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Looking Past Borders: Transnational Politics Offer Solutions for Women's Health

One of the major successes of the global women’s movement has been to critically examine the division between the personal and the political, and even to assert its nonexistence. Women’s rights activists achieved the recognition that violations against women in the domestic sphere deserve policy redress in the public sphere. By eliminating barriers between spheres of inquiry, women have illuminated previously neglected avenues for policy action to protect human rights. 

The time has come to tear down yet another wall: the intellectual and political barriers between foreign and domestic policy, just as women tore down those dividing notions of the domestic and public spheres. 

A few major signs indicate that now is the right and necessary moment to undertake this project. First, recent political upheavals, like the US election of Donald Trump and the UK Brexit vote, amply reveal the decisive role that foreign concerns play in domestic affairs and vice versa. While this interplay is not new, its scale and impact in an increasingly interconnected world is arguably at an alltime high. Indeed, Trump’s invocation of ‘America First’ is in part an attempt to deny this interdependence between ‘home’ and abroad. Second, dismantling the false barriers between these realms, rather than simply recognizing their interplay, can uncover urgently-needed strategies to remedy human rights violations that remain obscured if we assume only the disjuncture between the foreign and domestic realms. 

Women’s rights activists are uniquely positioned to engage in this project as part of the ongoing feminist work of contesting and renaming boundaries. Just as extending the human rights framework to the private sphere offered new strategies for combatting domestic violence, today, leveraging the indivisibility of human rights helps reveal remedies that recognize the multiplicity of women’s identities and the ways they intersect to shape women’s experiences of discrimination. Finally, women’s rights activists, who are well versed in transnational movement building theory and practice, bring more than past experience to this inquiry. They have often worked across national boundaries, leveraging their numbers globally, while supporting and learning from each other’s local and regional struggles. This collaboration has had the added effect of growing relationships of solidarity in the face of some governments’ xenophobic and destructive foreign policies. They can employ this perspective to build transnational activist strategies at the nexus of foreign and domestic policy realms. In fact, the core issues that we, as a global society, confront —including the vital need to secure protections for women’s health worldwide —demand that we reveal and strengthen strategies currently eclipsed by our siloed domestic-vs-foreign thinking. An examination of reproductive, economic, and environmental policies as they shape women’s health illustrates this mode of inquiry 

Reproductive Policies and Women’s Health 

We can start to uncover those transnational activist strategies with the issue of reproductive justice as a cornerstone of sexual health and women’s rights. In a US policy context, two legislative examples restricting abortion access help show the need to remove barriers between domestic and foreign realms in our thinking. 

The 1973 Helms Amendment to the US Foreign Assistance Act prohibits US funding from paying for abortions around the world. The continuing impact of the amendment is to underfund women’s health programs and compel women to seek out unsafe abortions. The World Health Organization (WHO) estimates that 21.6 million women have unsafe abortions each year; 47,000 die from it. 

The Helms Amendment was created as a direct response to the Supreme Court’s Roe v. Wade decision that same year. Senator Jesse Helms, who advanced the amendment, did not limit himself to blocking non-US women from having abortions; he imposed that ideology wherever opportunity allowed. Helms was successful in using the backlash against the domestic reproductive rights protection of Roe v. Wade to obstruct women’s access to abortions worldwide. But he was just as adamant about restricting women’s abortion access in the United States, promulgating such measures as a 1981 bill to give fetuses constitutional rights. 

Meanwhile, another bill, the Hyde Amendment, took a few more years to take shape. Passed in 1976, it prohibits the use of federal funds from covering abortions domestically except to save the woman’s life or if the pregnancy results from rape. The Hyde Amendment particularly takes aim at Medicaid funding, a program designed to provide health care to low-income families. From the perspective of the millions of women impacted by these policies, the Helms and Hyde Amendments reveal stark parallels: in their disproportionate impact on women of color and poor women, and in their denial of women’s bodily autonomy and reproductive choice, whether in the United States or around the world. 

Reproductive rights organizations in the United States and internationally have made some inroads in connecting efforts to overturn these two amendments. Yet, there are still untapped opportunities to render domestic US organizing more transnational. Often, domestically-oriented US women’s organizations make the understandable judgment call that they can little afford the resources to take on women’s crises beyond US borders. However, advocates should consider the possibilities that derive from transnational collaboration, and that solutions to their own crises may be found across national lines. 

Already, in their separated local contexts, women are constantly and by necessity innovating ways to overcome barriers to their reproductive health. These include, in the United States, the National Network of Abortion Funds, which pays for women’s expenses and travel to states where they can more easily access abortion services. In countries like El Salvador, Brazil, and Mexico, women share information on how to mitigate the risks of self-induced abortions using the WHO-recognized and over-the-counter medication misoprostol. 

As abortion restrictions tighten in local contexts, women and their supporters can gain new practical measures to provide for reproductive rights through cross-border exchanges. For example, a Dutch organization, Women on Waves, sends ships to drop anchor off the shores of countries where abortion is banned or severely restricted, and invites women to enter international waters to receive care. A report by Rewire shows that women in Texas, facing the shuttering of abortion clinics across the state, are now organizing to share WHO guidelines on the use of misoprostol, borrowing directly from the experiences of women in Latin America. These small-scale models offer an initial blueprint for the type of transnational activist strategies, borrowing from local initiatives, which can mitigate harms and secure reproductive rights in the face of restrictive policies.

Economic Policies and Women’s Health

This dynamic of finding solutions by erasing the divide between the domestic and the foreign also plays out in the realm of economic policy, with implications for women’s health. A conventional view of health as a measure of medical fitness obscures the fact that economic forces are the primary determinant of people’s health. Consider the consequences of poverty, which is the root cause of most people’s poor nutrition, lack of access to basic health care, and lack of clean water and sanitation. Poverty and economic inequality are also major contributors to public health crises such as violence, mental illness, stress, and substance abuse. Therefore, efforts to improve women’s health outcomes require taking on global and domestic economic inequality and poverty. 

Economic conditions that generate poor health were widely enforced by the much-maligned Washington Consensus, through which powerful financial institutions like the World Bank and International Monetary Fund implemented a set of top-down economic policies throughout much of the Global South. These were imposed on countries in need of development aid to remedy years of economic exploitation by the backers of that same Washington Consensus. 

The cocktail of enforced austerity, deregulation, and privatization was a onesize-fits-all neoliberal recipe incorporated into multiple US trade agreements with countries in Latin America, Africa, and Asia. It also found its counterpart in domestic US economic policies, referred to since the 1980s with monikers like ‘Reaganomics,’ ‘the end of Big Government,’ and most recently, “the deconstruction of the administrative state.” 

While generally presented in technical, macroeconomic terms without regard to gender, these policies generate particular consequences for women, including specific threats to women’s health. When government-funded social services fall under the ax of ‘fiscal discipline,’ the safety net upholding living standards for women and families is torn. Care work formerly provided by public programs, schools, and hospitals is pushed into the informal, unpaid sector; in the gendered division of labor, this work becomes the responsibility of women. Today, global statistics show that women do more than twice the unpaid labor of men, and in countries subjected to neoliberal economic reforms, women’s work burdens become even heavier. For instance, a report by the European Women’s Lobby showed that austerity measures reduced access to care services across the region, with public kindergartens closing in Greece and Portugal, with 30,000 children turned away from preschools in the Czech Republic, and with Ireland slashing the number of beds in nursing homes. This displaced care work becomes women’s responsibility, with corresponding impacts on women’s economic independence and employment rates. 

In essence, women are expected to care for those who can no longer afford health care, largely due to the assumption that women’s unpaid labor is limitless and cost-free. It is neither. While attempts are sometimes made to place a dollar value on that unpaid labor (a 2015 McKinsey report sets the figure at US$10 trillion per year), another vital measure would be found in the health impacts of women’s overwork, including physical and psychological stress. 

Harsh austerity policies also have direct negative impacts on women’s health. During the worst days of Greece’s economic crisis, health researchers warned about the decline in maternity care as a result of steep budget cuts, resulting in an increase in the rate of stillbirths. In the early days of the Trump administration, initial reports reveal that the new administration is considering the elimination of programs meant to combat violence against women, as part of sweeping cuts in their ‘blueprint’ budget. Given that the US Centers for Disease Control and Prevention estimates that 1 in 3 women will face intimate partner violence in her lifetime, violence against women remains one of the most prevalent and deadly threats to women’s health today. 

Like austerity measures, wage suppression, another staple of neoliberalism in US foreign and domestic policy, has severe impacts on women’s health. In 2011, State Department cables released by WikiLeaks revealed the extent to which the US government intervened in Haiti’s minimum wage struggle. The US Embassy and the US Agency for International Development pushed misleading data about the impacts of a wage increase as part of a vigorous fight against a widely popular proposal that would raise Haiti’s minimum wage to a paltry US$5 per day. The cables showed that, in an effort to support brand name companies like Levi’s, Hanes, and Fruit of the Loom, which opposed the increase, Washington also closely monitored pro-wage increase protests, and UN troops were used to tamp down student mobilizations. These back channel efforts to suppress wages have particular effects on women, especially in sectors where they are overrepresented, like the garment industry. 

Meanwhile, in the United States, the government has used taxpayer resources on behalf of large corporations in efforts to undermine social movements advocating for economic equality. For example, a Freedom of Information Act request by the Partnership for Civil Justice Fund revealed that the Federal Bureau of Investigation (FBI) and other intelligence and police agencies monitored the Occupy Wall Street movement under the guise of combatting terrorism, while simultaneously holding secret meetings with the New York Stock Exchange. Of course, much of the opposition has happened in plain sight: the US-based workers’ campaign known as Fight for $15, to raise minimum wages to US$15 per hour, has faced legislative blocks by lawmakers across the country. According to a 2014 report by the US Bureau of Labor Statistics, women make up more than 61 percent of people with wages at or less than minimum wage, signifying that women and women’s health are disproportionately impacted by political attempts to suppress wages. 

In response to the opposition they faced, US organizers of the Fight for $15 put out a call for support. They found that allies not only within the United States but from 33 countries rallied to the cause, and non-US supporters staged solidarity rallies when US workers went on strike. While the victories in this minimum wage struggle will necessarily be implemented at the local and domestic level, transnational activism helps mobilize new and larger constituencies for policy change. 

Climate Policies and Women’s Health 

Just as the women’s health impacts of economic policies are often overlooked, climate change continues to be treated primarily as a technical or scientific problem. In fact, its impact on women’s health, especially for the world’s poorest women, is severe and disproportionate. As the Intergovernmental Panel on Climate Change (IPCC) points out, “[people] who are socially, economically, culturally, politically, institutionally, or otherwise marginalized are especially vulnerable to climate change.” The IPCC underscores the inequities that drive greater climate vulnerability, and result from intersecting “discrimination on the basis of gender, class, ethnicity, age and (dis)ability.” Indeed, women in poor countries are more likely to die during climate catastrophes like flooding and hurricanes than men are. 

Moreover, their lack of legal assets, property, and rights leaves them less equipped to rebuild and more vulnerable to gender-based violence and other harms that further the cycle of poverty and ill health. Moreover, women’s day-to-day unpaid work of feeding and caring for families and communities becomes harder and absorbs more time as a result of climate change, compounding the negative impacts of economic policies. For instance, when drought makes water scarcer, women and girls tasked with seeking out dwindling supplies must carry heavy loads over greater distances and lose valuable hours for activities that correlate with improved health outcomes, including education, paid work, and leisure. 

In drought-stricken areas of Kenya, women have documented how climate change intersects with gender discrimination to produce specific threats to women’s health. As livelihoods are destroyed by the drought, parents desperate to feed their families increasingly pull their daughters out of school and into early marriage in exchange for a dowry. Early marriage, in turn, is linked to two of the greatest threats to women’s health in this region: female genital mutilation and maternal mortality. 

The world’s poorest people, including women, bear both the greatest health impacts of climate change and the least responsibility for causing it. For example, the abovementioned protracted drought in Kenya is exacerbated by greenhouse gas emissions generated thousands of miles away. At root, climate-related threats to women’s health in communities worldwide emerge from a classic tragedy of the global commons. When powerful countries and companies exploit finite natural resources and pollute our shared environment, the impacts are not constrained to national boundaries. 

This dynamic renders the utility of dividing environmental policy into categories of ‘foreign’ and ‘domestic’ particularly limited. As with reproductive health and economic policy, the transnational impetus and impacts of environmental policies invite women’s health and rights advocates to organize across political boundaries for the greatest impact. In fact, the outpouring of solidarity with the women water protectors of Standing Rock from women climate justice activists worldwide is predicated on the understanding that a fight to stop fossil fuel extraction or a pipeline in one corner of the world has ramifications across the globe. 

Women climate activists further recognize that while the causes of climate chaos are transnational, health impacts are experienced locally, necessitating that women’s political organizing span the local and global and focus on the interplay between these realms. At the local level, grassroots women climate defenders are creating rain harvesting methods to conserve water, setting up seedbanks and greenhouses, sharing adaptive farming techniques, and more. By building their communities’ resilience to climate change impacts, these women help secure better health outcomes, from reducing the incidence of waterborne diseases and child marriage to improving overall food security. 

Transnational exchanges enable women in diverse local contexts to share and adapt ideas to strengthen climate change adaptation strategies. For instance, indigenous women in Nicaragua have borrowed and replicated rainwater harvesting techniques established by women in Kenya, after participating in an exchange as part of my organization’s partner network. 

Such tested approaches offer a blueprint for policymaking far beyond the local level. When indigenous women in Kenya set up clean water and rain harvesting systems, protecting people from waterborne illness and freeing women from the time-intensive labor of water-fetching, these community-based interventions present models that can be replicated, adapted, and scaled-up through national and international policy frameworks. Yet, despite the adaptive solutions being innovated by grassroots women, these actors are routinely and systematically excluded from meaningful participation in environmental policy and planning efforts. 

Women’s health and rights advocates’ ability to impact policymaking spaces is bolstered by their transnational collaboration, as they reach out across borders to share their expertise, evidence, advocacy strategies, and climate policy solutions. A transnational perspective further understands that there are multiple points of entry for advocates to influence climate change policy globally, including by offering a much-needed framing of climate change as a public health issue with particular gendered impacts. That is why women climate activists at the Kenya-based Indigenous Information Network devote their energies both to local lobbying to ensure that county-level budgets support women’s efforts to build community health and resilience to climate change, and also to convening with other indigenous climate activists around official UN climate negotiations like the 2015 Paris Conference. By gathering with other activists grappling with similar challenges, local activists deepen their understanding of their own context and consolidate shared strategies for influence, especially when they face exclusion. In this way, they are further empowered to play key roles in addressing climate change and its many threats to public health. 


To tackle as holistic and global an issue as women’s health, countless realms of life are implicated and drawing dividing lines is not only difficult, it is ill-advised. Examining these three areas—reproductive, economic, and environmental policies—reveals that not only does each set of policies have impacts on global women’s health, they traverse national boundaries as well. To better equip themselves to advance women’s health and rights, activists must be ready to work across these permeable boundaries, forging new alliances and activating transnational strategies to confront root causes. 

This is an enduring principle, but it is sorely tested by the times we live in. Heads of state like Donald Trump, by espousing rhetoric and enacting policies based on a ‘clash of civilizations’ worldview, attempt to pit the one side—the United States and the Western world—against enemies portrayed as so-called ‘radical Islamic terrorism’ or ‘illegal’ immigrants. As is typical of ‘us vs. them’ binaries throughout history, this manufactured clash invokes women’s bodies and identities to reinforce political and nationalist categories and to trigger fear and anxiety about infiltration by the ‘Other.’ Consider the pejorative terminology of ‘anchor babies’ used in the United States to cast suspicion on undocumented mothers, or the recurring attempts in certain European countries to regulate the clothing of Muslim women by banning hijabs and other religious coverings. 

Such policies seek to re-inscribe the boundaries between foreign and domestic by rooting out the ‘Other’ within the ‘homeland,’ with negative consequences for women’s health and human rights. For example, undocumented women who fear deportation or Muslim women who face hostility and Islamophobia will encounter barriers to accessing their right to respectful, high-quality health care and to recourse from gender-based violence—rights recognized under international law. 

The prescription of transnational collaboration and activism carries new urgency in this moment. Women’s rights activists must not make the mistake of inadvertently reinforcing the inward-facing posture of ‘America First.’ Now is the time to reach out across the borders—physical and conceptual—that opponents of human rights, including women’s rights to health, are seeking to fortify.

September 2, 2017  / Women's Health