Power, Suffering, and the Struggle for Dignity. Alicia Ely Yamin

International Workers of the World LGBT lesbian, gay, bisexual, and transgender LRA Lord’s Resistance Army MCH maternal child health *MDGs Millennium Development Goals MoHSW Ministry of Health and Social Welfare MMR maternal mortality ratio MSM men who have sex with men NAFTA North American Free Trade Agreement NALSA National Legal Services Authority NGO nongovernmental organization NHRI national human rights institution *ODA official development assistance OHCHR UN Office of the High Commissioner for Human Rights PEPFAR U.S. President’s Emergency Program for AIDS Relief PHR Physicians for Human Rights PHU primary health unit PJF Policia Judicial Federal (Federal Judicial Police of Mexico) PLWAs persons living with HIV/AIDS PMA Pharmaceutical Manufacturers Association PMTCT prevention of mother-to-child transmission PPP public-private partnership PTSD Post-traumatic Stress Disorder *QALYs quality-adjusted life years SAM social accountability monitoring *SBA skilled birth attendant *SDGs Sustainable Development Goals SRH sexual and reproductive health SRHR sexual and reproductive health and rights TBA traditional birth attendants UDHR Universal Declaration of Human Rights UHC universal health coverage UNDP United Nations Development Programme UNICEF United Nations Children’s Fund WHO World Health Organization

      Introduction

      How Do We Understand Suffering?

      We humans can tolerate suffering: we cannot tolerate meaninglessness.

      —Desmond Tutu, Believe: The Words and Inspiration of Desmond Tutu

      Human rights are being violated on every continent…. Human suffering anywhere concerns men and women everywhere.

      —Elie Wiesel, Nobel Peace Prize Acceptance Speech, December 10, 1986

      Before I had my two children, I had a miscarriage. I was living in New York City at the time and medically it was not a major event. I required surgery, but I was admitted to the hospital very early in the morning and by that same evening I was released and at home. Of course, emotionally it was deeply, deeply painful. Earlier, I had been invited to go on a human rights fact-finding delegation to the state of Chiapas in southern Mexico that was scheduled for the week after my unexpected miscarriage. I had lived in Mexico for years and been to Chiapas many times before, and the political events that prompted the delegation felt very immediate to me. And, undoubtedly to escape the emotional pain I felt and to stop feeling sorry for myself, the very next week I did indeed go.

      Chiapas is the state where the Zapatista Army of National Liberation (EZLN, according to its Spanish acronym) had launched its revolt on the day that the North American Free Trade Agreement (NAFTA) went into effect on January 1, 1994. The EZLN was protesting economic and political policies that left indigenous people systematically marginalized and impoverished. Its goals included achieving basic citizenship rights, indigenous control over resources (especially land), and demilitarization of indigenous areas.¹ In December 1997, when I was there on this occasion, paramilitary violence was at its height in Chiapas. The Mexican government was exploiting religious and political fault lines in these impoverished indigenous communities and arming paramilitary groups with Orwellian names, such as “Peace and Justice,” in order to terrorize potential Zapatista sympathizers. On December 22, 1997, thirty-six women and children were killed in Chenalhó, a community in los Altos, the “mountainous region,” of Chiapas.² In the weeks preceding the Acteal massacre, as it came to be called, an upswing in violence had already exacerbated the displacement of Zapatista-sympathizing communities.

      It was in one of those communities of internally displaced persons that I encountered a woman who was hemorrhaging as a result of a miscarriage. She was just about at the same stage of pregnancy as I had been the week before. However, in her case the hemorrhage was a life-or-death situation. She was weak from the loss of blood and obviously terrified. Her husband and the elders in the community had decided that it would be better for her to “die with dignity” than to be taken to the nearest hospital because they viewed the public health facilities as an arm of the government counterinsurgency.³

      I was immediately gripped by the sense of, “there but for the grace of God go I.” After all, I could easily have been in the same situation. I dropped the neutral human rights investigator role and the delegation arranged for this woman to be accompanied to the hospital in San Cristóbal de las Casas by a representative of a local nongovernmental organization (NGO) who the community elders accepted. The NGO representative made sure that the woman would not have to answer any political questions—which was a common tactic that government facilities at the time were using to intimidate Zapatista sympathizers—and that she was treated appropriately by the health providers. Afterward, the woman—alive and healing—was transported back to her community by the same NGO representative.

      In retrospect, however, it was not “but for the grace of God” that she was in a life-or-death situation—and that I, the previous week, was not. It was because of very human choices about laws and policies about women’s education and the use of health facilities; it was because I was a white, middle-class woman with good health insurance living in a city with excellent health care; and it was because I was able to make decisions about my own body, and my own life—whereas she was not.

      I cannot count how many times during the years I have been engaged in this work that I have heard that the “will of God” led to the death or suffering of a woman, a child, or a family. And often “God’s will” has seemed to be tinged with a good dose of misogyny. I remember Lidia, for example, who had