Reproductive rights under threat  

Community Gynaecologist Dr Asha Kasliwal will tell RCPI obstetricians and gynaecologists that access to equitable reproductive healthcare is in crisis around the world

Dr Asha Kasliwal, a consultant in community gynaecology at Manchester University NHS Foundation Trust, UK, will deliver a keynote address at the upcoming RCPI Institute of Obstetricians and Gynaecologists webinar – ‘Reproductive Rights as Human Rights’ – on Wednesday 18 September. She will explore the global healthcare crisis denying this basic human right. However, she believes that Ireland is at the forefront of progress in the area.

Dr Kasliwal will share insights and experience from 15 years at the helm of the Manchester community gynaecology service. She established the service in 2008 to create a more holistic approach to healthcare with a focus on local delivery, equitable access and support for healthcare workers. 

“Patients had expressed a preference for services closer to home in a community setting. The Manchester community gynaecology service was set up and has over 1,600 attendances annually with appointments within four weeks of referral,” said Dr Kasliwal, who is a former President of the Faculty of Sexual and Reproductive Healthcare at the Royal College of Obstetricians and Gynaecologists in London and a member of the International Federation of Gynaecology and Obstetrics.

Crisis

However, despite global efforts to improve access to reproductive healthcare, Dr Kasliwal argued that there is a crisis around the world with regressive laws restricting access to care.

“One of the targets of the sustainable development goals [of the World Health Organisation] is to guarantee universal access to sexual and reproductive healthcare services. Basically, what we mean is for people to be able to choose who to have sex with and to be able to access sexual and reproductive healthcare,” Dr Kasliwal said.

“But we are concerned – we have a crisis around the world. Even where there isn’t a warzone, there are regressive laws coming in, like in America. Those are the two aspects to it: One, in crisis zones where we are concerned about people’s reproductive rights; the other is places where there aren’t conflicts, but the political landscape is making it difficult for women to access healthcare.”

During the RCPI webinar, Dr Kasliwal will explore the three main pillars of reproductive rights she has identified in her research: The rights to equality and non-discrimination; the rights to reproductive self-determination; and the rights to sexual and reproductive health services, information, and education.

Roe v Wade

“We know in America, [the overruling by the US Supreme Court of] Roe v Wade has created massive legal issues where a number of states aren’t providing abortion care. We don’t mean only abortion care when we mean reproductive rights – we mean access to contraception, access to fertility treatment. Even those are now getting restricted.

“One of the other things I want to cover is where reproductive rights are protected, it gives healthcare professionals confidence to deliver these services. Regressive laws affect not only the patient, but also healthcare professionals, because they worry about providing [care],” Dr Kasliwal explained.

Savita Halappanavar

She referenced the tragic death of Savita Halappanavar, who died from sepsis after her request for an abortion during a prolonged miscarriage was denied on legal grounds in 2012. In the national outcry over her death, Irish voters repealed the Eight Amendment via referendum in 2018.

“She was an Indian woman. I’m from India, and India doesn’t have those kinds of regressive laws, so people really couldn’t understand why she had to die. Sometimes you get reform. Leo Varadkar was able to bring in massive reform and people supported and voted for it,” she said.

“It’s brilliant. Ireland is now at the forefront. Even in the UK, abortions are subject to criminal law. In all the other healthcare settings, you have a Care Quality Commission that oversees the standards, whereas abortions are subject to criminal law.

“As President of the Faculty of Sexual and Reproductive Health, we’ve tried to decriminalise abortion care in the UK. We’ve had some pluses: In terms of reproductive rights access with over-the-counter provision of the progesterone-only pill in 2021; allowing women to take abortion medication at home without having to come into a service. These are some of the successes we’ve had over the years. However, decriminalisation [remains] a challenge.”

Advocacy

Over the course of her career, Dr Kasliwal has seen consultants playing more and more of a role in public advocacy.

“Gone are the days doctors put their head down and did their work. They are realising they can be a powerful voice. At the Royal College of Obstetricians and Gynaecologists, we did a members’ survey about decriminalisation of abortion legislation.” A motion, in 2017, agreed to change the College’s position from neutrality on the issue to urging repeal of that legislation.

“I have given evidence to a parliamentary inquiry about access to contraception. We’ve done a lot through the newspapers, through lobbying members of parliament, including around legislation in Northern Ireland. More and more, advocacy and lobbying policymakers comes with the remit of being a consultant. We can be a powerful voice together,” she said.

The RCPI Institute of Obstetricians and Gynaecologists’ webinar will also feature Prof Maeve Eogan, Rotunda Hospital, Dublin; and Prof Dov Feldberg, Helen Schneider Women’s Hospital, Israel, who will present on sexual assault treatment services and transgender healthcare. Dr Kasliwal said she is increasingly seeing transgender services being brought into the conversation of reproductive rights.

“It’s really important because a lot of transgender people find themselves discriminated against, that people don’t have the knowledge and understanding. It’s really important to raise that issue, to improve understanding and train people.”

For Dr Kasliwal, it is an interest in improving women’s lives that drives her.

“I genuinely believe if we work hard to make women’s lives better, society will be better as a whole. They are 51 per cent of the population…. Giving them a voice is what I’m passionate about.”

‘Reproductive Rights as Human Rights.’ An Institute of Obstetricians and Gynaecologists webinar takes place on 18 September. Register at https://web-eur.cvent.com/event/1b18dc93-5673-4159-8090-57203e6139e1/summary.

This article was produced by the RCPI.