It’s Time to Recognize Sexual and Reproductive Healthcare Providers as Human Rights Defenders

Around the world, frontline reproductive healthcare workers are facing physical and verbal abuse, public shaming and humiliation, harassment, legal threats, death threats, sexual assault and rapes—simply for doing their jobs.

Samson Otiago (R), a doctor specializing in reproductive health, attends to a patient at his clinic in Nairobi, Kenya, in the densely populated, low-income neighborhood Kayole. Otiago’s clinic provides services to victims of sexual violence. (Tony Karumba / AFP via Getty Images)

Around the world, frontline healthcare workers defending our right to sexual and reproductive healthcare services are under vicious attack from anti-rights actors.

In the horn of Africa, one district health official who has been providing sexual and reproductive health services for 15 years described the attacks he faces from local conservatives: “They tried to even shoot me because of the belief and the values that I had …  I had provided family planning service[s] in my district. They said, ‘You are a genocider.’”

This terrifying experience is part of a deeply worrying but largely underreported and undocumented global trend.

Over the last two years, in our work as institutional experts and researchers in sexual and reproductive health, rights and justice (SRHRJ), we have collected harrowing accounts of physical and verbal attacks on our colleagues, including midwives, gynecologists and obstetricians, as well as community health workers, peer-educators, volunteers, researchers and advocates for sexual and reproductive health services. Those on the frontlines have described physical and verbal abuse, public shaming and humiliation, both in-person and online, harassment, legal threats, death threats, sexual assault and rapes.

“In 2019, there was a midwife raped by many people at the clinic,” recalled one colleague in South Asia. “Nothing happened … just the midwife (moved away), lost her job, lost her income.”

Another colleague said of the local anti-rights actors: “They try to destroy our health center … they were stoning the windows.”

In Ghana, an advocate for sexual and reproductive rights described how health service providers have been beaten and publicly shamed, simply for educating people about contraception or intervening in child marriage cases, particularly in rural areas.

Safety fears also extend to health workers’ family members.

“It’s a death threat,” said a colleague in South Asia. “I had to work from home and … [my employer] would send me different cars, so they [the attackers] wouldn’t relate me to the same car. Then I got this threat saying, ‘You need to stop this work. We know where your children go to school.’”

In the United States, at least 11 providers of SRHR have been murdered since 1990, with 42 bombings, 196 arson attacks and 491 assaults against sexual and reproductive health services perpetrated since 1977.

These are just a handful of examples from 23 interviews we conducted with SRHR workers around the world, in collaboration with leading SRHR organizations including the International Planned Parenthood Federation (IPPF), MSI Reproductive Choices, Ipas, International Confederation of Midwives and the International Federation of Gynecology and Obstetrics (FIGO). All interviewees have been kept anonymous for their own safety. Still, despite the risks, healthcare workers have bravely continued their day-to-day work in openly hostile environments through their enduring commitment and resilience.

But enough is enough.

Until now, our collective knowledge of these matters has been scattered and primarily anecdotal. Recognition of this bravery is long overdue and collective action is needed to protect and uphold their human rights. Those who defend SRHR must be protected and fully supported in their workplaces, for both their own and their patients’ safety, as well as for the benefit of the entire health system.

While there is significant evidence of hostilities against SRHR workers, little is known of the causes or consequences of these attacks.

A Matter of Vital Public Interest

When the safety and well-being of health advocates and service providers are compromised, provision of care is also undermined.  

Our colleagues talk about the psychological toll of such hostilities, including panic attacks, sleep disturbance, loss of appetite and depression, which deeply impact their personal lives and relationships. They also describe facing professional disadvantages, believing themselves to be at risk of rejection from future employers and of being denied professional advancement for having worked in SRHR. Such reprisals have a major impact in the health sector; distracting from, limiting, or otherwise constraining health workers’ ability to serve clients, many of whom may face their own safety concerns for seeking these services.

“Doctors and nurses were suffering a stigma with their families and colleagues,” said one health worker we interviewed. “They feel ashamed to tell the people they loved that they were working in [abortion care].”

The mental and physical health and well-being of our colleagues must be taken more seriously, as must the cycle of strain, stress and demoralization that such hostility perpetuates in the health system more broadly.

Escaping Accountability

According to the World Health Organization (WHO), over 60 percent of healthcare workers worldwide have experienced workplace violence. This is even more pronounced for those working on sex, sexuality and reproduction—topics that are often politically charged by political and religious actors who promote public debates, laws and policies that are openly antagonistic towards these services.

Anti-AIDS messages painted on the walls of the basketball court at the loveLife Y-Centre in Orange Farm township, South Africa. The multi-purpose youth centre is part of a program of providing adolescent reproductive health services in non-clinical settings. (Smiley N. Pool / Houston Chronicle via Getty Images)

We have witnessed authoritarian leaders in countries like Argentina, Poland, the United States, Uganda, Russia and Kenya, among many others, shore up their own political power by deploying stigma, fear and hate-speech against those seeking and those providing sexual and reproductive health services.

Yet, many of those who commit acts of violence against SRHR workers, or those who publicly incite antagonism, largely escape accountability for the consequences of their actions. This means that these human rights defenders continue to live in constant fear of being attacked and prosecuted for providing this essential, life-saving care.  

The good news, however, is that collective action has begun.

In early 2022, we launched a call to better protect frontline defenders of sexual and reproductive rights through human rights-based responses and an action-oriented inquiry into the situation globally for SRHR’s frontline defenders.

We published our first results last year, confirming that while there is significant evidence of hostilities against SRHR workers, little is known of the causes or consequences of these attacks.

Then, in November 2023, our colleagues at Amnesty International released a groundbreaking report revealing how healthcare workers, activists, advocates and accompanists supporting access to safe abortions often face abuse, and may confront arrest, prosecution and imprisonment for their work, even where it is allowed by law. The report provides clear recommendations to states, educational and professional bodies, unions, intergovernmental organizations, social media companies and donors to support and protect those providing abortion care services.

An Unstoppable Movement

This year marks the 25th anniversary since the U.N. Declaration on Human Rights Defenders, and there are many ways in which the hostility against these global defenders can be transformed, starting with the recognition of all SRHR providers as human rights defenders.

Amplifying the voices of our colleagues on the frontlines is also vital to raise public awareness about these dangerous and unacceptably high levels of hostility. Their voices and experiences are essential in building a more robust evidence-base on the nature and consequences of this hostility, which can be used to call on states to meet their human rights obligations to protect those seeking and providing healthcare services.

Together, we form a historical moment in an unstoppable movement for an undeniable right to essential services. These services must be provided by skilled professionals working without fear, threat, or undue interference to realize our most intimate rights: our human rights to sexual and reproductive health and justice.

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About and

Dr. Victoria Boydell is a social anthropologist who has carried out research in the U.K., the Philippines, El Salvador, Tanzania, Nigeria, Uganda, Indonesia, Kyrgyzstan and Bosnia Herzegovina. After completing her Ph.D. at the London School of Economics and Political Science (2010), she oversaw global monitoring and reporting for the Fund for Gender Equality at U.N. Women and held a range of positions at the International Planned Parenthood Federation. She has over 15 years of experience in the field of family planning, reproductive health and gender equality.
Kate Gilmore is a fellow at the Carr Center for Human Rights Policy, Harvard Kennedy School, researching human rights concerns. Kate was United Nations deputy high commissioner for human rights from 2014 to 2019 and was assistant secretary general and deputy executive director, United Nations Population Fund (UNFPA) from 2012 to 2014. Before this, she was executive deputy secretary general at Amnesty International from 2000 to 2009. She is the chair of the Board of Trustees at the International Planned Parenthood Federation (IPPF).