Global Prescriptions: Gendering Health and Human Rights (review)

Rosalind Petchesky's latest book, Global Prescriptions: Gendering Health and Human Rights, is global in scope, meticulously researched, and deeply engaged with feminist activism. From various vantage points—global to national, activist and intellectual, Petchesky offers key analysis and insights into transnational feminist organizing over the last three decades. The signal achievements of the transnational women's movement, such as the strategic role played in shaping the new discourse on sexual and reproductive health as articulated in the United Nations International Conference on Population and Development (Cairo), are analyzed, with attention to the critiques and conflicts generated within the movement, as well as the limits of such engagement.

Her pioneering theoretical work on sexual and reproductive rights enables Petchesky to adeptly orient the reader to the theoretical and ethical frameworks that relink the body and social development, human rights, and basic needs. She tracks how complex and contested ideas and concepts of reproductive and sexual rights travel across boundaries and attain new meanings and vitality, drawing new actors to this struggle. Issues of authenticity and ownership as well as tensions between North and South over these meanings are elaborated, and the critical contributions and leadership roles of feminists from the global South are underlined and acknowledged.

Petchesky moves beyond Cairo to other locales where transnational women's organizing has been decisive. She pragmatically situates feminist demands and visions in the context of a global constellation of forces—the "macroeconomic restructuring on poverty levels and health, [and] the rise of anti-feminist, fundamentalist politico-religious forces" (1), and the ever-growing power of corporations in their relentless drive for profits over people—that impinge on attaining women's human rights and demands to meet basic needs. She challenges transnational women's and other nongovernmental coalitions to identify structural changes that have transformative power. Among efforts underway she discusses the development of people's and women's budgets, calls for transparency and accountability on the part of transnational corporations and international financial institutions, and discusses proposals for the regulation of transnational capital flows. She argues for feminist organizing to change the priorities of macroeconomic policies of global institutions as a critical challenge that must be confronted.

Global Prescriptions also introduces the reader to successful efforts that are using human rights principles to demand international and corporate responsibility and challenging corporate dominance and trade regimes skewed in favor of the powerful. The recent campaigns to recognize access to life-prolonging medicines as part of the human right to the highest attainable standards of health are outlined with particular attention to the efforts of the Treatment Action Campaign in South Africa to expand access to essential HIV/AIDS medicines. Similarly, she examines the factors and forces that led Brazil to "assert public health needs and human rights over intellectual property claims and corporate profit" in its efforts to make both prevention and treatment of HIV/AIDS a public health priority (95).

Despite the headway made in broadening access to essential medicines as well as challenging intellectual property rights regimes, feminist political activists and broad-based social movements insist that for the right to health to be realized, it is essential to challenge global capitalism. Global Prescriptions examines the popular and intellectual bases of these challenges, and explores in particular how health is managed under global capitalism and how women are most disadvantaged by current utilitarian health sector reform proposals. Not content to merely provide the reader with trenchant academic and activist critiques, she discusses various approaches being formulated for an alternative ethics of health provision. This includes formulations that view health as a "global public good," promoted by "macro-economists and health reformers seeking to reconcile market systems with principles of social justice and inclusion" (172). The "capabilities approach" pioneered by Amartya Sen moves away from the market approach to health care toward "ethical criteria for setting health priorities" (174). The human rights framework transforms issues of health from being treated as a private...