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A Rights Approach of Sexual and Reproductive Health, Including HIVAIDS, in Conflict Situations

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Title: A Rights Approach of Sexual and Reproductive Health, Including HIVAIDS, in Conflict Situations


1
A Rights Approach of Sexual and Reproductive
Health, Including HIV/AIDS, in Conflict
Situations
  • Brussels, May 13, 2003
  • Marleen Bosmans
  • International Centre for Reproductive Health

2
1. Purpose of This Presentation
  • To present the international legal framework of
    sexual and reproductive health (SRH) ofpeople
    affected by war and armed conflict.
  • To highlight the importance of a rights approach
    of STI/HIV/AIDS in humanitarian aid operations.
  • To raise awareness about the importance of a
    gender approach of SRH in conflict situations.
  • To initiate a process of reflection on the need
    for a comprehensive approach of sexual and
    reproductive rights and needs in conflict
    situations.

3
2. Context 2.1. War and Armed Conflict
  • Dramatic increase in number of armed conflicts
    and wars since end of World War II.
  • Most of them in developing countries.
  • 45 in Least Developed Countries.
  • Tendency to be protracted for several years.
  • Forced displacement of people and refugees
    increasingly used as tactics in war.
  • Main burden of displacement on developing
    countries.
  • Vast majority in developing countries with some
    of the worst estimations of maternal mortality.

4
2.2. Sexual and Reproductive Health in Conflict
Situations
  • 2.2.1. SRH Definition
  • ICPD Programme of Action, 1994
  • Everyone has the right to the enjoyment of the
    highest attainable standard of physical and
    mental health. States should take all appropriate
    measures to ensure, on a basis of equality of men
    and women, universal health care services,
    including those related to reproductive health
    care, which includes family planning and sexual
    health. Reproductive health care programmes
    should provide the widest range of services
    without any form of coercion. (Principle 8)

5
  • Reproductive health is a state of complete
    physical, mental and social well-being (...) in
    all matters relating to the reproductive system
    and to its functions and processes... It also
    includes sexual health the purpose of which is
    the enhancement of life and personal relations,
    and not merely counseling and care related to
    reproduction and sexually transmitted
    diseases... (Art. 7.2.)

6
  • 2.2.2. Key Issues in SRH in Conflict Situations
  • a. Safe motherhood
  • b. Family Planning
  • c. STI/HIV/AIDS
  • d. Gender-Based Violence
  • e. Harmful Traditional Practices

7
  • a. Safe Motherhood
  • Unsafe deliveries leading cause of death among
    women (15-49 years) (515.000 a year)
  • Lifetime risk of maternal death
  • Europe 1 in 3200, Africa 1 in 16
  • 15 of pregnant women life-threatening
    complications
  • Leading cause of mortality among Afghan women in
    Pakistan (22)
  • 5 of the bottom 10 ranking countries in the
    Mothers Index are countries in conflict.

8
  • b.Family Planning
  • Up to 1/3 of maternal mortality and morbidity
    worldwide could be avoided.
  • Absence of minimal, reliable and affordable FP
    services in conflict situations.
  • Increase in unwanted pregnancies, unsafe
    abortions, close birth-spacing, dangerous
    pregnancies, transmission of STI/HIV/AIDS.

9
  • c. STI/HIV/AIDS
  • Increased incidence of STI/HIV/AIDS
  • Example Rwanda
  • Pre-conflict (1994)
  • high urban rate (gt10) low rural rate (1)
  • Post-conlict (1997)
  • urban and rural 11
  • 12-14 years olds 4
  • from rural area living in camp 8,5
  • rape survivors 17

10
  • c. Gender-based Violence
  • Types rapes, attended rape, sexual abuse, sexual
    slavery, enforced prostitution, forced pregnancy,
    enforced sterilisation, forced marriage, domestic
    violence, …
  • Effects physical injury, STIs including
    HIV/AIDS, unwanted pregnancy, psychosocial
    injury, social stigma.

11
  • d. Harmful Traditional Practices
  • Early marriage.
  • Female genital mutilation.
  • Honour killings.
  • Widowhood.
  • e. Mental Health
  • Increased mental health problems.
  • Psychosocial traumas.

12
3. International Framework of the Right to SRH in
Conflict Situations
  • Body of international agreements, regulations,
    conference documents and guidelines on
  • international humanitarian law
  • refugee rights
  • human rights
  • womens human rights
  • childrens rights
  • sexual and reproductive rights

13
  • Growing awareness about the importance of
  • right to health, including SRH
  • gender-mainstreaming of health, including SRH
  • sexual and reproductive rights and needs in
    conflict situations

14
3.1. International Treaties and Conventions
  • 3.1.1. UN Treaties and Conventions
  • a. International Humanitarian Law
  • 1949 Geneva Conventions (4) the 1977 Additional
    Protocols (2).
  • b. International Law
  • Convention Relating to the Status of Refugees
    (Geneva Convention, 1951) and Protocol Relating
    to the Status of Refugees (1967).
  • Rome Statute of the International Criminal Court
    (ICC, 1998)

15
  • c. International Human Rights Standards
  • International Convention on the Elimination of
    All Forms of Racial Discrimination (Racial
    Discrimination Convention, 1965).
  • International Convenant on Civil and Political
    Rights (Civil and Political Rights Convenant,
    1976).
  • International Convenant on Economic, Social and
    Cultural Rights (Economic, Social and Cultural
    Rights Convenant, 1976).

16
  • Convention on the Elimination of All Forms of
    Discrimination against Women (CEDAW, 1979).
  • Convention against Torture and Other Cruel,
    Inhuman or Degrading Treatment or Punishment
    (1984).
  • Convention on the Rights of the Child (1989) and
    Optional Protocols (2000).

17
  • 3.1.2. Regional Treaties and Conventions
  • a. Europe
  • European Convention for the Protection of Human
    Rights and Fundamental Freedoms (1950)
  • b. Africa
  • OAU Convention Governing the Specific Aspects of
    Refugee Problems in Africa (1969)
  • African Charter on Human Rights (1981)

18
  • c. Americas
  • American Convention on Human Rights (Pact of San
    José, 1969)
  • Cartagena Declaration on Refugees (1984)
  • Inter-American Convention on the Prevention,
    Punishment and Eradication of Violence against
    Women (Convention of Belém do Para, 1994)

19
  • 3.1.3. Restrictions and Benefits
  • UN treaties are legally binding for the States
    Parties.
  • Regular monitoring of the UN human rights
    conventions.
  • Need to be translated into national legislations.
  • Instruments should be provided for the
    implementation of these rights.
  • Resources should be made available for the
    development of these instruments.

20
3.2. International Conferences, Documents and
Guidelines
  • 3.2.1. Basic Declaration
  • Universal Declaration of Human Rights (1948)
  • 3.2.2. International Conferences
  • First International Conference of Human Rights
    (Teheran, 1968)
  • Vienna Declaration and Programme of Action (UN
    World Conference on Human Rights, 1993)

21
  • ICPD Programme of Action (International
    Conference on Population and Development, 1994)
    and ICPD 5 (1999)
  • Beijing Platform of Action (Fourth World
    Conference on Women, 1995) and Beijing 5 (2000)
  • A World Fit for Children (UN Special Session on
    Children, 2002)

22
  • 3.2.3. International Guidelines
  • Guiding Principles on Internal Displacement
    (UNHCR, 1998)
  • Guidelines on the Protection of Refugee Women
    (UNHCR, 1991)
  • Sexual Violence against Women. Guidelines on
    Prevention and Response (UNHCR,1995)
  • Guidelines for HIV Interventions in Emergency
    Settings (UNHCR, WHO, UNAIDS, 1995)
  • International Guidelines on HIV/AIDS and Human
    Rights (OHCHR, UNAIDS, 1998)

23
  • International Guidelines on HIV/AIDS and Human
    Rights. Revised Guideline 6. Access to
    Prevention, Treatment, Care and Support. (2002,
    OHCHR, UNAIDS)

24
  • 3.2.4. Restrictions and Benefits
  • UN conference documents, programmes of action and
    guidelines are not legally binding.
  • They are the result of a continuous process of
    negotiation and advocacy efforts.
  • They represent a consensus agreed upon by state
    representatives.
  • They provide an important mandate for the
    promotion of sexual and reproductive rights of
    women displaced by war and armed conflict.

25
4. Landmarks in the Recognition of Sexual and
Reproductive Rights and Needs in Conflict
Situations
  • Sexual and reproductive rigths
  • need to be known
  • need to be understood
  • need to be applied.
  • No unanimous interpretation of sexual and
    reproductive rights.
  • Interpretation is determined by a variety of
    factors political, economical, social, legal and
    cultural (including religious).
  • UN Decade for Women (1976-1985) paved the way for
    the rights and needs of women.

26
  • 1949 Geneva Convention Relative to the
    Protection of Civilian Persons in Time of War
    (IVth Geneva Convention, 1949)
  • (...) Women shall be especially protected
    against any attack on their honour, in particular
    against rape, enforced prostitution, o any form
    of indecent assault. (Art.27)

27
  • 1951 Convention Relating to the Status of
    Refugees
  • The Contracting States shall accord to refugees
    lawfully staying in their territory the same
    treatment as is accorded to nationals in respect
    of … social security (legal provisions in respect
    of maternity, disability old age, death). (Art.
    24.1.b.)

28
  • 1976 International Convenant on Economic,
    Social and Cultural Rights
  • Recognizes (...) the right of everyone to the
    enjoyment of the highest attainable standard of
    physical and mental health (Art. 12.1.) i.e.
    the right to control ones health and body,
    including sexual and reproductive freedom (...)
    (2000, General Comment, 8)

29
  • 1977 Protocol Additional to the Geneva
    Conventions of 12 August 1949, and relating to
    the Protection of Victims of International Armed
    Conflict (Protocol I), 8 June 1977
  • Women shall be object of special respect and
    shall be protected in particular against rape,
    forced prostitution and any other form of
    indecent assault. (Art.76. 1. Protection of
    Women)
















30
  • 1979 Convention on the Elimination of All Forms
    of Discrimination against Women (CEDAW)
  • right on information, counselling and services on
    family planning (Art. 10.h Art.14.2.)
  • equal access of men and women to health services,
    including family planning (Art.12.1.)
  • appropriate services to pregnant women (Art.12.2.)

31
  • ...special attention should be given to the
    health needs and rights of (…) refugee and
    internally displaced women … (1989, General
    Recommendation 24.8.)
  • The issues of HIV/AIDS and other sexually
    transmitted diseases are central to the rights of
    women and adolescent girls to sexual health...
    (1989, General Recommendations 24.18.)

32
  • 1993 Vienna Declaration and Programme of Action
  • The human rights of women and of the girl-child
    are an inalienable, integral and indivisible part
    of universal human rights. (...) (Par.I.18)
  • (…) Violations of the human rights of women in
    situations of armed conflict are violations of
    the fundamental principles of international human
    rights and humanitarian law. (...) including in
    particular murder, systematic rape, sexual
    slavery, and forced pregnancy,(...) (Par.II.38)

33
  • The World Conference on Human Rights recognizes
    the importance of the enjoyment by women of the
    highest standard of physical and mental health
    throughout their life span (…) and recognizes
    a womans right to accessible and adequate
    health care and the widest range of family
    planning services (…) (Par.II.41)

34
  • 1994 ICPD Programme of Action
  • (...) reproductive rights embrace certain human
    rights that are already recognized in national
    law, international human rights documents and
    other consensus documents. These rights rest on
    the recognition of the basic right of all couples
    and individuals to decide freely and responsively
    the number, spacing and timing of their children
    and to have the information and means to do so
    and the right to attain the highest standards of
    sexual and reproductive health (...) (Art. 7.3.)

35
  • (...) The promotion of the responsible exercise
    of these rights for all people should be the
    fundamentel basis for government- and
    community-supported policies and programmes in
    the area of reproductive health, including family
    planning (...) (Art. 7.3.)

36
  • 1995 Beijing Platform of Action
  • Womens rights are human rights. (Declaration
    par.14)
  • The human rights of women include their right to
    have control and decide freely and responsibly on
    matters related to their sexuality, including
    sexual and reproductive health, free of coercion,
    discrimination and violence (…) (Art. IV.C.96)

37
  • Many women face additional barriers to the
    enjoyment of their human rights because (…) they
    are (…) migrants, including (…) displaced women
    or refugees. (Art.IV.I.225)

38
5. Human Rights and HIV/AIDS 5.1. Relationship
  • Human rights are inextrincably linke with the
    spread and impact of HIV/AIDS.
  • A lack of respect fuels the spread and
    exacerbates the impact of HIV/AIDS through
  • increased vulnerability (particularly of women
    and children)
  • discrimination and stigma
  • impediment of effective responses to HIV/AIDS.
  • At the same time HIV/AIDS undermines the progress
    in the realization of human rights.

39
5.2. International Guidelines on HIV/AIDS and
Human Rights
  • Joint initiative of the UN Office of the High
    Commissioner for Human Rights and UNAIDS (1998).
  • Highlight the importance of cooperation among a
    widely varied range of stakeholders. (Par.12)
  • Stress that an effective response to HIV/AIDS
    requires the implementation of all human rights,
    civil and political, economic, social and
    cultural, and fundamental freedoms of all people,
    in accordance with existing international human
    rights standards. (Par. 15.a.)

40
  • Specifically refer to the importance of ensuring
    womens sexual and reproductive rights
    (Par.30.f.)
  • Draw attention to the disproportionally high
    spread of HIV/AIDS among vulnerable groups
    including women, children, (…) refugees and
    internally displaced persons (…) (Par.75).
  • Emphasize that particular attention should be
    paid to human rights of children and women.
    (Par.81)
  • States that HIV/AIDS demonstrates the
    indivisibility of human rights since the
    realization of economic, social and cultural
    rights, as well as civil and political rights, is
    essential to an effective response (…) (Par.79)

41
5.3. International Guidelines on HIV/AIDS and
Human Rights. Revised Guideline 6. Access to
Prevention, Treatment, Care and Support.
  • Issued in 2002.
  • Emphasize the need for a comprehensive approach
    of HIV/AIDS.
  • Stress that positive measure should be taken to
    address factors that hinder equal access of
    vulnerable individuals and populations to
    prevention, treatment, care and support
    including women, children, refugees and
    internally displaced persons (Recommendation a.).
  • Highlight that particular attention should be
    paid to gender inequalities, with respect to
    access to care in the community for women and
    girls. (Recommendation f.)

42
6. Conclusions
  • Sexual and reproductive rights are human rights.
  • Sexual and reproductive rights are inextrincably
    linked with womens rights and childrens rights.
  • Sexual and reproductive rights include the right
    to HIV/AIDS prevention, treatment, care and
    support.
  • Like all human rights, sexual and reproductive
    rights are inalienable, integral and indivisible.

43
  • The promotion and protection of these rights
    should also be a priority in situations of war
    and armed conflict.
  • The promotion and protection of these rights
    should be gender sensitive.
  • The promotion and protection of these rights
    should be integrated and comprehensive.
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