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Protect women’s sexual and reproductive health and rights

Human rights comment
Strasbourg 21/07/2016
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Protect women’s sexual and reproductive health and rights

In these times of resurgent threats to women’s rights and gender equality, we must redouble our efforts to protect women’s sexual and reproductive health and rights. Among the international and European legal instruments that protect these rights, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) guarantees women’s rights to decide freely and responsibly about the number and spacing of their children and to have access to information, education and means to enable them to exercise these rights.

Sexual and reproductive health and rights are fundamentally linked to the enjoyment of many other human rights, as recently stated by the UN Committee on Economic, Social and Cultural Rights. As widely illustrated by the case-law and guidelines of human rights bodies, sexual and reproductive health is often the context in which human rights are violated, including the right to the highest attainable standard of physical and mental health, but also the prohibition of torture and inhuman or degrading treatment and the right to private life. The right to be free from discrimination on grounds of sex or gender is also at stake, as this right is breached when reproductive health services that only women require are not provided.

Access to sexual and reproductive rights is a precondition for the realisation of other human rights, including in the fields of education and employment. At the same time, impediments in access to sexual and reproductive health services are the result of violations of other human rights, not least the long-standing discrimination and harmful gender stereotyping against women that still need to be fully eradicated in Europe. I have expressed concern at the development in recent years of regressive trends and attempts to exert control over women’s bodies and sexuality which could further hamper women’s access to these rights and endanger progress achieved so far in the field of gender equality.

The pivotal role of access to sexuality education

Teaching sexuality education to all boys and girls in schools is essential to guarantee women’s sexual and reproductive rights and is a full component of the rights to education and to health. Both the European Committee of Social Rights and the UN Committee on the Rights of the Child have stressed that adolescents should have access to appropriate and objective information on sexual and reproductive issues, including family planning, contraception and the prevention of sexually transmitted diseases, as part of the ordinary school curriculum and provided without discrimination on any ground.

However, sexuality education at school has been met with strong resistance from some parents and other stakeholders. In some places, parents can decide to exempt their children from sexuality education classes. Those teaching sexuality education sometimes lack the necessary training and knowledge. In other cases, sexuality education teaching can contain misleading information and value judgements, with problems including the stigmatisation of homosexuality or abortion by young girls. In some countries, including Lithuania, Romania and Russia, there is currently an absence of age-appropriate sexual and reproductive health and rights education with a gender perspective, in the curricula of basic and secondary schools.

The need to further remove barriers in access to contraception

As stressed by World Health Organization (WHO) , meeting the need for contraception is an important strategy for reducing unintended pregnancies, abortions and unplanned births. However, despite significant medical progress in this field, recent studies have shown that access to contraception is hindered by several factors in Europe, including misinformation about the safety of contraceptives and stigma hindering women from discussing contraceptives with medical professionals. Persons in dire economic situations encounter difficulties in accessing contraceptive methods tailored to their needs due to lack of reimbursement by public health services in some countries.

Ensuring women’s rights, dignity and autonomy in maternity health care

I have received disturbing reports of human rights violations in the context of maternity health care, as illustrated by recent NGO-led research on Slovakia. Patterns of segregation against Roma women in maternity hospitals in several countries are also an issue of concern. In recent conclusions concerning Croatia, the Czech Republic and Slovakia, the CEDAW Committee stressed the need to ensure adequate standards of care and respect for women’s rights, dignity and autonomy during deliveries, expressing concerns in particular at reports that childbirth conditions and obstetric services unduly curtail women’s reproductive health choices. The European Court of Human Rights has also made it clear that “private life” incorporates the right to choose the circumstances of giving birth.

The need to ensure access to safe and legal abortion

As noted by WHO, highly restrictive abortion laws are not associated with lower abortion rates. The Parliamentary Assembly of the Council of Europe also recalled that “the lawfulness of abortion does not have an effect on a woman’s need for an abortion, but only on her access to a safe abortion”. A ban on abortions does not result in fewer abortions, but only leads to clandestine abortions, which are more traumatic and increase maternal mortality.

While most countries in Europe ensure access to abortion without restrictions in law as to the reasons, some have kept restrictive abortion laws in contradiction with the case-law and guidelines of international human rights treaty bodies. In a case concerning Ireland, the UN Human Rights Committee concluded last month that a woman who was forced to choose between carrying her foetus to term, knowing it would not survive, or seeking an abortion abroad was subjected to discrimination and cruel, inhuman or degrading treatment as a result of Ireland’s legal prohibition of abortion. The Committee stated that to prevent similar violations from occurring, “ (...) the State party should amend its law on voluntary termination of pregnancy, including if necessary its Constitution, to ensure compliance with the [International] Covenant [on civil and Political Rights], including effective, timely and accessible procedures for pregnancy termination in Ireland, and take measures to ensure that health-care providers are in a position to supply full information on safe abortion services without fearing being subjected to criminal sanctions”.

In my country work, I have also recently called on San Marino and Andorra to move towards decriminalisation of abortion. I expressed concern at a bill prepared in Poland introducing a total ban on abortion except to save a pregnant woman’s life. Criminalisation of abortion, often combined with the societal pressure on women and doctors, has a chilling effect on pregnant women and doctors who would be ready to perform a legal abortion. Women afraid of seeking an abortion, for fear of a backlash and harassment on the part of certain segments of society, resort to clandestine abortions or, when they can afford it, travel abroad to get an abortion.

Even when access to abortion is provided for by law, there can be barriers. In the P. and S. v. Poland case, a 14-year old girl, who was pregnant as a result of a rape, was seeking an abortion that would have been available under Polish law. She was confronted with such deplorable treatment on the part of the authorities that the European Court of Human Rights held that her right to private life and her right to be free from torture and inhuman or degrading treatment was violated.

Mandatory counselling and medically unnecessary waiting periods for abortion are not in line with WHO’s recommendations and have been repeatedly criticised for impinging on women’s rights. Recent trends towards introducing such requirements are therefore of concern. In several European countries, under the conscientious objection clause or clause of conscience, health care practitioners may refuse to perform abortion on the grounds that it is against their conscience. The European Committee of Social Rights has recently concluded that Italy was in violation of the right to health of the Revised European Social Charter as the authorities did not take the necessary measures in order to ensure that, as provided by law, abortions requested in accordance with the applicable rules are performed in all cases, even when the number of objecting medical practitioners and other health personnel is high.

Groups of women particularly vulnerable to violations of sexual and reproductive health and rights

Multiple discrimination related to sexual and reproductive health and rights is also an issue of concern. In times of continuing austerity measures, poor women are disproportionately affected by budgetary cuts in reproductive health services. Women living in rural areas and migrant women in an irregular situation may also find it more difficult to receive appropriate and timely sexual and reproductive health care.

In several European countries, women, in particular Roma women and women with intellectual and psycho-social disabilities, have been involuntarily sterilised. Such cases have been documented in the Czech Republic, Norway, Slovakia, Sweden and Switzerland. According to the case-law of the European Court of Human Rights, such practices constitute serious human rights violations. Governments are therefore obliged to establish accessible and effective mechanisms to obtain reparations. This is why I recently urged the Czech authorities to adopt the bill on reparations for involuntary sterilisation of Roma women.

The way forward in enhancing women’s sexual and reproductive health and rights

All member states of the Council of Europe should take the necessary steps to ensure women full and equal access to sexual and reproductive health and rights including the following measures:

States should ensure that sexual and reproductive health services, goods and facilities are available to all women throughout the country, physically and economically accessible, culturally appropriate, and of good quality in line with the Committee on Economic, Social and Cultural Rights General Comment No. 22 (2016) on the Right to sexual and reproductive health;

All women, including adolescent girls, should have access to sexual and reproductive health information that is evidenced-based, non-discriminatory, and respectful of their dignity and autonomy. Mandatory, comprehensive sexuality education that is age-appropriate, evidence-based, scientifically accurate and non-judgmental should be taught in all schools;

States should take all necessary measures to remove barriers in access to contraception for all women; giving them access to modern contraceptives, including emergency contraception and making them affordable by covering their costs under public health insurance mechanisms;

States should put in place adequate safeguards, including oversight procedures and mechanisms, to ensure that women have access to appropriate and safe child birth procedures which are in line with adequate standards of care, respect women’s autonomy and the requirement of free, prior and informed consent;

Where it is not already the case, states should make lawful, at a minimum, abortions performed to preserve the physical and mental health of women, or in cases of fatal foetal abnormality, rape or incest. All states are strongly encouraged to decriminalise abortion within reasonable gestational limits. In addition, all necessary measures should be taken to ensure that access to safe and legal abortion as provided by law is fully implemented in practice by removing all existing barriers;

States should protect all women and in particular Roma women, women belonging to minorities, migrant women in regular or irregular situations, women with disabilities, LBT women, poor women or rural women, and young or older women against multiple forms of discrimination in the field of sexual and reproductive health and rights.

Nils Muižnieks

List of useful links

  • UN Office of the High Commissioner for Human Rights (OHCHR) Website on Sexual and Reproductive Health and Rights
  • Committee on Economic, Social and Cultural Rights, General Comment No. 22 (2016) on the Right to sexual and reproductive health (article 12 of the International Covenant on Economic, Social and Cultural Rights), 4 March 2016
  • UN OHCHR, Reproductive rights are human rights, a handbook for National Human Rights Institutions, UNFPA, the Danish Institute for Human Rights, 2014
  • Center for Reproductive Rights, Factsheet on Mandatory Waiting Periods and Biased Counseling Requirements in Central and Eastern Europe, Restricting access to abortion, undermining human rights, and reinforcing harmful gender stereotypes, 2015
  • Factsheet of the European Court of Human Rights on Reproductive Rights, December 2015
  • Report of the round-table with human rights defenders on women’s rights and gender equality in Europe organised by the Office of the Council of Europe Commissioner for Human Rights (Vilnius, 6 - 7 July 2015) CommDH(2016)15, 19 January 2016