Looking back and pushing forward: Radically shifting how we work, learn, and think  about sexual and reproductive health globally

2 October, 2020


Written by Emily Harris, a Master of Public Health student at the University of Waterloo. She also holds a Master of Arts in globalization and international development with a concentration in women’s studies. She is passionate about the intersection of health and reproductive rights and has worked in different capacities with institutions that aim to promote health both locally and globally, including the Government of Canada (Global Affairs Canada), the United Nations Population Fund (UNFPA), Médecins Sans Frontières, and St. Michael’s Hospital.

Around the world, women’s[1] bodies and their reproduction have long been subject to external forces of control. In Western Europe and North America, the feminist movements of the 19th and early 20th centuries were built to resist structural manifestations of men’s power over women’s minds and bodies, including their reproductive capacity (LeGates, 2001), while actively rejecting and excluding the lived experiences of women of colour (Agnew, 2002). Often called First-wave Feminism, this historical narrative is recognized above the substantial but less-publicized impact of women’s movements outside of the Western world and the contributions of women whose voices have been silenced (see Further Reading).

After the end of the Second World War, international agendas to bring “development” to nations beyond postwar Europe veiled efforts to curtail a much-feared population explosion in Asia, Latin America, and Africa (Carter, 2018). It is important to note that international development as a concept has historically been grounded in colonial, paternalistic, and racist philosophy. In writing this work, I acknowledge the problematic history of international development as well as the current manifestation of inequity and bias that exist in its practice today.

Led and financed by wealthy countries, Malthusian international development policies to halt reproduction and control population growth were commonplace and inherently destructive to women’s autonomy (Hartmann, 1995;Bhatla, et al., 2020). Over the decades and through the dedicated efforts of advocates, a movement away from the paradigm of population control crept forward towards a focus on reproductive rights as human rights (Wheeler, 1999). This conceptualization grew to prominence at many levels, though its realization can be criticized as overly focused on rhetoric rather than meaningful action.

Beyond the 1990s, the thinking around women’s reproduction was absorbed into international guidance mechanisms such as the United Nations’ (UN) Millennium Development Goals. These global objectives arguably missed the mark with respect to women’s reproductive health as, well into the 2000s, much of women’s reproduction globally has been characterized as a means of contributing to growth for their country’s economies (Mohindra & Nikiéma, 2010).

Our most recent history has demonstrated that reproductive rights continue to be fragile in many contexts globally and susceptible to regressive ideologies and their resulting policies. It remains true that much of the work done internationally towards improving sexual and reproductive health is funded by wealthy countries in the Global North  – countries that, in 2020, have demonstrated a shift towards right-wing populism (Rodrik, 2020) and the degradation of women’s ability to make choices about their bodies (Ziegler, 2020).

Those of us with a passion for sexual and reproductive health and rights have heard these histories before; they sadden and enrage us while simultaneously driving us to create change through dynamic research and praxis. We know that reproduction has often been the chessboard upon which international power dynamics are played out and we try to work towards building a new arena.

But are we doing enough to truly make a change?

Some outwardly-focused efforts have been made at international and local levels to address power imbalances and move programming work up the classic ladder of citizen participation (Arnstein, 1969) towards broader consultation with target populations and true partnership. This occurs through the themes of our global conferences, the design of international reproductive health policies, the creation of participatory research efforts, and the planning of community-led reproductive health programs.

However, it is the unfortunate reality that, in many contexts, headquarters (HQ) located in the Global North still hold the vast majority of the power in directing interventions for sexual and reproductive health. This occurs despite the value many organizations place on amplifying the voices of those receiving care (often dubbed “empowerment” which, as a concept, is not exempt from inherent assumptions about superiority, i.e. who is empowering whom and how this empowerment manifests [see Further Reading]).

As a Canadian woman who has worked in HQ in governmental, UN, and other international non-governmental organizations that focus on global sexual and reproductive health, both as a volunteer and as staff, I have experienced and been complicit in this hierarchical structure. After years of reflection, study, and in conversation with colleagues, fellow students, and friends, I find myself asking challenging questions that I believe learners, teachers, practitioners and all those of us working towards global sexual and reproductive health must ask:

Are we doing enough as individuals to actively and aggressively break down structurally entrenched inequalities, injustices, and prejudices that inevitably infuse the plans and actions of international sexual and reproductive health organizations at the highest levels?

Are we building organizations, universities, and communities that humble themselves, recognize that they have been complicit in perpetuating damaging actions, and take real action to divest from oppressive ideologies to advance the voices of groups that have been silenced?

Are we going beyond two-day seminars, implicit bias tests, and reports to our boards about diversity and inclusion committees to sit with ourselves as individuals and examine the ways that we are complicit in and perpetuate destructive systems of power that ultimately impact sexual and reproductive health around the world?

When we engage the work of Black, Indigenous, People of Colour and other marginalized groups who choose to speak and teach about anti-racist strategies, are we paying fairly for benefiting from their knowledge and guidance?

Are we hiring leaders and board members in our reproductive health organizations that recognize the damage caused by focusing primarily on creating value for donors?

And are we challenging donor-centrism (both public and private), highlighting that the use of donors funds should not entitle a choice in the direction of programming objectives at the expense of the bodily autonomy of women?

Are we terminating contracts by international fieldworkers who commit sexual crimes and are we holding them to account so other agencies do not hire them without knowledge of their actions?

Are we considering ourselves to be acting in the spirit of allyship before coming to a true understanding of our positionality and concluding that, sometimes, our voices are not needed and that others’ should be amplified instead? And are we recognizing that actions speak louder than words in all cases?

Are we trying to not only reimagine a world where international non-governmental organizations, research facilities, and communications initiatives focused on reproductive health don’t need to exist, but building plans to make that a reality?

Are we moving beyond a history of sexual and reproductive health work that has been dominated by patriarchal, white, Western, colonial thinking?

…or can we do better?

The way we choose to live, the policies we choose to accept, and the actions we choose to take (or not take) within our HQ environments both inform and are informed by our thinking about reproductive health, hierarchy, and power. In turn, these thoughts are a product of a deeply problematic history that is difficult to unlearn.

In the wake of recent and powerful rejections of the status quo in international work, may we now be entering a new age – one of responsibility to not only do no harm but to actively take steps towards razing the era of supremacy and neocolonialism in sexual and reproductive health?

This piece began with our history; a history of power imbalance, control, and coercion that has suffocated efforts to make substantive and sustainable improvements sexual and reproductive health around the world. This history does not need to become our future. However, we must take profound and radical personal and organizational steps to push our efforts forward towards creating a new decolonized, anti-racist, participatory paradigm within sexual and reproductive health.


Note: The questions posed here are the product of a multitude of conversations, reflections, and collaborated critical analyses by colleagues, friends, and fellow students; they are not ideas that I have developed in isolation and I am grateful to those that have guided my thinking along these line, specifically (in alphabetical order) Alex Bremshey, Calais Caswell, Tiffany Chiang, Idriss Lomba, and Raj Ram.



Agnew, V. (2002). Canadian feminism and women of colour. Women’s Studies International Forum, 16(3), 217-227.

Arnstein, S. R. (1969). A ladder of citizen participation. Journal of the American Institute of Planners, 35(4), 216-224.

Bhatla, R., Sasser, J. S., Ojeda, D., Hendrixson, A., Sarojini, N., & Ellen, F. E. (2020). A feminist exploration of ‘populationism’: engaging contemporary forms of population control. Gender, Place & Culture, 333-350.

Carter, E. D. (2018). Population control, public health, and development in mid twentieth century Latin America. Journal of Historical Geography, 62, 96-105.

Hartmann, B. (1995). Reproductive Rights & Wrongs: The Global Politics of Population Control. New York: Harper & Row.

LeGates, M. (2001). In Their Time: A History of Feminism in Western Society. Taylor & Francis.

Mohindra, K., & Nikiéma, B. (2010). Mohindra, K., & Nikiéma, B. (2010). Women’s Health in Developing Countries: Beyond an Investment? International Journal of Health Services , 40 (3), 543-567. Women’s Health in Developing Countries: Beyond an Investment?, 40(3), 543-567.

Rodrik, D. (2020). Why Does Globalization Fuel Populism? Economics, Culture, and the Rise of Right-wing Populism. NBER Working Paper No. 27526. Retrieved from https://www.nber.org/papers/w27526

Wheeler, M. (1999). ICPD and its aftermath: throwing out the baby? Policy and Practice, 77(9).

Ziegler, M. (2020). Abortion in America: Roe v. Wade to the Present. Cambridge: Cambridge University Press.


Further Reading

Archibald, T. (2011). Rethinking Empowerment: Theories of Power and the Potential for Emancipatory Praxis. New Prairie Press. Adult Education Research Conference. https://newprairiepress.org/ aerc/2011/papers/3

Dumond, Val. (1990). The Elements of Nonsexist Language. New York, NY: Prentice Hall Press.

Ehrlich, Susan, and Ruth King. “Feminist Meanings and the (De)Politicization of the Lexicon.” Language in Society 23.1 (1994): 59-76. Print. “Gender-Neutral Pronouns.” Wikipedia. Wikimedia Foundation, 22 Feb. 2011. Web. 22 March 2011.

Ma, Yuxin. (2010). Women Journalists and Feminism in China, 1898-1937. Amherst, NY: Cambria Press. https://books.google.ca/books?id=TiVg\_CP4rMAC

MSAfropolitan. (2012). Feminism has always existed in Africa. https://www.msafropolitan.com/2012/06/feminism-has-always-existed-in-africa.html

Penfield, Joyce. Women and Language in Transition. Albany, NY: State University of New York Press, 1987. Print.

Wayne, Linda D. “Neutral Pronouns: A Modest Proposal Whose Time Has Come.” Canadian Woman Studies 24.2/3 (2005): 85-91. Print.

The Keenan Institute for Ethics at Duke University. (2017). The Problem with ‘Empowerment’? https://kenan.ethics.duke.edu/the-problem-with-empowerment/

Tolentino, Jia. (2016). How ‘Empowerment’ Became Something Women Could Buy. New York Times. https://www.nytimes.com/2016/04/17/magazine/how-empowerment-became-something-for-women-to-buy.html?_r=0

[1]Much feminist literature has examined constructions of gender and sex through linguistic categorizations and considered the complexity of the word “woman/women” (see Further Reading). It is important to explicitly state that women as a category must be inclusive of the lived experiences of all women, specifically making space for and valuing trans and non-binary identities.