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).

Top of Page

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.

Top of Page

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).

Top of Page   Go to Key Issues