaraguan National Assembly outlawed all forms of abortion. This meant that women in need of potentially lifesaving therapeutic abortion, such as those experiencing haemorrhage during pregnancy, could be legally turned away from clinical care. Indeed, the new law put medical professionals in danger of criminal prosecution for providing therapeutic abortions or post-abortion care during obstetric emergencies, since it mandated prison sentences for doctors who performed abortions under any circumstances, as well as for women who sought abortions for any reason. Many feminist scholars, activists, international health organisations and human rights agencies have denounced the Nicaraguan law, which has resulted in a pervasive fear among women to seek reproductive health services and among doctors who wish to intervene to protect the health of women. Indeed, a scathing report by Human Rights Watch, provocatively entitled ‘Over Their Dead Bodies’, documents that fear of prosecution among women in need of obstetric care and medical professionals may have already led to many fatalities in Nicaragua that could have otherwise been prevented (Møllman 2007). This Special Issue of Global Public Health, ‘Gender, Sexuality, Health and Human Rights in Latin America and the Caribbean’, focuses on urgent contemporary public health issues, such as the Nicaraguan abortion ban, that are affecting the health and well-being of vulnerable groups and populations throughout the Latin American and Caribbean (LAC) region. It takes as its point of departure the position that some of the most complex global health problems facing the LAC region are in fact about much more than ‘health’, at least in the traditional biomedical sense of pathophysiological conditions or states. Rather, we consider public health outcomes, such as the elevated rates of maternal mortality likely to persist under the Nicaraguan abortion ban, as products of power struggles fought out through the complex interrelationships among social, political, economic, moral and legal domains. It is the intersection and interplay of these multiple forces, and the ways they combine to shape health outcomes, that is the focus of our analysis and inquiry. The contributors to this special issue all share a common vision that the health problems they study, and the persons primarily affected by them, are embedded in broader social contexts and unequal social conditions as a consequence of disparities in power. As Paul Farmer argues in his analysis of ‘pathologies of power’, this approach reframes public health problems as struggles over the control of conditions deemed necessary to achieve a state of health and well-being, and leads the public health practitioner, analyst or activist to consider the most effective means of transforming the social and structural ‘pathologies’ that drive and maintain disparities in health (Farmer 2003). Several articles in this Special Issue of Global Public Health similarly point in the direction of social or legal pathologies that contribute to the stigmatisation