ment. Discrimination is unacceptable even when it is not intentional, and, by virtue of the state obligation to protect, states are accountable even if the discrimination is caused by a private actor. At the work place, for instance, a private employer cannot discriminate against a woman due to her marital status and the fact that she is in her reproductive years. If that happens, the state has the obligation to intervene. The lack of action by the state to prevent this type of discrimination is a breach of the right to non-discrimination and the violating state can be held accountable.
Discrimination by private actors is especially relevant to health issues, including repro-ductive health issues, as it is forbidden to deny a person access to health care based on this person’s attachment to a particular group, nationality, gender, age, HIV-status etc. For example, if health professionals deny young unmarried women access to contraceptives based on marital status, a case of discrimination under state responsi-bility could be made. The state must ensure such incidents do not happen by passing non-discrimination legislation as well as ensuring suitable contractual provisions and education initiatives.
It is prohibited to deny women access to healthcare, including reproductive health-care, because they are women. This is understood to mean that the state cannot deny health services that only women need, such as services related to pregnancy,
preg-Non-discrimination obligations go beyond states’ non-interference with individuals’
rights. Arising from their obligations to combat discrimination, states have a duty to ensure that health information and ser-vices are made available to all individuals, including marginalized and excluded groups.
It is also crucial that states take action and ensure that the laws passed and their pol-icies not only do not discriminate against specific groups but also secure actual equal treatment. Laws must take into consid-eration de facto differences to guarantee equality. Furthermore, states must take steps to empower women to make decisions in relation to their sexual and reproductive health free of coercion, violence and dis-crimination. It is the state that has to ensure that women and girls can make these deci-sions free from discrimination. If women and girls do not have this right, the state must take measures to ensure that they do by, for example, using affirmative measures. The principle of non-discrimination also obliges the state to make sure that all groups have similar access to (reproductive) health care, irrespective of sex, age, ethnicity, domicile, disability, etc. This entails among other things making sure that even the poorest person living far from urban centres can access reproductive health care.
Non-discrimination and equality measures have to be thought through the entire state apparatus. It is not sufficient for a piece of legislation to be for example gender neu-tral if it in practice discriminates against
According to the Committee on the Elimina-tion of All Forms of DiscriminaElimina-tion against Women, violence against women is a form of discrimination against women. States must take action to redress violence against women and ensure that there are sensitive counselling services available for the sur-vivors of gender-based violence, including rape and incest. As it has been explained above, violence against women directly
services for sexual and reproductive health.4 Adolescents should not be discriminated against due to their young age; on the con-trary, they have to be placed at the centre of policies and laws dealing with reproductive matters.
It is a fundamental role for a NHRI to mon-itor that a state does not discriminate with respect to the protection of reproductive
5 ICPD Program of Action, sect. 12.12.
6 See Committee on the Elimination of All Forms of Discrimination against Women, General Recommendation, age – and rightly so since many of the most egregious issues, such as preventable maternal mortality and morbidity, are most relevant for this age group. However, it is important not to overlook the fact that persons above the reproductive age have reproductive health issues that should be taken into account when taking a holistic approach to reproductive rights. The ICPD refers to the need to secure reproductive health services “suitable for different age and cultural groups and for different phases of the reproductive cycle”.5 The need to take a life cycle approach has also been confirmed in the practice of e.g. the Committee on the Elimination of All Forms of Discrimination against Women.6 This box aims at given some information on the issues relevant to ageing women, even though it is acknowledged that ageing men also have health concerns based on sex.7 Nevertheless, there are more women in older age than there are men and women bear a heavier burden. Due to women’s structural discrimination in general and their role in reproduction, reproductive health issues for ageing women are more acute than for ageing men.
“Older women” normally refers to women aged 50 and older, whereas the term ageing women acknowledges that ageing is a process that occurs differently for different individuals and groups. Women who endure a lifetime of poverty, malnutrition and heavy labour may be chronologically young but functionally old at age 40. Women are usually more vulnerable than men are in older age. Specific issues include: lack of access to education; childbirth with-out the adequate health care; low income and inequitable access to decent work; domestic violence, which may begin in childhood, continue in marriage and is a common form of elder abuse; and cultural traditions and attitudes that limit access to health care in older age.
Some issues are especially relevant when ageing women and reproductive rights are con-cerned. One of them is the fact that ageing women remain at risk for HIV/AIDS and other sexually transmitted infections. Once infected, ageing women face a disproportionate burden of illnesses directly or indirectly caused by STIs, including AIDS resulting from HIV infection and cervical cancer as a result of the transmission of the human papillomavirus (HPV).
Cervical cancer kills approximately 274,000 women every year; it is the most common can-cer in women and the leading cause of cancan-cer deaths in developing countries. Providing girls with a vaccine to prevent the infection from HPV raises the possibility of eliminating the