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The basis for these rights can be found in various articles of the Convention on the Elimination of All Forms of Discrimination Against Women. Rights to reproductive and sexual health include the right to life, liberty and the security of the person; the right to health care and information; and the right to non-discrimination in the allocation of resources to health services and in their availability and accessibility. Of central importance are the rights to autonomy and privacy in making sexual and reproductive decisions, as well as the rights to informed consent and confidentiality in relation to health services.

The paper is illustrated by issues that reflect systemic violation of the above rights in varied forms, including maternal mortality, lack of procedures for legal abortion, inadequate allocation of resources for family planning, coercive population programs, spousal consent to sterilization, and occupational discrimination of pregnant women. The International Conference on Population and Development ICPD held in Cairo in marked the acceptance of a new paradigm in addressing human reproduction and health.

For the first time, there was a clear focus on the needs of individuals and on the empowerment of women, and the Looking for women sex Liberty of an evolving discourse about the connection between human rights and health, linking new conceptions of health to the struggle for social justice and respect for human dignity. The new attention to human rights in the ICPD marked a departure from the approach that treated women instrumentally, as tools through which to implement population programmes and policies.

The reproductive health and rights approach adopted at ICPD is premised on a view that values women intrinsically and is genuinely concerned about their health and well-being. The ICPD thus posits the human rights of women - their right to personal reproductive autonomy and to collective gender equality - as a primary principle in the development of reproductive health and population programs.

The meaning of these texts is illustrated through concrete examples of violations of the rights guaranteed thereunder, finding expression in country reports submitted within the monitoring mechanism of the Convention. The analysis is brought under two broad headings: personal autonomy, as derived from the Looking for women sex Liberty to liberty and including the right to life and to reproductive choice and informed consent; and gender equality as a component of social distributive justice in the allocation of resources.

The rights recognised in the ICPD are based in various international human rights treaties. The examples are taken from the reports of States Parties submitted in fulfilment of their obligations under the Convention, and considered by the Committee on the Elimination of Discrimination Against Women hereinafter - the CEDAW Committee at its 18th session in January It also took note of unofficial information provided independently by international and national non-governmental organizations - known as "shadow reports" - in accordance with the practice of the Committee, as of other human rights treaty bodies.

The issues presented in these materials include equality in the allocation of resources, the right to life, reproductive choice in relation to abortion and family planning, the right to informed consent, and equality before the law. Finally, the situation of women in vulnerable situations is given separate consideration. I must stress that this paper is not intended in any way to single out the countries under discussion.

In every society there exist multiple forms of violations of human rights. The presentation of the examples in this paper illustrates merely some of this diversity, and does not even exhaust the situation in the countries under consideration. The use of reports submitted to the CEDAW Committee shows how the reporting mechanism of the human rights treaties can serve to develop standards of human rights jurisprudence in international law and to sensitize us to the meaning of the rights guaranteed under the international instruments.

I must emphasise further that the views expressed in this paper are my own, and are in no way to be taken as an official statement of the CEDAW Committee as such. The Programme of Action adopted at the ICPD is a consensus document, the end product of a process of negotiation and compromise involving over States. A separate chapter addresses gender equality and empowerment of women, placing the eradication of sex discrimination as a priority objective of the international community in relation to policies and programs of population and development.

Reproductive health is defined in paragraph 7. The ICPD referred to the term "reproductive rights " as embracing "certain human rights that are already recognized in The human rights already recognized in "international human rights documents" include "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" as guaranteed by Article 12 of the International Covenant on Economic, Social and Cultural Rights ICESCR.

These include the right to life, the right to liberty and security of the person, and the right to privacy, to mention just a few.

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Reproductive rights, according to the ICPD, Looking for women sex Liberty on the recognition of the basic right of all couples and individuals to decide freely and responsibly thespacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. Reproductive rights, according to the ICPD, also include the right "to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents.

Before proceeding to examine the Convention more closely, it is worth noting that a subsequent consensus document of the international community, that is, the Platform for Action of the Fourth World Conference on Women FWCWheld in Beijing inreiterated the paradigm shift of the ICPD.

The Beijing Declaration stated that "the explicit recognition and reaffirmation of the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment". Both of these are consensus documents, expressing political will. As opposed to this, international human rights documents - treaties or conventions - are sources of international lawand as such are considered to be legally binding. In general, States Parties to the Convention undertake to pursue a policy of eliminating discrimination in all its forms, and to guarantee women the exercise and enjoyment of human rights and fundamental freedoms on a basis of equality with men.

It is composed of 23 expert members elected by States Parties from among their nationals and serving in their personal capacity. The Committee may also make general recommendations based on the examination of reports and information received from the States Parties. Some of these general recommendations address formal matters, such as the reporting obligations of States Parties, while others are explications of substantive matters and constitute authoritative interpretations of the rights guaranteed under the Convention.

As already mentioned, article 16 1 e of the Convention guarantees the right to decide on the and spacing of children, but that is only one of the articles that address. Article 12 is central. In addition to the aforementioned articles, the right of access to specific educational information and advice on family planning is guaranteed under article 10 h. And article 14 b specifies, in particular, the right of women in rural areas to have access to adequate health care facilities, including information, counselling and services in family planning.

Before examining concrete instances of violations of health-related rights, I would like to clarify the meaning of two key concepts: autonomy and discrimination. Autonomy means the right of a woman to make decisions concerning her fertility and sexuality free of coercion and violence. Much turns on our understanding of coercion and violence. Key to this is the notion of choice.

In health care contexts, the rights to informed consent and confidentiality are instrumental to ensuring free decision making by the client. These rights impose certain correlative duties upon health care providers and deliverers of services. They are bound to disclose information of proposed treatments and their alternatives so as to obtain the informed consent of the client, and they must respect her right to refuse treatment. Likewise, they are bound to maintain secrecy so as to allow her to make private decisions without Looking for women sex Liberty interference of others whom she has not chosen to consult, and who might not have her best interests at heart.

The right to autonomy in making health decisions in general, and sexual and reproductive decisions in particular, derives from the fundamental human right to liberty. The word "autonomy" itself is not mentioned expressly in the Convention, but the value of autonomy is certainly implicit in the fundamental freedoms it guarantees to women, on a basis of equality with men.

Autonomy is intimately and intrinsically connected with many fundamental human rights, such as liberty, dignity, privacy, security of the person, and bodily integrity. These form the basis for asserting rights to informed consent and confidentiality in relation to health services and health care. Women have the right to be fully informed of their options in health care, including likely benefits and potential adverse effects of proposed methods of treatment and available alternatives, including the option of refusing treatment.

One of the most eloquent explications of the meaning of "autonomy" is that of Isaiah Berlin in his essay, Two Concepts of Liberty. For Berlin "liberty" in the ordinary sense is a "negative" right to freedom, in that one is entitled to be free in certain areas from the interference of others. It is not merely freedom "from" but freedom "to". I wish my life and decisions to depend on myself, not on external forces of whatever kind. I wish to be a subject, not an object; to be moved by reasons, by conscious purposes, which are my own, not causes which affect me, as it were, from outside.

I wish to be somebody, not nobody; a doer - deciding, not being decided for, self-directed and not acted upon by external nature or by other men as if I were a thing, or an animal, or a slave incapable of playing a human role, that is, of conceiving goals and policies of my own and realizing them. This is at least part of what I mean when I say that I am rational, and that it is my reason that distinguishes me as a human being from the rest of the world. I wish, above all, to be conscious of myself as a thinking, willing, active being, bearing responsibility for my choices and able to explain them by references to my own ideas and purposes.

I feel free to the degree that I believe this to be true, and enslaved to the degree that I am made to realize that it is not. The second concept that deserves some explication is that of discrimination. Equality implies non-discrimination, and discrimination is violation of the right to equality. Two comments are in place. First, the Convention adopts an "effect" approach, whereby discrimination is condemned even if it is not purposeful.

This is of particular ificance in the area of health, where much of the discrimination is evident in differences in the health status of women and men, but is the result of certain patterns of behavior, sometimes described as "natural". These patterns persist by the mere inertia of habit if no intervention is undertaken for the removal of discriminatory barriers, or if we fail to pay attention to the factors that comprise the "real" differences - some biological or physiological, and some social - between women and men in relation to their health.

It should Looking for women sex Liberty mentioned in this context that the Committee has noted that discrimination under the Convention is not restricted to action by or on behalf of governments. This means that states may also be responsible for acts of discrimination perpetrated in the private sphere by non-governmental actors, including health care providers. The second comment is that the definition of discrimination under the Convention applies to all women, irrespective of their marital status. This is of ificance in two respects.

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The area of health is particularly interesting in terms of equality theory because of what has already been noted: "real" differences between women and men - some biological or physiologicaland some social. Cultural and religious attitudes may value women according to their ability to produce children.

Their health may consequently be jeopardized by repeated pregnancies spaced too closely together, often as the result of efforts to produce male children. Women who have not borne children may be cast out of marriages on the assumption that they, rather than their male partners, are infertile. Women may be denied access to health care that is unrelated to their reproductive functions, and their health needs may be considered secondary to those of their children or, in the case of pregnant women - to the health of their fetuses.

These entail unnecessary interventions, such as female genital mutilation, forced virginity examinations and hymen repair.

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While such social phenomen are clearly mediated by gender discrimination, health-related discrimination might be attributed in part to biological differences between women and men. Contemporary feminist legal theory propounds that the principle of gender equality takes into such difference, rather than requiring women to meet standards set by a male model. Equality requires that we treat the same interests without discrimination, and also that we treat different interests in ways that respect those differences.

Failure to take into the special health needs of women, so as to ensure their access to appropriate health information and services, constitutes discrimination. Equality is not a formal matter of guaranteeing to women the same rights as men and combatting purposeful discrimination, but rather a substantive matter of ensuring the effective enjoyment of equal outcome in health status and well being.

The text of the Convention is abstract, and expresses principles that are to serve as guides for conduct. What meaning do they have in actual practice? The Looking for women sex Liberty imposes a duty under international law to respect, protect and fulfil the human rights articulated thereunder. In an ideal world the aspirations of the legal norms would be observed, but the reality is such that they are not observed. Violations of these standards take different forms at different times and in different places. As mentioned, the following examples of some contemporary patterns of rights violations are taken from reports considered by the CEDAW Committee at its 18th session.

The issue of distributive justice in the allocation of resources for health is of major concern throughout the world, given the rising costs of medical technology and budget cuts often associated with programs of structural adjustment. This is illustrated well in those countries characterised as "economies in transition". In Croatia, for example, contraception was the first medication to be removed from state funding in a comprehensive public health system within budget cuts resulting from economic constraints, as was abortion the first medical procedure to be removed from otherwise free health services.

Similarly, in Bulgaria - where the government reported that the of abortions was considerably higher than that of births - it was noted that family planning education was inefficient due to the economic situation in the country, with its free-of-charge health care system suffering from the economic crisis of the transition period.

Cuts in budgets in Azerbaijan resulted in a decrease in the of maternity health centers. In addition, despite the fact that maternity care was officially provided free-of-charge by a state-funded health system, there had developed an informal fee-for-service practice which made hospital delivery unaffordable to many women and resulted in a rise in the of home births. At the same time Azerbaijan reported that maternal mortality rates had increased five-fold between and Indeed, discrimination against women is a ificant factor in the high s of deaths and complications related to pregnancy and childbirth.

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Maternal mortality and morbidity can Looking for women sex Liberty be avoided through the provision of reproductive health services, including contraception, safe abortion, and essential and emergency obstetric care. The report explained that many women prefer home births "due to convenience, low cost and flexible payment arrangements, the aftercare offered and the comfortable atmosphere prevailing in home deliveries". While the case of Azerbaijan illustrates violation of the right to affordable services, in the Dominican Republic there appeared to be a violation of the right to quality of care.

The actual rate of maternal mortality was not known until recently, due to the unreliability of health statistics in general and the lack of sex-disaggregated data in particular, but in latter years there had been an increase in maternal deaths, despite the prevalence of prenatal care and hospital births. Unsafe abortion is also a major cause of maternal mortality and morbidity. Thus, Zimbabwe reported that haemorrhage and infection after abortion are major causes of death, though actual figures are not ascertainable given the illegality of abortion. The Dominican Republic, similarly, reported that "clandestine abortions" are the third leading cause of maternal death following toxemia, and haemorrhages during childbirthbut noted "heavy underreporting".

There are grounds for the view that laws which criminalize health services that only women need - whether aimed at the persons who provide such services, or the women who receive them - are discriminatory as such. In many countries there are exceptions to the criminal norm, allowing for legal abortion in limited circumstances, such as in cases of danger to the life of the mother or the fetusor where pregnancy has resulted from rape.

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In Indonesia, however, rape does not constitute grounds for legal abortion, which means that the state is effectively compounding the sexual violence targeted at the woman by forcing her to carry the resultant pregnancy. The right to reproductive choice means that women have a right to choose whether or not to reproduce, including the right to decide whether to carry or terminate an unwanted pregnancy and the right to choose their preferred method of family planning and contraception.

A fact-finding mission investigating allegations of the practice, found that all women applying for work in this sector were routinely required to undergo pregnancy testing for screening, and that employed women were forced to re when they became pregnant. In some factories women were obliged to show sanitary napkins to company nurses as a condition of ongoing employment.

The report concluded that such practices penalize women for exercising reproductive choice, and inherently compromise their ability to decide freely on the and spacing of their children, and that the government of Mexico was responsible to ensure that such employment practices cease. Family planning services are particularly important where abortion is illegal. In the Dominican Republic, abortion is illegal, but birth control education is provided only by non-governmental organisations. Arguably, where the state does not allow for safe legal abortion, its core obligation is to at least provide itself those family planning services that guarantee women their right to exercise reproductive choice.

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