Global health. The current scenario and future perspectives

230 undoubtedly requires intersectoral public policies but also faces difficulties in gaining ground in political discussions. Gender bias gravitates towards considering SRHR as a private issue and gives limited importance to female voices. Traditional power structures within politics often portray subordinations in this manner. This becomes very clear in Chile when reviewing legislative discussions that grant legitimacy to some voices over others; it is part of how patriarchy allocates value based on its worldview (Palma 2015). Significant obstacles remain represented by women’s absence from political discussions and the unquestioned control that the State assumes it can have over women’s bodies and their decisions. This leads us to think about the idea of a patriarchal state, as commented by Bareiro (Seminario Prigepp Democracias 2021) who visualizes and locates this axis of domination and reveals, in her analysis, the discriminations reproduced in our societies from its structure. The State and its agencies are the main actors in what it is defined as institutional violence, recognized by various legislations on gender-based violence in the region. Countless rulings from the Inter-American Court of Human Rights (IACHR) precisely demonstrate violations of SRHR with evident participation of the State through action or omission. In 2017, IACHR called on States to “adopt comprehensive and immediate measures to respect and guarantee women’s sexual and reproductive rights ” 21 . The dominance of biological factors over social and cultural aspects is evident in this discussion. Prioritizing sex over gender helps to sideline the political dimension of this conversation. It may seem obvious, but as in any other aspect of social and human life, not everything related to sexuality and reproduction can be controlled. In patriarchy, ambivalently, women are punished for not taking control over their fertility while also being restricted access to tools that would allow them greater autonomy in keeping that control. Technology has allowed women to regulate their fertility, space out pregnancies, terminate unwanted pregnancies and undergo assisted fertilization. Excluding violence and accidents - unfortunately both so frequent - parenthood increasingly becomes a matter of decision-making faced with daily dilemmas. We know these decisions are crucial in life, especially in societies where reproductive consequences disproportionately rely on female resources, starting with their own bodies. However, despite abundant declarations supporting sexual and reproductive health rights, it is precisely gender order, based on political power or religion, that weighs most. In our country, and throughout the region, new barriers are erected against access to education and information and to ensuring that human and technological resources are devoted to greater autonomy of women in these areas. 21 https://www.oas.org/es/cidh/prensa/comunicados/2017/165.asp.