Variables

The study employs data from a cross section of 162 countries across different geographies. The development variable is operationalised by the human development index (HDI) developed by the UNDP. It includes and captures three major capabilities: access to long life (longevity), access to knowledge and access to a decent standard of living. The HDI is a measure of average achievements in key issues of human development. When looking at it from a human rights perspective, all the key variables for development must be assessed in order to determine usefulness and accuracy of data. This study employs the HDI released in 2010 by the UNDP by utilising the average value of HDI for the years between 2004 and 2010.

The variables operationalising health are from World Bank, World Development Indicators (WDI) Database (The World Bank, 2014). The WDI database includes cross-country data for a wide range of health variables with subheadings, risk factors, nutrition, disease prevention, mortality, reproductive health and health systems. From the database, the researchers chose variables that represent disease prevention, mortality and health systems. The selected variables are as follows: ‘mortality rate under 5 (per 1000 live births)’; ‘mortality rate neonatal (per 1000 live births)’ (MORT_NEO); ‘immunisation of diphtheria, pertussis and tetanus (DPT) (% of children ages 12–23 months)’ (DPT); ‘immunisation of measles (% of children ages 12–23 months)’; ‘number of hospital beds per 1000 people’ (HOSP); ‘number of physicians per 1000 people’ (PHYS); ‘lifetime risk of maternal death (%)’; ‘improved sanitation facilities (% of population with access)’ and ‘life expectancy at birth’ (LIFE_EXP).

There are two categories of variables that operationalise human rights. The first set of variables operationalises CPR. These are as follows: ‘Physical Integrity Index’ (an additive index constructed from the Torture, Extrajudicial Killing, Political Imprisonment and Disappearance indicators; ranges from 0 [no Government respect] to 8 [full government respect]), ‘Empowerment Rights Index’ (an additive index constructed from the Foreign Movement, Domestic Movement, Freedom of Speech, Freedom of Assembly & Association, Workers’ Rights, Electoral Self Determination and Freedom of Religion indicator; ranges from 0 [no Government respect] to 14 [full Government respect]), ‘Women’s Political Rights’ (WOPOL) (a score from 0 to 3 depending on the level of political rights for women) and ‘Independence of the Judiciary’ (a score from 0 to 2 depending on the level of independence). All the CPR data for the 162 countries were obtained from the Cingranelli-Richards (CIRI) Human Rights Data set. The data set is open access and does not require permission for use since it is publicly available. Ethics approval was therefore not required. The CIRI database was chosen since the variables reflect the CPR variables that are parallel to the International Covenant on Civil and Political Rights.

The second set of variables on human rights operationalises economic, social and cultural rights that follow the terms and requirements of the International Covenant on Economic, Social and Cultural Rights (ICESCR). The definition suggests that countries are obligated to devote the maximum of their available resources to progressively realise the substantive rights enumerated in the ICESCR. We use the data from Social and Economic Rights Fulfillment (SERF) index of 162 countries covering all but high-income Organisation for Economic Co-operation and Development countries (Core SERF index). SERF index operationalises economic, social and cultural rights (ESCR) that follows the terms and requirements of the ICESCR. The core country index consists of the right to food (% of children under 5 years not stunted) (FOOD); right to education (primary school completion rate; combined school enrolment rate) (EDUC); right to health (contraceptive use; child under 5 years survival rate; age 65 years and over survival rate) (HEALTH); right to housing (% of rural population with access to improved water source; % of population with access to improved sanitation) (HOUSE) and right to decent work (% of population with income greater than $2 per day) (WORK). The variables used for the core index and supplemental index are not the same so it is neither possible to compare nor merge the two series (Fukuda-Parr, Lawson-Remer and Randolph, 2011). We use the following core index for the study: ‘women’s economic rights’ (a score from 0 to 3 depending on the level of economic rights for women) and ‘women’s social rights’ (a score from 0 to 3 depending on the level of social rights for women) are obtained from CIRI Human Rights Dataset.

Given the principle of progressive realisation, the researchers used a control variable in the regression model. The aim is to account for the role of economic resources for enabling access to health services and products. We use per capita (pc) current health expenditures (CHE) adjusted by purchasing power parity (PPP) in international dollars (CHE_pc_PPP). The data are from the WHO data set for the years 2004 and 2010. The variable measures the average capital, including domestic general government, private and external source health expenditure, per citizen of a country spent on healthcare goods and services during a year after adjusting by PPP.

For purposes of consistency, we took the overlapping years (2004–2010) for the different data sets described above and used average values for all variables on a sample of 162 countries that represent different geographies across the world. Note that in the analysis it was not possible to use the whole set of countries due to missing values.

Analysis Methods

One way to explore the correlation between human rights issues and health or human development is to use regression analysis. The aim is to account for different human rights issues in an econometric model to explore the distinctive effects of human rights variables on health and human development. Here, the dependent variables are the selected health variables and HDI. The independent variables are human rights variables and the control variable is CHE_pc_PPP. In order to overcome the problem of multicollinearity, also reflecting the unobserved latent factors of these variables, we use factor analysis to reduce the number of human rights variables. We use principal axis factoring for extraction and varimax method for rotation. In regression model, we used factor scores to represent different and independent dimensions of human rights variables.

In order to explore whether there are systematic variations across countries, the researchers grouped the countries according to different levels of women’s rights. The country grouping is made using hierarchical cluster analysis. Cluster analysis is a class of techniques used to classify objects or cases into relatively homogeneous groups called clusters. Objects in each cluster tend to be similar to each other and dissimilar to objects in the other clusters. The aim of the cluster analysis is to classify the countries into dissimilar human rights groups in order to see whether countries that are grouped according to distinct human rights variables also differ in health and human development variables. The analysis aims to reveal systematic differences in health and human development variables within the clusters that are formed using different issues of women’s right variables. In order to eliminate potential biases in cluster analysis due to differences on measurement of the human rights values, we use z-transformation to standardise the variables.

Patient and public involvement

In this study, patients and public were not involved. The data consist of secondary data as described above.

Principle Findings

The results of the regression analysis reveal that while WESR and ESR are correlated with health outcomes, the predictive power of the CPR variable in explaining variations in health outcomes is weak. Moreover, health system variables such as number of hospital beds and number of physicians are better explained by per capita health expenditures but not by women’s rights. All other health outcomes are correlated with the WESR variable. Cluster analysis results are consistent with the results of the regression analysis and show that promotion of women’s right is significant in explaining health outcomes.

Our findings further demonstrate discrepancies across nations with respect to the gender divide, despite having signed, or more importantly, ratified CEDAW. The findings of the cluster analysis show that despite high level of ESR, respect for women’s rights is low for some countries. For example, although Algeria, Egypt, Iraq, Syria, Iran, China and Indonesia have high respect for ESR, the cluster analysis results show that these countries have poorly respected WESR. Similarly, Morocco and Turkey have high ESR but moderate WESR, whereas Yemen and Pakistan have moderate ESR but low WESR. Since the promotion and protection of women’s rights play a fundamental role in progress for states as they unite health, human rights and development, nations that have the ability to promote WESR, as evidenced by their support of ESR, are missing a crucial component in positive health outcomes.

Thus, CEDAW has not shown to be very successful in altering the disparity in the aforementioned states. Although states have acceded the bill and have agreed to the specific mandates, they still show poorly or moderately respected WESR. The majority of nations with highly respected ESR have signed ICESCR and have followed those regulations. However, the countries with highly respected ESR may show poor WESR. The ICESCR defines a broad set of rights that all states must provide to their citizens that pertain to housing, education, cultural rights (eg, language and religion), as well as self-determination.

Findings in relation to other studies

The idea that CEDAW ratification does not necessarily entail implementation of women’s rights is no new finding in the literature. In fact, a larger frame of literature has also seen similar trends. In an attempt to emphasise the dual edge of international bodies, Dutton found that, statistically, even countries with the worst practices would sign international human rights legislature if the ‘treaty mechanisms are too weak for the states to view them as a credible threat to their sovereignty’.20 Similarly, the study found that in treaties with strong enforcement mechanisms, such as the creation of the International Criminal Court with an independent Prosecutor and Court, states are only willing to join if they are willing to comply, as ‘states with poorer records are significantly less likely to commit’.16 This study complies with our findings, as many states have ratified CEDAW, yet have poor implementation of WESR. According to Dutton,16 this may be due to the fact that CEDAW lacks strong enforcement mechanisms.

One of the core works of human rights literature, The Power of Human Rights details the conditions under which theories of human rights may be converted into practice, most commonly known as the spiral model.21 The model stress the need for transnational regimes that can normalise human rights practices in individual states and how these networks may affect violating behaviour through five phases. Phase four of this model claims that international regimes may be able to coerce states through various forms to more liberal policies or government and administrative changes.17 In an attempt to understand the course of human rights behaviours through quantitative research, Beth Simmons claims that such detailed methodological theories may not be effective in changing enforcement tactics. Rather, Simmons claims that understanding the disconnect between theory and practice, through quantitative data, can encourage change through adjusting the problems that are already prevalent.22

The findings within this study, therefore, further contribute to the literature by displaying the lack of enforcement in women’s’ rights, specifically WESR, despite ratifications to transnational treaties such as the CEDAW. This fortifies the idea that, though the spiral model may have been one of the most carefully executed treaties of the time, mainstream research, specifically quantitative research, has shown the shortcomings of current regimes. Thus, our study adds to the current literature that continues to show the unambiguous relationship between treaty ratification and human rights implementation.

The disparity between CPR and ESR among the general population in several countries correlates with women’s rights and may impact development. Per the Gender Gap Report in 2016, economic participation and opportunity for women have been inconsistent since 2006 and have steadily declined since 2013.23 Since 2006, the rate of WCPR has steeply inclined, especially after 2013, which shows a discrepancy between WCPR and WESR. Political empowerment for women has no direct impact on their ESR as indicated by the opposing trends since 2013.19 The disparate statistics between ESR and WESR show that a shortcoming in WESR can result in low-paying jobs for that are stereotypically feminine, or even unemployment for many women.24 For instance, occupations such as teachers, which offer relatively static salaries could restrict women financially.25 Given the lack of access to healthcare, whether it be due to deficiencies in transportation, financial shortfalls or inability to acquire beneficial goods and services, health largely parallels economic status. An indication of how economic curtailment affects women’s health is that individuals with higher incomes, regardless of gender, have a lower mortality and morbidity rate as compared with those with overall lower incomes.26

The gradient between socioeconomic status and health can be detrimental for the public. In order to treat growing numbers of unhealthy women, who cause financial pressure, governments would need to allocate higher amounts of funds into public health and, in turn, elicit heavier taxes.22 These taxes would harm morale and aggravate the gradient between health and economy further. Economic status for both men and women would decrease and health will follow. Health has the highest global gender gap with a nearly 100% disparity while economic disparity is 60%.27 Despite all this, the gender gap for politics has been steadily narrowing closing almost 80% of the gap in some nations.28 WCPR are important in society; however, development cannot be sustained if the trend of WESR is not changed.

There are many global problems that overcast the bright light of development throughout the world. Reproductive health and maternal and infant care are a huge health concern. One of the leading causes of death in women between the ages of 15–19 years worldwide is labour.29 Lack of access due to socioeconomic conditions or discrimination has led many young women into preventable deaths. Similarly, inability to access contraceptives and strict abortion regulations have stagnated developed countries and has limited developing countries from maturing.30 Gender discrimination seems to be prevalent and common even in the most developed countries. No nation has closed over 80% of the gender gap between men and women.24

Within this study, it has been found that even in a state of low resources, a nation with strong instruments to promote and maintain WESR would still arrive at positive health outcomes. However, there are some states that highly respect ESR yet fail to extend these rights to include women.

Implications

The impact of limited women’s rights influences more than just women. As Paul Wolfowitz, former President of the World Bank said, ‘Gender equality is not only a women’s issue, it is a development issue'.31 In this study, specifically, the data were quantified to show a more discrete correlation between WESR and development. This has an impact on current events as these findings can help the SDG and the UN in implementing factors that account for WESR at a greater level. Though correlation does not cede causation, the implications of higher WESR can only help advance development goals. Today, the value of human rights has often been questioned from an economic standpoint; however, our data find that rather than limit progress, human rights, and WESR in particular, can only benefit them.

Limitations

The study is a preliminary work using average values of all variables for the 2004–2010 years. Given the focus within 10 years, older data are not analysed and accounted for, perhaps leading to a different trend. Since the data set consists of average values, there is no way to determine the specificities, causes and rationale behind some of the values. Finally, the data emphasises countries specifically, without considering their status within their respective subregion, nor the dynamics within the country as well. Further studies should investigate longer time periods to determine an overarching trend, along with the need to view countries in equalised settings. That is, countries with similar human rights trends should be compared with one another for greater insight into the development of WESR. Subsequent research should also include an in-depth investigation into the various statistics and undercurrents within each country.