1
tive interpretations of their provisions, have recognized reproductive rights as legally binding and have in that respect addressed the various elements of reproductive rights as presented in Chapter 4 below and further documented in Annex 1. The Committee on the Rights of the Child, the Human Rights Committee (that monitors implementation of the International Covenant on Civil and Polit-ical Rights), the Committee on Economic, Social and Cultural Rights and, to a lesser extent, the Committee against Torture and the Committee on the Elimination of Racial Discrimination have all made statements on various aspects of reproductive rights.
The Inter-American Commission on Human Rights and the African Commission on Human and Peoples’ Rights have recognized reproductive rights as human rights. In addi-tion, the European Court of Human Rights has made various decisions on matters relat-ing to reproductive rights, includrelat-ing findrelat-ing that the right to private life incorporates the right to respect for the decisions both to become and not to become a parent.1 Finally, United Nations member states have adopted by consensus a number of
1 Judgment by the Grand Chamber of the Europe-an Court of Justice, EvEurope-ans vs. the UK 6339/05, (10 April 2007), para. 71.
adopted by consensus, albeit with a number of reservations, and later endorsed by the United Nations General Assembly.2 Another important document, also adopted by con-sensus and endorsed by the United Nations General Assembly,3 is the Beijing Declaration and Platform for Action, adopted in 1995 at the Fourth World Conference on Women.
Furthermore, the 2005 World Summit Outcome, adopted by the United Nations General Assembly in 2005,4 and the com-mitment to both sexual and reproductive health in the outcome document of the 2010 United Nations Summit on the Millennium Development Goals, adopted by the United Nations General Assembly in 2010,5 further confirmed the commitment to reproductive health. In June 2012, the United Nations reaffirmed its commitment to reproductive rights in the United Nations Conference on Sustainable Development, Rio+20.6
2 United Nations General Assembly Resolution A/RES/49/128.
3 United Nations General Assembly Resolution A/RES/50/203.
4 United Nations General Assembly Resolution A/RES/60/1.
5 United Nations General Assembly Resolution A/RES/65/1.
6 UN Doc. A/CONF.216/16.
EXAMPLES OF KEY PRACTICAL ELEMENTS
OF REPRODUCTIVE RIGHTS
and timing of their children and to have the information and means to do so. In practice, this means that everyone should have access to contraception and to the necessary information on reproductive health issues. Contraception and the nec-essary information should also be available to marginalized groups, meaning that it should be available both in towns and in rural areas and for all women and men, adults and adolescents. Information should be available in all relevant languages and in age- and gender-appropriate forms.
Marriage and childbearing are closely con-nected in most cultures. Consequently, the right to decide freely the number, spacing and timing of children also includes the right not to be married before reaching adulthood and the right not to be forced to marry. The proper legislation should be in place and implemented and necessary sensitization should take place.
The second part of the definition guarantees the right to attain the highest standard of sexual and reproductive health. Sexual and reproductive health is concerned not only with issues related to child bearing but also securing a safe and satisfying sex life. The right to the highest standard of sexual and reproductive health contains the access to a comprehensive package of health services including voluntary family planning, abortion where it is not against the law, post abor-tion care, ante- and post-natal care, both for
Consequently, sexual and reproductive health services cannot be offered only in the main population centres but must be made available also in rural and underserved areas.
The last part of the definition guarantees the right to make decisions concerning repro-duction free of discrimination, coercion and violence. In addition to what has already been set out, this means that persons with dis-abilities, ethnic minorities and other groups in situation of vulnerability or exclusion are entitled to the same sexual and reproductive health services as all other groups. In certain countries, persons with disabilities have been subject to sterilization without their free, prior and informed consent; the same has been the case for ethnic minorities. In many places, lesbian, gay, bisexual and transgen-der (LGBT) persons are not provided access to sexual and reproductive health services;
this is clearly a manifestation of discrimina-tion. The right not to be subject to harmful practices such as female genital mutilation (FGM), child, early or forced marriage is an additional protection against violence and coercion affecting the girl child. The state must ensure that no one is coerced into entering into marriage, bearing of children or sexual relations, including with their spouse.
This for example necessitates implementing provisions on minimum age for marriage and criminalizing marital rape. Gender-based violence also has the potential to curtail the free choice of in particular women. Studies have shown a close link between domestic
constellation of methods, techniques, ser-vices, goods and facilities that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely coun-selling and care related to reproduction and sexually transmitted diseases.7
Sexual health and reproductive health over-lap and, in addition to supporting physio-logical functions such as pregnancy and childbirth, aim to reduce adverse outcomes of sexual activity and reproduction. They are also about enabling people of all ages, including adolescents and those older than the reproductive years, to have safe and satisfying sexual relationships by tackling obstacles such as gender discrimination, inequalities in access to health services,
7 International Conference on Population and De-velopment, 1994 Program of Action (United Nations, 1995).
tion, and gender-based violence.
According to the World Health Organiza-tion (WHO), sexual and reproductive health involves five key components, namely:
• Ensuring contraceptive choice and safety and infertility services;
• Improving maternal and new born health;
• Reducing sexually transmitted infections, including HIV, and other reproductive morbidities;
• Eliminating unsafe abortion and provid-ing post-abortion care; and
• Promoting healthy sexuality, including adolescent health, and reducing harmful practices.8
8 UNFPA. Sexual and Reproductive Health for All.
2010.
INTERNATIONAL COMMITMENTS – A HISTORICAL OVERVIEW
Before the 1990’s, issues related to repro-ductive health focused on controlling wom-en’s fertility in order to diminish population growth and not much more than that.
Health was the key entry point and rather than reproductive wellbeing more broadly.
reproductive health have been developed;
some examples are as follows:
The first document to formally embed reproductive rights within human rights was the 1968 Final Act of the Tehran
Con-1975 – Declaration of Mexico on the Equality of Women and their Contri-bution to Development and Peace and Plans of Action
1994 – International Conference on Pop-ulation and Devel-opment (ICPD) and Programme of Action
2000 – Millennium Summit and the Mil-lennium Declaration – and subsequent
1993 – World Con-ference on Human Rights adopted the Vienna Declaration and Programme of Action
1995 – Beijing Dec-laration and
section 16 “Parents have a basic human right to decide freely and responsibly on the number and spacing of children and a right to adequate education and information in this respect”. The General Assembly endorsed the Final Act in December 1968.10
The 1975 Declaration of Mexico on the Equality of Women and their Contribution to Development and Peace confirms the princi-ple of equal rights within the family and the principle of inviolability of the human body
and to have the information, education and means to do so”.11
In 1993, the World Conference on Human Rights adopted the Vienna Declaration and Programme of Action, another document signalling a worldwide consensus on the right to sexual and reproductive health.
Section 3 of the Programme of Action12 deals with women’s rights and their right to accessible and adequate health care and the widest range of family planning services,
131415
13 Siegal, Reva B., “Sex Equality Arguments for Reproductive Rights: Their Critical Basis and Evolving Constitutional Expression”. (2007) Faculty Scholarship Series. Paper 1137.
and reproductive rights are part of women’s rights. For biological and social reasons women are more directly affected than men by decisions with respect to reproduction; decisions which in turn are shaped by issues related to gender equality, stereotypical gender roles and the role of women in society more broadly. Reproductive rights matters are crucially import-ant to women as they affect women’s mental and physical integrity, their health and sexual autonomy, “their ability to enter and end relationships, their education and job training, their ability to provide for their families, and their ability to negotiate work-family conflicts in institutions orga-nized on the basis of traditional sex-role assumptions”.13
Nonetheless, men too should be involved in sexual and reproductive health programmes.
“Men’s general knowledge and attitudes concerning the ideal family size, gender preference of children, ideal spacing between child births, and contraceptive method use greatly infl uence wom-en’s preferences and opinions”.14 Only in societies where men and women have equal rights and responsibilities will reproductive rights be equally shared by all.
The non-involvement of men and boys in matters related to reproductive rights contributes to
“the poor preparation of men for adulthood, contraceptive use, and safe sex”.15 As men are usually responsible for the decision making processes within families, including with regard to repro-duction, family size and contraception use, involving men can assist in the process of empow-ering women.
Men have a stake in reproductive rights through their multiple roles as sexual partners, hus-bands, fathers, family and household members, community leaders and gatekeepers to health information and services. In addition, not all men live in traditional families but still have needs related to their sexual and reproductive health. To be effective, reproductive health pro-grammes need to address men’s behaviour in these various roles as well as their reproductive rights needs simply as human beings. Involving men can:
• Share the burden of preventing diseases and health complications;
• Promote satisfying sexual lives for men and women;
• Inform men and women about male and female anatomy, contraception, STIs and HIV/
AIDS prevention and women’s health care needs during pregnancy and childbirth.16 Men’s sexual and reproductive health must also be addressed by focusing on:
• Uro-genital infections;
• STIs;
• Infertility and erectile dysfunction; and
• Prostate and testicular cancer.17
The 1994 International Conference on Pop-ulation and Development (ICPD) in Cairo placed reproductive rights on the global agenda. Its Programme of Action clearly affirmed and articulated that reproduc-tive and sexual health is protected by the human rights already recognized by both national and international law. In addition, the Programme of Action contributed to the recognition of the complex links between population growth and gender equality. The generally acknowledged definition of
repro-In 1995, the Fourth World Conference on Women took place in Beijing.18 The Bei-jing Declaration and Platform for Action, adopted at the Conference, among other things highlights the right to equal access to and equal treatment of women and men in education and health care and the enhance-ment of women’s sexual and reproductive health as well as education. Both the ICPD Programme of Action and the Beijing Dec-laration and Platform for Action show that alongside health and health care, education
Millennium Declaration.19 Based on the Millennium Declaration, primarily Section III on development and poverty eradication, the eight Millennium Development Goals (MDGs) were established.
Four out of eight MDGs relate to reproduc-tive and sexual health and rights. MDG 5 concerns maternal health and contains two targets:
a) to reduce the maternal mortality ratio by three quarters between 1990 and 2015 and
b) to achieve universal access to repro-ductive health by 2015.20 MDG 4 is to reduce the mortality of children under five with two thirds between 1990 and 2015. MDG 3 deals with promoting gender equality and empowerment of women. Finally, MDG 6 concerns the combat of HIV/
AIDS, malaria and other diseases.
Based on current data, MDG 5 is considered the least likely of all the MDGs to be achieved within the timeline set.21
19 United Nations General Assembly Resolution A/55/L.2.
20 This latter element of MDG 5 was only agreed to at the World Summit in 2005.
21 According to Francesca Perucci, chief of the
the commitment to the Millennium Decla-ration and reiterates the “determination to ensure the timely and full realization of the ...
Millennium Development Goals”. In addition, the World Summit Outcome contains new commitments, four of which became part of the revised MDGs during 2006-2007. One is the achievement of universal access to reproductive health by 2015 (that became an addition to MDG 5); another is universal access to HIV/AIDS treatment by 2010 (that became an addition to MDG 6).
As mentioned above in Chapter 1, these international declarations and statements are underpinned by binding human rights instruments that contain the specific stan-dards of reproductive rights. This will be further elaborated in Chapter 4.
and access to quality sexual and reproductive healthcare services is crucial for women and men living with HIV and AIDS. Sexual and reproductive health services are also vital for pre-vention of new HIV infections. Some 80% of HIV cases globally are transmitted sexually and a further 10% are transmitted during pregnancy, labour and delivery, or through breast-feed-ing. Sexual and reproductive health (SRH) programmes can make an important contribution to HIV prevention, treatment, care and support, and SRH services are important for those living with HIV and AIDS.23
The following measures should be taken for HIV and AIDS prevention:
• Voluntary counselling and testing for HIV should be available;
• Sexual behaviour should be influenced through education on risk reduction strategies and provision of the skills and means to negotiate and practice safer sex;
• Comprehensive sexuality education should cover adolescents in and out of school set-tings, with a particular focus on addressing the information needs of adolescent girls who often carry the burden of new transmissions and deaths;
• Male and female condoms for both family planning and prophylactic reasons should be provided;
• Family planning, antenatal, delivery and post-partum care and STI services should be expanded;
• Condoms should be promoted as a primary form of protection and the importance of dual protection to avoid unwanted pregnancy and STIs should be stressed;
• Anti-retroviral drugs (HIV medicine), on the WHO Model List of Essential Medicines, should be made available to persons infected with HIV.
Both men and women must be educated in relation to the importance of condoms not only for the prevention of pregnancy, but also, and most importantly, as an efficient way to pre-vent the transmission of STIs and HIV. Additionally, it is important that married women are included in HIV/AIDS prevention initiatives along with other groups of women, who have often been marginalized by these kinds of initiatives, such as young single women, migrant and refugee women, injection drug users and women selling or trading sex for money and support.
Special focus should be on female sex workers, as they often have high rates of STIs and are at high risk of violence. These infections and frequent unprotected sexual exposure put women in prostitution, their clients and other partners, and their clients’ partners all at high risk of acquiring HIV/STIs. Other groups that might be in high risk with respect to HIV/STIs are male homosexuals, especially in countries where the LGBT community is marginalized due to legislation, attitudes etc.; this should be taken into account when designing HIV/AIDS policies. Men in prostitution are also a group of risk.
Pregnancy-related care – before, during and after delivery – is an obvious place to situate attention to HIV and AIDS testing and counselling, prevention and treatment services and information for both women and infants. It is crucial to invest in drugs that prevent vertical transmission (mother to child transmission). This has helped prevent the infection of many infants but there is still a lot to be done, such as addressing the issue in rural areas and investing in births assisted by a healthcare professional.
Whereas preventing transmission of HIV/AIDS is naturally a key element of securing the sex-ual and reproductive health and rights of the population, it is also important to keep in mind the reproductive rights of persons who are already infected. Legislation and policies should be in place to secure that infected persons are not discriminated against, and infected persons should be secured access to all reproductive and sexual health care services. In countries where the state provides fertility services, such services should in general also be offered to persons infected with HIV/AIDS.24
NHRIs are very different when it comes to legislative basis, powers and structure but they are all supposed to adhere to the Paris Principles, adopted in 1991, approved by the United Nations General Assembly in 1993 and being the universally accepted framework for NHRIs. The Paris Principles set out in detailed form the minimum mandate for NHRIs.1 In addition to the man-datory tasks, NHRIs may be given the authority to hear and consider complaints in individual cases. In many countries, this is considered the most important part of their work.
NHRIs are supposed to play a key role in both the promotion and the protection of human rights in their respective countries. As has been set out above, reproductive rights as defined primarily in the ICPD Programme of Action are human rights; the various elements are pro-tected by both the main global and the main regional human rights instruments. In conse-quence, NHRIs have an important role to play in the promotion and protection of reproductive
1 Accordingly, an NHRI shall have the responsibilities, cf. Section A of the Paris Principles:
“a) To submit to the government, parliament and any other competent body, on an advisory basis either at the request of the authorities concerned or through the exercise of its power to hear a matter without higher referral, opinions, recommendations, proposals and reports on any matters concerning the protection and promotion of human rights. The national institution may decide to publicize them. These opinions, recommendations, proposals and reports, as well as any prerogative of the national institution, shall relate to the following areas:
i) Any legislative or administrative provisions, as well as provisions relating to judicial organization, intended to preserve and extend the protection of human rights. In that connection, the national institution shall examine the leg-islation and administrative provisions in force, as well as bills and proposals, and shall make such recommendations as it deems appropriate in order to ensure that these provisions conform to the fundamental principles of human rights. It
i) Any legislative or administrative provisions, as well as provisions relating to judicial organization, intended to preserve and extend the protection of human rights. In that connection, the national institution shall examine the leg-islation and administrative provisions in force, as well as bills and proposals, and shall make such recommendations as it deems appropriate in order to ensure that these provisions conform to the fundamental principles of human rights. It