objections from medical staff, high prices, lack of knowledge about the law, lack of access to medical care (especially in rural areas). the de facto inability of women to access abortion even in countries where it is legal is highly controversial because it results in a situation where women have rights only on paper, not in practice; the un in its 2017 resolution on intensification of efforts to prevent and eliminate all forms of violence against women and girls: domestic violence urged states to guarantee access to "safe abortion where such services are permitted by national law". there are two primary arguments for maintaining legalized abortion today in the u.s. the first is recognizing the full citizenship of women. the roe v. wade court case on abortion compared the citizenship of women and fetuses because the constitution defines born people as citizens, justice harry blackmun ruled that fetuses were not citizens. the citizenship of women is emphasized because fetuses are not individual entities that can exist without the woman. another reason why the full citizenship of women is defined by advocates for abortion is that it recognizes the right of women to manage their own bodies. fertility affects women's bodies. the argument for abortion prevents others from making decisions that alter a woman's body. pro-choice advocates also attempt to confirm that state-mandated education or other outside biases do not attempt to influence these decisions. feminists argue that women throughout history have had to justify their citizenship politically and socially. the right to manage one's own body is a matter of health, safety, and respect. the citizenship of women and the right to manage their own bodies is a societal confirmation that feminists highlight as a pro-choice justification. the second primary argument to uphold legalized abortion and creating better access to it is the necessity of abortion and the health and safety of pregnant women. there are two events that largely changed the course of public opinion about abortion in the u.s. the first is sherry finkbine, who was denied access to an abortion by the board of obstetrician-gynecologists at her local hospital. although she was privileged enough to afford the trip, finkbine was forced to travel to sweden for an abortion to avoid caring for a damaged fetus in addition to four children. the other event that changed public opinion was the outbreak of rubella in the 1950s and 60s. because rubella disrupted the growth of fetuses and caused deformities during pregnancy, the california therapeutic abortion act was signed in 1967, permitting doctors to legally abort pregnancies that pose a risk to a pregnant woman's physical or mental health. these two events are commonly used to show how the health and safety of pregnant women are contingent upon abortions as well as the ability to give birth to and adequately take care of a child. another argument in favor of legalized abortion to service necessity are the reasons why an abortion might be necessary. nearly half of all pregnancies in the united states are unintended, and over half of all unintended pregnancies in the united states are met with abortion. unintended pregnancy can lead to serious harm to women and children for reasons such as not being able to afford to raise a baby, inaccessibility to time off of work, difficulties facing single motherhood, difficult socio-economic conditions for women. unintended pregnancies also have a greater potential for putting women of color at risk due to systematically produced environmental hazards from proximity to pollution, access to livable income, and affordable healthy food. these factors as threats to the health and safety of pregnant women run parallel to data that shows the number of abortions in the united states did not decline while laws restricting legal access to abortion were implemented. at a global level, the region with the strictest abortion laws is considered to be latin america (see reproductive rights in latin america), a region strongly influenced by the catholic church in latin america. female genital mutilation main article: female genital mutilation fgm in africa, iraqi kurdistan and yemen, as of 2015 (map of africa). female genital mutilation (fgm), also known as female genital circumcision or cutting, is the traditional, non-medical practice of altering or injuring the female reproductive organs, often by removing all or parts of the external genitalia. it is mostly practiced in 30 countries in africa, the middle east, and asia, and affects over 200 million women and girls worldwide. more severe forms of fgm are highly concentrated in djibouti, eritrea, ethiopia, somalia, and sudan. the who categorizes fgm into four types: type i (clitoridectomy) is the removal of all or part of the clitoris. this may or may not include removing the prepuce along with the clitoral glans. type ii (excision) is the removal of the clitoris along with all or part of the labia minora. this may or may not include removing all or part of the labia majora. type iii (infibulation) is the act of removing the inner or outer labia and sealing the wound, leaving only a narrow opening. type iv refers to "all other harmful procedures to the female genitalia for non-medical purposes (piercing, scraping, cauterizing of the genital area)." fgm often takes the form of a traditional celebration conducted by an elder or community leader. the age that women undergo the procedure varies depending on the culture, although it is most commonly performed on prepubescent girls. certain cultures value fgm as a coming of age ritual for girls and use it to preserve a woman's virginity and faithfulness to the husband after marriage. it is also closely connected with some traditional ideals of female beauty and hygiene. fgm may or may not have religious connotations depending on the circumstances. anti-fgm road sign, bakau, gambia, 2005 there are no health benefits of fgm, as it interferes with the natural functions of a woman's and girls' bodies, such as causing severe pain, shock, hemorrhage, tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue, recurrent bladder and urinary tract infections, cysts, increased risk of infertility, childbirth complications and newborn deaths. sexual problems are 1.5 more likely to occur in women who have undergone fgm, they may experience painful intercourse, have less sexual satisfaction, and be two times more likely to report a lack of sexual desire. in addition, the maternal and fetal death rate is significantly higher due to childbirth complications. fgm can have severe negative psychological effects on women, both during and after the procedure. these can include long-term symptoms of depression, anxiety, post-traumatic stress disorder, and low self-esteem. some women report that the procedure was carried out without their consent and knowledge, and describe feelings of fear and helplessness while it was taking place. a 2018 study found that larger quantities of the hormone cortisol were secreted in women who had undergone fgm, especially those who had experienced more severe forms of the procedure and at an early age. this marks the body's chemical response to trauma and stress and can indicate a greater risk for developing symptoms of ptsd and other trauma disorders, although there are limited studies showing a direct correlation. the istanbul convention prohibits fgm (article 38). legislation has been introduced in certain countries to prevent fgm. a 2016 survey of 30 countries showed 24 had policies to manage and prevent fgm, although the process to provide funding, education, and resources were often inconsistent and lacking. some countries have seen a slight decline in fgm rates, while others show little to no change. child and forced marriage poster against child and forced marriage the practice of forcing young girls into early marriage, common in many parts of the world, is threatening their reproductive health. according to the world health organization: the sexual and reproductive health of the female in a child marriage is likely to be jeopardized, as these young girls are often forced into sexual intercourse with an older male spouse with more sexual experience. the female spouse often lacks the status and the knowledge to negotiate for safe sex and contraceptive practices, increasing the risk of acquiring hiv or other sexually transmitted infections, as well as the probability of pregnancy at an early age. niger has the highest prevalence of child marriage under 18 in the world, while bangladesh has the highest rate of marriage of girls under age 15. practices such as bride price and dowry can contribute to child and forced marriages. international conference on population and development, 1994 the international conference on population and development (icpd) was held in cairo, egypt, from 5 to 13 september 1994. delegations from 179 states took part in negotiations to finalize a programme of action on population and development for the next 20 years. some 20,000 delegates from various governments, un agencies, ngos, and the media gathered for a discussion of a variety of population issues, including immigration, infant mortality, birth control, family planning, and the education of women. in the icpd program of action, 'reproductive health' is defined as: a state of complete physical, mental and social well-being and...not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. reproductive health, therefore, implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, as well as other methods of birth control which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. this definition of the term is also echoed in the united nations fourth world conference on women, or the so-called beijing declaration of 1995. however, the icpd program of action, even though it received the support of a large majority of un member states, does not enjoy the status of an international legal instrument; it is therefore not legally binding. the program of action endorses a new strategy which emphasizes the numerous linkages between population and development and focuses on meeting the needs of individual women and men rather than on achieving demographic targets. the icpd achieved consensus on four qualitative and quantitative goals for the international community, the final two of which have particular relevance for reproductive health: reduction of maternal mortality: a reduction of maternal mortality rates and a narrowing of disparities in maternal mortality within countries and between geographical regions, socio-economic and ethnic groups. access to reproductive and sexual health services including family planning: family planning counseling, pre-natal care, safe delivery and post-natal care, prevention and appropriate treatment of infertility, prevention of abortion and the management of the consequences of abortion, treatment of reproductive tract infections, sexually transmitted diseases and other reproductive health conditions; and education, counseling, as appropriate, on human sexuality, reproductive health, and responsible parenthood. services regarding hiv/aids, breast cancer, infertility, delivery, hormone therapy, sex reassignment therapy, and abortion should be made available. active discouragement of female genital mutilation (fgm). the keys to this new approach are empowering women, providing them with more choices through expanded access to education and health services, and promoting skill development and employment. the programme advocates making family planning universally available by 2015 or sooner, as part of a broadened approach to reproductive health and rights, provides estimates of the levels of national resources and international assistance that will be required, and calls on governments to make these resources available. sustainable development goals half of the development goals put on by the united nations started in 2000 to 2015 with the millennium development goals (mdgs). reproductive health was goal 5 out of 8. to monitor the progress, the un agreed to four indicators: contraceptive prevalence rates adolescent birth rate antenatal care coverage unmet need for family planning progress was slow, and according to the who in 2005, about 55% of women did not have sufficient antenatal care and 24% had no access