Please note: This archive was last updated in 2005.
RHO archives : Topics : Gender and Sexual Health
Special Focus: Human Rights, Gender, and Reproductive Health
Gender-based disadvantages not only harm women’s reproductive health and limit their access to services, but they are also human rights abuses (HRP 1999; Kols 2003). For example, female genital mutilation (FGM) and sexual trafficking violate women’s right to liberty and security of the person; forced early marriages violate women’s right to choose whether or not to marry and found a family; and gender-based violence violates women’s right to be free from inhuman and degrading treatment (IPPF 1996). Advancing women’s rights empowers them to take greater control over every aspect of their lives, including sex and childbearing, and is essential to achieving reproductive health objectives.
Putting rights on the agenda
Women’s advocates moved human rights to the center of the reproductive health agenda during a series of three landmark international meetings in the 1990s (Jacobson 2000; Murphy and Ringheim 2001). The 1993 World Conference on Human Rights in Vienna affirmed that women’s rights are human rights, that they should not be subordinated to cultural or religious traditions, and that they extend to matters of sexuality and reproduction. The 1994 International Conference on Population and Development (ICPD) in Cairo created a comprehensive framework to realize the right to reproductive and sexual health and called on governments to address the gender inequities that create barriers to reproductive health. The 1995 Fourth World Conference on Women in Beijing reinforced women’s reproductive rights and called on governments to create the social and economic conditions that would enable women to realize their right to health.
All three conferences built on the foundation laid by the modern human rights system developed under the auspices of the United Nations. This system consists of a series of international and regional treaties on human rights, committees that monitor whether ratifying nations are complying with treaty provisions, and, in some parts of the world, regional human rights courts (Human Security Network 2003). In addition to guaranteeing fundamental human rights, the treaties explicitly prohibit discrimination based on gender as well as race, descent, and ethnic origin.
The treaties impose three obligations on governments: to respect, protect, and fulfill human rights (Cook et al. 2003). Respect means not interfering with people’s ability to enjoy their rights, for example, not prohibiting adolescents from getting contraceptives. Protection requires taking action against violators, for example, prosecuting rapists. Fulfillment means creating the conditions that allow people to fully realize their rights, for example, expanding women’s education so they can access and understand information about reproductive health, such as how to recognize danger signs during pregnancy or prevent HIV.
Taken as a body, the human rights defined in international treaties guide almost every aspect of the delivery of reproductive health care, defining what services must be offered, to whom, and in what fashion. Three principles are key for women’s reproductive health (CRLP 2000):
- Based on the rights to liberty, to marry and found a family, and to decide the number and spacing of one’s children, women as well as men have the right to reproductive self-determination—that is, to control their sexual and reproductive lives and make reproductive decisions without interference or coercion.
- The right to non-discrimination and respect for difference requires governments to offer everyone—including adolescents, unmarried women, sex workers, refugees, and other marginal groups—equal access to health care and to address the unique health needs of women and men.
- To fulfill people’s rights to life and health, governments must make comprehensive reproductive health services available to all and remove barriers to care, many of which are rooted in gender inequality.
In contrast to the public health approach, which focuses on the outcomes of health services for the whole population, a rights-based approach emphasizes the service delivery process and the well-being of individuals (Jacobson 2000). What matters, for example, is whether sex workers have access to comprehensive reproductive health services and are treated with respect by providers, not the prevalence of HIV/STI infections among them.
Implementing a rights-based approach
The law and social setting can affect women’s reproductive health status as profoundly as the health care system. For example, cultural traditions, religious beliefs, educational and economic opportunities, and social norms, often reinforced by law and policy, determine at what age women marry, how vulnerable they are to violence, their ability to negotiate when and under what circumstances sexual intercourse takes place, and their access to reproductive health services.
A rights-based approach helps health care providers, managers, and policy makers understand how societal factors, including gender inequality, influence reproductive health. It also encourages a broader response to women’s health problems that reaches beyond the health sector, which requires political will and leadership (Germain 2004). Advocates of reproductive rights and health use a wide range of approaches (Violence Against Women 2003), including:
- Advocating for social action, policy reform, and legal change. Simply framing a health problem as a human rights or social justice concern can raise its visibility and put it on the political agenda (Cook et al. 2003; CRLP 2000).
- Litigating individual cases of human rights violations. Individual legal cases can draw attention to systemic problems, while appealing to international treaty obligations in the courts can bring outside pressure on governments to change discriminatory laws and policies (Cook et al. 2003) (see Peru Mestanza program example).
- Participating in the treaty monitoring process. NGOs can prepare shadow reports for international treaty monitoring committees while providers can contribute to government reports. Their input can help the committees accurately assess how well a nation is complying with its treaty obligations (Edouard and Olatunbosun 2000).
- Conducting human rights audits. The impact of reproductive health policies and protocols on clients’ reproductive rights can be assessed at both the facility and the national levels (Freedman 2001).
- Monitoring process as well as outcome indicators. Process indicators reflecting access to and the quality of services can measure the extent to which reproductive health services respect clients’ rights (Yamin and Maine 1999).
- Training providers about human rights and the international treaty system. Providers must understand and appreciate the core values and ethical framework underlying a rights-based approach before they can apply it to their work (Freedman 2001).
- Educating clients and the community about human rights. Rights education can empower clients by instilling a sense of entitlement and also can change social norms that support rights abuses such as FGM and domestic abuse (Eastman 2000; Petchesky 2000).
Annotated bibliography
Center for Reproductive Law and Policy (CRLP). Reproductive
Rights 2000: Moving Forward. New York: CRLP; 2000. Available
in English
at: www.reproductiverights.org/pub_bo_rr2k.html and in Spanish
at: www.reproductiverights.org/esp_pub_bo_rr2k.html.
This report systematically examines how to use a rights-based approach to
promote reproductive health. Separate chapters address population and family
planning policies, contraception, abortion, HIV/AIDS and STIs, FGM, rape
and other sexual violence, marriage and family law, and adolescents. Each
chapter describes how reproductive rights relate to a specific health issue,
its legal status in countries around the world, recent changes in national
law, policy, and programs, and recommendations for action by governments,
law enforcement officials, NGOs, family planning associations, advocacy
groups, and donors.
Cook RJ et al. Reproductive Health and Human
Rights: Integrating Medicine, Ethics, and Law. Oxford: Clarendon
Press; 2003.
The first half of this book reviews at length the medical, ethical, legal,
and human rights principles that are relevant to reproductive health. The
second half applies these principles to common challenges facing reproductive
health care providers, such as responding to an adolescent girl’s
request for sexual and reproductive health care or caring for a pregnant
HIV-positive woman. Each scenario opens with a case study, describes the
broader social context of the issue, analyzes its medical, ethical, legal,
and human rights dimensions, and closes with a discussion of the provider’s
clinical obligations and the opportunities for social action.
Eastman P. Senegal:
grassroots democracy in action. IK Notes. No. 16. Washington,
DC: World Bank; 2000. Available at: www.worldbank.org/afr/ik/iknt16.pdf.
During its village education program, Tostan staff discovered that local
people in Senegal were deeply interested in and wanted to know more about
human rights, especially the rights of women and children to be free from
discrimination and violence. After conducting extensive participatory research,
staff developed a new training module that used the term “democracy”
to refer to local as well as national social arrangements that promote human
rights. The democracy module has prompted participants to denounce domestic
violence, lobby for the certification of children’s births, debate
early marriage without the consent of girls, and support a grassroots movement
to ban FGM. In addition, community governance has become more transparent,
and women are showing more interest in voting, taking on leadership roles,
and monitoring national legislation on women’s rights.
Edouard L, Olatunbosun O. Sexual and reproductive
rights: statements, rhetoric, and responsibilities. British Journal
of Family Planning. 2000;26(1):44–47.
Health professionals have been slowly discovering the clinical relevance
of a human rights approach to sexual and reproductive health. This article
reviews lessons learned from initiatives in reproductive health and human
rights and discusses the content and implications of key human rights conferences,
conventions, and charters. The authors encourage health care providers and
their professional associations to get involved in enforcing human rights
treaties by participating in the country reporting process run by international
treaty monitoring committees.
Freedman LP. Using human rights in maternal
mortality programs: from analysis to strategy. International Journal
of Gynecology & Obstetrics. 2001;75:51–60.
Human rights can be used not just to denounce the injustice of death in
pregnancy and childbirth, but also to guide the design and implementation
of maternal mortality policies and programs at the clinic, facility management,
and national levels. Applying human rights principles to maternal mortality
highlights the need for: universal access to high quality emergency obstetric
care services; respectful, non-discriminatory treatment of patients, providers,
and staff in the clinical setting; and community participation to improve
responsiveness and functioning of health facilities.
Germain A. Reproductive
health and human rights. Lancet. 2004;363:65–66. Available
at: www.thelancet.com/journal/vol363/iss9402/full/llan.363.9402.editorial_and_review.28252.1.
This article introduces a special section on reproductive health and human
rights in honor of the tenth anniversary of the International Conference
on Population and Development in Cairo. Women’s rights to life, health,
and reproductive autonomy have not yet been fully realized. Many governments
try to control childbearing and are doing little to make pregnancy and delivery
safe. Endemic violence also continues to threaten women and girls. A concerted
popular and political effort, built on a strong research base, is needed
to achieve women’s rights.
Human Security Network. Understanding
Human Rights: Manual on Human Rights Education. Graz, Austria:
European Training and Research Centre for Human Rights and Democracy (ETC)
and the Federal Ministry for Foreign Affairs of Austria; 2003. Available
at: www.etc-graz.at/human-security/manual/.
This training manual on human rights is designed for both trainers and students.
The first section traces the history of the modern human rights system,
explains key concepts, and describes the international instruments and regional
systems that protect human rights. The second section includes detailed
modules on selected human rights issues, including the right to health and
the human rights of women. The third section lists additional resources
and reference materials.
International Planned Parenthood Federation (IPPF).
IPPF Charter on Sexual and Reproductive
Rights: Vision 2000. London: IPPF; 1996. Available at: www.ippf.org/charter/.
IPPF developed this charter to serve as a bill of rights in the field of
sexual and reproductive health and to link human rights language with service
delivery realities. It identifies 12 basic rights from international human
rights instruments and lists the specific sexual and reproductive rights
that flow from each one. In the addendum, extracts from UN conferences and
other key documents summarize the international consensus on government
commitments, definitions, and priority activities regarding each of the
12 rights.
Jacobson JL. Transforming family planning programmes:
towards a framework for advancing the reproductive rights agenda. Reproductive
Health Matters. 2000;8(15):21–32.
This article explores the practical implications of moving from a demographic
to a rights-based agenda for family planning programs. The shift means focusing
as much on the process as the outcomes of reproductive health care, addressing
the gender and power dimensions of reproductive and sexual decision-making,
building a sense of entitlement among both clients and providers, and considering
ethical values along with technical skills. Obstacles to these kinds of
changes include lack of institutional and political support for a rights
agenda, a continuing narrow focus on reducing fertility, fuzzy definitions
of key concepts, and lack of capacity of civil society groups to ensure
accountability.
Kols A. A
rights-based approach to reproductive health. Outlook. 2003;20(4):1–8.
Available at: www.path.org/files/EOL_20_4_dec03.pdf.
Human rights and reproductive health advocates increasingly are working
together to advance women’s and men’s well-being. This article
discusses fundamental human rights principles and major developments; the
benefits of a rights-based approach to reproductive health; and obligations
and responsibilities at the international, national, health care system,
and community levels. Reproductive health managers can implement a rights-based
approach by assessing the impact of policies and programs on clients’
reproductive rights, by training health workers to understand and embrace
the concept of human rights, by empowering clients and community members
to claim their rights, and by monitoring the process indicators that reflect
reproductive rights.
Murphy E. and Ringheim K. eds. Reproductive
Health, Gender, and Human Rights: A Dialogue. Washington, DC:
PATH; 2001. Available at: www.path.org/files/RH-GHR-Dialogue.pdf.
This collection of articles by public health and human rights experts was
presented at a December 1999 conference. The articles examine the common
interests and significant differences that the two perspectives bring to
reproductive health issues. A wide range of topics is covered, including
sexuality, maternal mortality, family planning, abortion, HIV/AIDS, and
violence against women.
Petchesky RP. Human rights, reproductive health
and economic justice: why they are indivisible. Reproductive Health
Matters. 2000;8(15):12–17.
This editorial argues that health is a cross-sectoral issue that can only
be addressed effectively through a broad gender and development lens. Examples
illustrate how trade agreements and poverty undermine reproductive health.
The author argues that community organizing for health and human rights
is essential to advance the vision of integrated human rights. Descriptions
of community programs in India show how they have built a popular culture
of rights and created a sense of entitlement among women and girls, while
bridging a wide range of sectors, including economic development, literacy,
gender violence, and health care. Grassroots organizing of this kind can
make people aware of the links between a gender perspective, a human rights
perspective, and economic justice.
UNDP/UNFPA/WHO/World Bank Special Programme
of Research, Development and Research Training in Human Reproduction (HRP).
Women,
reproductive health and international human rights. Progress
in Human Reproduction Research. 1999;50(1). Available at: www.who.int/reproductive-health/hrp/progress/50/news50_1.en.html.
This article applies a broad human rights perspective to the analysis of
health and gender. Based on the language of modern human rights conventions,
health disadvantages suffered by women may be classified as social injustices
and violations of human rights law. For example, high rates of maternal
mortality may reflect violations of women's rights to readily available
health care services, to education, and to the equitable distribution of
national wealth to meet a population's basic needs. The article calls for
states to meet their legal obligations and respect women's rights by taking
action to overcome women's health disadvantages.
Violence against women. Human Rights
Dialogue. 2003;2(10):4–35. Available at: www.carnegiecouncil.org/viewMedia.php/prmTemplateID/8/prmID/1061.
The articles in this special issue of Human Rights Dialogue describe
how activists around the world are using international human rights instruments
to combat domestic violence, FGM, honor killings, and other forms of gender-based
violence, and why some are avoiding rights-based approaches as unproductive.
Yamin AE, Maine, DP. Maternal mortality as a human
rights issue: measuring compliance with international treaty obligations.
Human Rights Quarterly. 1999;21(3):563–607.
This article reviews the current state of knowledge about the rates and
causes of maternal mortality, ways to prevent maternal deaths, and monitoring
methods. It then discusses whether, legally and practically, UN guidelines
developed for program managers to assess access to and utilization of services
for serious obstetric complications can be used to define states’
obligations under and compliance with international human rights treaties.
The authors conclude that these indicators can indeed be assessed according
to human rights criteria and selectively adopted as monitoring tools by
national and international institutions in order to evaluate compliance
with treaty obligations.
Links to resources
Amanitare: African Partnership for Sexual and
Reproductive Health and Rights of Women and Girls
www.amanitare.org
Launched in 2000, Amanitare’s goal is to build an influential social
movement to institutionalize the recognition of African women’s and
girls’ sexual and reproductive health rights as fundamental to their
civil and human rights. It provides a regional mechanism to support the
work of African NGOs by facilitating the exchange of information, technical
skills, leadership training, and institutional capacity building between
partner NGOs; creating platforms for discussion at local, national, regional,
and international levels; and developing user-friendly information to raise
public awareness. Three action groups have been formed: Advocating for Freedom
from Gender-Based Violence, Integrating Women’s Rights into Health
Care Delivery, and Reaching Out to New Generations.
Center for Health
and Gender Equity (CHANGE)
www.genderhealth.org
A U.S.-based international reproductive health and rights organization,
CHANGE uses scientific evidence, policy analysis, and research-based advocacy
to develop practical approaches to integrating gender, health, and rights
concerns into policies and programs. CHANGE is currently focusing its efforts
on four program areas (informed choice, gender-based violence, HIV/STIs,
and health sector reform) and four countries (India, Peru, Mexico, and Tanzania).
A variety of publications are posted online, including articles on how policy
and legislative change in these four countries affect reproductive rights.
Center for Reproductive Rights
www.reproductiverights.org
The Center for Reproductive Rights (formerly the Center for Reproductive
Law and Policy, or CRLP) is a nonprofit legal and policy advocacy organization
that promotes women's reproductive rights around the world, often collaborating
with the United Nations and national NGOs. A series of reports on Women of the World
detail local laws, policies, and quality-of-life statistics as they relate
to women's reproductive health and rights in different regions of the world
(www.reproductiverights.org/pub_books.html). Of special interest are two
other publications: Reproductive
Rights 2000: Moving Forward (www.reproductiverights.org/pub_bo_rr2k.html)
and Bringing
Rights to Bear: An Analysis of the Work of UN Treaty Monitoring Bodies on
Reproductive and Sexual Rights (www.reproductiverights.org/pub_bo_tmb.html).
The website is available in English, French, and Spanish.
Commonwealth Medical Trust (Commat)
www.commat.org
Based in London, Commat promotes health, the prevention of disease and disability,
and the advancement of human rights and medical ethics, particularly for
poor and marginalized groups in the Commonwealth and other developing countries.
Commat works with health professional associations and other NGOs in developing
countries on advocacy and educational activities, mainly in sexual and reproductive
health, HIV/AIDS, adolescent health, and women’s health. Of special
interest is Commat’s training
manual on ethical and human rights standards for health care professionals
(www.commat.org/Medical%20Ethics%20and%20Right%20to%20Health/Ethics/toc.htm).
Latin American and Caribbean Committee
for the Defense of Women’s Rights (CLADEM)
www.cladem.com
This regional women’s rights network of individuals and NGOs uses
the law as a tool for change. It promotes women's rights at the national
level through research, litigation, advocacy, and formulating legislative
and policy proposals. It also lobbies for women's human rights at the international
level. The website is available in English, Portuguese, and Spanish.
Franois-Xavier Bagnoud
Center for Health and Human Rights
www.hsph.harvard.edu/fxbcenter
Based at the Harvard School of Public Health, this academic center operates
programs on international health, humanitarian crises, and development.
The international health program works to enhance the development, implementation,
and evaluation of health policies, programs, and strategies based on sound
public health and human rights principles and practice. The center publishes
Health and Human Rights: An International Journal (www.hsph.harvard.edu/fxbcenter/journal.htm)
and posts working papers online.
Human Rights Watch: Women’s
Rights
www.hrw.org/women
This advocacy organization investigates human rights violators and lobbies
governments to end abusive practices and respect international law. The
Women's Rights Division monitors many gender inequities, including domestic
and sexual violence, HIV/AIDS, and trafficking. Country
reports documenting specific women’s rights abuses are available
online at http://hrw.org/doc/?t=women_pub. The website is available in Arabic,
Chinese, English, French, German, Portuguese, Russian, and Spanish.
International Council of AIDS Service
Organizations (ICASO)
www.icaso.org
ICASO and its regional secretariats work to strengthen the community-based
response to HIV/AIDS around the world. They promote human rights in the
development and implementation of all policies and programs concerning HIV/AIDS.
ICASO has published a summary of the international
guidelines on HIV/AIDS and human rights (www.icaso.org/docs/hivaidsguidelnsumm.htm),
a report on the
application of those guidelines (www.icaso.org/docs/JFAP%20-%20Web.pdf),
and case studies
on HIV/AIDS and human rights (www.icaso.org/docs/hivaidsstories.htm). In
addition, the Asia Pacific secretariat has produced a training
manual on HIV/AIDS and human rights (www.apcaso.org/html/ReadFrame.asp?pDocument=../Documents/HumanRights/HIV-AIDS-T-Manual-5-03.pdf).
POLICY Project
www.policyproject.com
Promoting human rights and gender equality is an integral part of the POLICY
Project’s efforts to achieve a more supportive policy environment
for family planning/reproductive health, HIV/AIDS, and maternal health worldwide.
Its website hosts the Human
Rights Matrix (www.policyproject.com/matrix/), which links reproductive
health issues with human rights concepts, international human rights documents,
and potential legal remedies.
United Nations Office of the
High Commissioner for Human Rights (UNHCHR)
www.ohchr.org/english/
In addition to outlining basic human rights principles and issues, this
website posts the full text of international
human rights treaties and conventions (www.unhchr.ch/html/intlinst.htm)
along with general comments and
recommendations, ratifications, and countries’ reporting status
for each treaty (www.unhchr.ch/tbs/doc.nsf). A section on women’s
rights (www.unhchr.ch/women) focuses on the issues of violence against
women, racial discrimination, trafficking, reproductive rights, traditional
practices, and HIV/AIDS. The website is available in Arabic, Chinese, English,
French, Russian, and Spanish.
Uplift International
www.upliftinternational.org
This U.S.-based organization provides humanitarian aid and technical assistance
to developing country programs in the areas of health and human rights,
health promotion, and disease prevention. The Global Health and Justice
Program at Uplift International promotes a rights-based, multidisciplinary
approach to solving health problems that demand active collaboration between
health and legal professionals. Uplift International is currently working
with the School of Law at the University of Washington to implement a medical
and legal advocacy program in Indonesia that is simultaneously working toward
population health and human rights.
Women’s Global Network for Reproductive
Rights (WGNRR)
www.wgnrr.org
Based in the Netherlands, WGNRR links groups and individuals to work for
reproductive rights and self-determination for women worldwide. WGNRR believes
that transforming social, political, and economic conditions is an integral
part of the reproductive rights agenda. The website is available in English,
French, and Spanish.
Women’s Human Rights Net (WHRnet)
www.whrnet.org
WHRnet provides comprehensive news, information, and analysis on women’s
human rights and global issues. The site addresses a different rights issue
each month, providing interviews, commentaries, and links along with an
overview of the issue. The website is available in English, French, and
Spanish.
World
Health Organization (WHO): Gender and Reproductive Rights
www.who.int/reproductive-health/gender/index.html
WHO believes that gender equity and respect for human rights is crucial
to promoting sexual and reproductive health. This site describes WHO’s
efforts to help governments respect, protect, and fulfill their human rights
obligations related to health. To this end, it has developed a training
manual for health managers on gender and rights in reproductive health
(www.who.int/reproductive-health/pages_resources/listing_gender.en.html).
Of special interest are reports on formulating
reproductive health laws (www.who.int/reproductive-health/publications/RHR_00_1/RHR_00_1_contents.htm)
and advancing
safe motherhood through human rights (www.who.int/reproductive-health/publications/RHR_01_5_advancing_safe_motherhood/RHR_01_05_table_of_contents_en.html).
