Blog Global Health Center Sexual Health

Are we really promoting harm reduction in the United States?

Jessica S. Li, MD candidate at Elson S. Floyd College of Medicine, Washington State University, and a Summer Pediatric Research in Global Health Translation (SPRIGHT) Scholar in the 2022 Institute for Public Health Summer Research Program

In the wake of the U.S. Supreme Court overturning of Roe v. Wade, it is hard to imagine that we are moving forward in gender-based equity in many states. A decades-standing ruling that has sat as a pinnacle for women’s reproductive rights has fallen. This puts into perspective just how much work needs to be done to reach SDG 16Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.

Some of the targets in this goal include promoting the rule of law at the national and international levels, ensuring equal access to justice for all and strengthening relevant national institutions, including through international cooperation, for building capacity at all levels, in particular in developing countries, to prevent violence and combat terrorism and crime. However, the seminar given by Kim Thuy Seelinger, JD, associate professor at the Brown School and School of Law at WashU and director of the Center for Human Rights, Gender and Migration at the Institute for Public Health, demonstrates the steps we need to take to hold instigators of violence accountable and how to empower those outside the legal field to protect women and other individuals from gender-based violence.

Seelinger made a powerful statement when speaking with the Institute for Public Health Summer Research Program – Public & Global Health Track cohort in that sexual violence has likely been around much longer in human history than armed violence. In the last 80 years, we have seen comfort women enslaved by Japan, forced marriages under the Khmer Rouge in Cambodia, and even today with the Russian-Ukrainian conflict occupied territories of Ukraine experiencing sexual violence. There have been many international tribunals that have attempted to hold perpetrators of these crimes accountable – for example, the Nuremberg Trials. These followed armed conflicts. So, how do we hold individuals accountable for these crimes against humanity outside of armed conflict?

The logo for World Day of International Justice | Source: National Today 2022

Seelinger outlined several components that simplify the components needed to prosecute these individuals. Beyond defining a victim and perpetrator, proof of actus rea, an act of crime, and mens rea, the mental conviction of crime, are needed. Alongside proof of the lack of consent, this is a criminal offense. While clearly laid out, how does an international court, for example, charge a military leader in which their soldiers committed crimes against humanity? There are many contextual components to create the mode of liability to the leader.

Seelinger provides the example of holistic accountability as demonstrated by the Kavumu case in the DR Congo where physicians seeing pediatric patients of rape, worked with the police to prosecute 11 people, including a prominent lawmaker, for child rape and the murder of the Kavumu Village–all crimes against humanity. It is incredibly empowering to hear that physicians worked beyond just the clinic to protect the well-being of their patients. But, in states that threaten to persecute physicians for assisting patients in seeking reproductive care, we seem to be moving away from the steps that are being taken globally toward gender equity.

No longer are clinicians empowered, but they are incentivized to perpetuate harm toward their patients. We are criminalizing acts specific to one sex, which has massive implications beyond that individual. This begs the question, are we enabling the perpetuation of gender-based violence in our own backyard by redefining modes of liability towards those who need protection?