Human Rights in the Modern Era

8/14/2019 Human Rights in the Modern Era

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OUTLOOKA Rights-Based Approachto Reproductive Health

Human rights and reproductive health advocates increasingly are working together toadvance womens and mens well-being. The modern human rights system is basedon a series of legally binding international treaties that make use of principles ofethics and social justice, many of which are directly relevant to reproductive health care.By placing reproductive health in a broader context, a rights-based approach can providetools to analyze the root causes of health problems and inequities in service delivery. Byemphasizing fundamental values, most notably respect for clients and their reproductivedecisions, a rights-based approach can shape humane and effective reproductive healthprograms and policies.1,2 By taking advantage of the international human rights treaty

system, a rights-based approach can challenge the status quo and pressure governmentsinto working proactively for reproductive health.3

Human Rights in the Modern Era

The concept of reproductive rights is rooted in the modern human rights system developedunder the auspices of the United Nations (UN). Since 1945, the UN has created interna-tionally recognized standards for a range of human rights, including the right to health, andhas established mechanisms to promote and protect those rights. In response to atrocitiescommitted during World War II, the UN General Assembly adopted the Universal Declarationon Human Rights in 1948. International treaties (see Table 1, page 2) have since transformedthe principles asserted in the declaration into legally binding obligations for nations thatratify the agreements.2 Parallel systems of human rights treaties and monitoring bodies alsoexist in some regions, including Africa, the Americas, the Arab states, and Europe.4,5

Transforming these legal obligations into a genuine political commitment to repro-ductive rights, however, required concerted and sustained pressure from womens advocates.The womens empowerment movement drew attention to human rights abuses stemmingfrom womens subordinate position in society and pressured governments to change thecircumstances of womens lives.2 In three landmark international meetings in the 1990s,the movement succeeded in forging a new consensus on reproductive rights and made themcentral concerns for health programs and policies around the world.6

The 1993 World Conference on Human Rights in Vienna afrmed that womens rightsare human rights and should not be subordinated to cultural or religious traditions. Theconference also marked a breakthrough for reproductive rights, acknowledging that humanrights can and should be broadly applied to the areas of sexuality and reproduction.

Volume 20 December

Number 4 2003

Outlook:Celebrating20yearsofproviding

reproductivehealthinformationworldwide.


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The 1994 International Conference on Population andDevelopment in Cairo created a comprehensive frameworkto realize reproductive rights and health.7 Womens advocatespersuaded governments to reject population policies focusedsolely on reducing fertility and to forge a new approach that

focused instead on meeting individual womens needs for awide array of reproductive health services.2The 1995 Fourth World Conference on Women in Beijing

conrmed and built on the link established in Cairo betweenwomens reproductive rights and human rights alreadyrecognized by international treaties and national laws. TheBeijing Platform for Action took a holistic, rights-focused viewof health and the social, political, and economic factors thataffect it. It focused on governments obligation to fulll theright to health by creating the conditions that enable womento realize their right to health.2

Fundamental Principles

Many of the human rights dened in international treatieshave implications for reproductive health care (see Table 2,page 3). They guide almost every aspect of the delivery of care,dening what services must be offered, to whom, and in whatfashion. Three principles are key for reproductive health:7

Based on the rights to liberty, to marry and found afamily, and to decide the number and spacing of oneschildren, individuals have the right to control theirsexual and reproductive lives and make reproductivedecisions without interference or coercion.

The right to non-discrimination and respect fordifference requires governments to ensure equalaccess to health care for everyone and to address theunique health needs of women and men.

To fulll peoples rights to life and health, govern-

ments must make comprehensive reproductive healthservices available and remove barriers to care. A rights-based approach to reproductive health i

especially powerful because all human rights, includingreproductive rights, are universal, inalienable, indivisibleand interdependent.8 Universal because everyone is bornwith and possesses the same rights, regardless of wherethey live, their gender or race, or their religious, culturalor ethnic background. Inalienable because peoples rightscan never be taken away, no matter what they do, nor canan individual ever give up his or her rights. Indivisible andinterdependent because all rightspolitical, civil, socialeconomic, or politicalare equal in importance and none

can be fully enjoyed without the others.The universal quality of human rights means thatnations cannot cite cultural or religious traditionswhichoften place women in a subordinate position and validateharmful practices such as early marriage and female genitalmutilation (FGM)as an excuse not to respect and protect allof womens rights, including their reproductive rights.

The principle of indivisibility recognizes that womencannot realize their reproductive rights without realizingtheir broader human rights. For example, women cannot

Table 1. Major International Human Rights Treaties

Treaty

Date

Adopted

No. ofRatifying

States Purpose

General Commentsand Recommendations Relevant

to Reproductive Rights

International Convention on

the Elimination of all Formsof Racial Discrimination

1965 169 Eliminates discrimination based on race,

color, descent, or national or ethnic originthat impairs human rights

General Recommendation 25 on Gender

Dimensions of Racial Discrimination(2000)

International Covenant onCivil and Political Rights

1966 151 Guarantees right to life, liberty, marryand found a family, freedom from inhumantreatment, and freedom of thought andexpression

General Comment 28 on Equal Rights ofMen and Women (2000)

International Covenant onEconomic, Social, and Cul-tural Rights

1966 148 Guarantees right to health, education,work, adequate standard of living, andbenets of scientic progress

General Comment 14 on Right to Health(2000)

Convention on the Elimina-tion of all Forms of Discrimi-nation Against Women

1979 174 Eliminates discrimination against womenin civil, political, economic, social, andcultural areas

General Recommendation 24 on Womenand Health (1999)

Convention Against Tortureand other Cruel, Inhuman

and Degrading Treatment orPunishment

1984 133 Eliminates intentional iniction of physi-cal and mental suffering for coercion,

punishment, or intimidation

Convention on the Rights ofthe Child

1989 192 Denes and guarantees civil, political,economic, social, and cultural rights ofchildren under age 18 and their parents

General Comment 3 on HIV/AIDS andthe Rights of the Child (2003); GeneralComment 4 on Adolescent Health andDevelopment (2003)

The treaties can be viewed online at the Ofce of the High Commissioner for Human Rights (www.unhchr.ch/html/intlinst.htm). General com-ments and recommendations, ratications, and countries reporting status can be viewed online at www.unhchr.ch/tbs/doc.nsf/.


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realize their right to choose the number and spacing of theirchildren unless they can afford transport to and user feesfor family planning services (right to freedom from povertyand to work). They also must have access to informationalmaterials and be able to read them (right to receive infor-mation and to education), and not fear a violent reactionfrom their partners (right to freedom from inhuman anddegrading treatment).9

Benets of a Rights-Based Approach

Human rights and health advocates can best achieve theircommon goalimproving peoples well-beingby taking

advantage of the complementary strengths of their twoelds.10 Taking a rights-based approach to reproductivehealth offers many benets:

Human rights can provide core values and an ethicalframework for public health practitioners.10

International treaty obligations increase the pressureon governments to provide adequate health services,11ght violence against women,14 and take other actionsthat improve public health.

Framing a health problem like maternal mortalityas a human rights or social justice concern raises itsvisibility and can make it an urgent policy concern.13

Table 2. Reproductive Rights

Human right Reproductive health obligations

Right to life and survival Prevent avoidable maternal deaths. End female feticide and infanticide. Screen for cancers that can be detected early and treated.

Ensure access to dual-protection contraceptive methods.Right to liberty and securityof the person

Eliminate female genital mutilation. Obtain informed consent for all procedures, including HIV testing, sterilization, and

abortion. Encourage clients to make independent RH decisions. Stop sexual trafcking.

Right to freedom from inhumanand degrading treatment

Protect and care for survivors of sexual assault and domestic abuse and prosecutethe perpetrators.

Prohibit involuntary abortion and sterilization. Eliminate rape as an instrument of war.

Right to marry and found a family Prevent early or coerced marriages. Provide access to infertility services to women and men. Prevent and treat reproductive tract infections that cause infertility.

Right to decide the numberand spacing of ones children

Provide access to a range of contraceptive methods. Help people choose and use a family planning method. Provide access to safe abortion services, where legal.

Right to the highest attainablestandard of health

Provide access to affordable, acceptable, and comprehensive RH services. Provide high-quality care. Allocate available resources fairly. Provide access to effective approaches to cervical cancer screening/early treatment.

Right to the benets of scienticprogress

Fund research on womens as well as mens health needs. Provide access to emergency contraception. Provide access to antiretroviral treatment for AIDS. Provide access to obstetric care that can prevent maternal deaths.

Right to non-discriminationand respect for difference

Offer RH services to all groups, including adolescents, unmarried women, and refugees. Ensure that a husbands or parents consent is not required for RH services.

Offer services that meet womens and mens distinctive RH needs.Right to receive and impartinformation

Make family planning information freely available. Offer sufcient information for people to make good RH decisions.

Right to freedom of thought,conscience, and religion

Do not limit RH services, such as emergency contraception, on religious grounds. Allow providers to refuse to offer contraceptive and abortion services on the grounds of

conscience where referrals are possible and treatment in emergency situations is protected.

Right to privacy Ensure privacy for all services. Keep clients information condential.

Sources: Cook et al., 2003 and IPPF, 1996.3,14


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Rights education can empower health care clients andthe community by instilling a sense of entitlement andestablishing new social norms (see box, above).6

Respecting human rights improves the effectivenessof health interventions: outcomes are better ifadolescents are offered reproductive health services,if couples are encouraged to make an informed choiceof family planning methods, and if sex workers areempowered, rather than coerced, to use condoms.16

A rights-based approach helps public health practi-tioners understand the societal factors, such as genderinequality, that inuence reproductive health and

reach beyond the health sector to address them.6,10Public health methodologies also offer benets to human

rights advocates. Epidemiological studies can explain thecauses of problems like avoidable maternal deaths anddocument their magnitudeunlike the case studies humanrights advocates traditionally use to analyze rights viola-tions.13 Statistical analysis of large data sets also can identifywidespread problems, such as provider bias toward certaincontraceptive methods, that may be too subtle to attract theattention of rights advocates.6 Public health methodologies

also are able to assess the impact of changes in policy andprograms on reproductive health indicators.17

The reproductive health problem posed by violence againstwomen demonstrates the synergies between the health andrights perspectives. Framing violence against women as aviolation of human rights raises awareness and increasespolitical will to address the problem. It holds governmentsaccountable and broadens the response to include non-healthsectors, like law enforcement and the judiciary. In Nicaraguafor example, activists used epidemiological research on theprevalence and effects of domestic violence to build supportfor legal reforms.18 It also increases appreciation of howpoverty, education, and social inequality contribute to levelsof violence.12,17 The public health approach encourages thegathering of convincing evidence on the magnitude of theproblem, its health consequences, and risk factors; developsinterventions to prevent violence and reduces harm whenit occurs; and assesses the impact and cost-effectiveness ofinterventions.17

Obligations and Responsibilities

Although human rights treaties directly place obligationonly on states and state ofcials, they indirectly createresponsibilities for other organizations and individuals.

International organizations.Each international humanrights treaty provides for a committee to monitor the performance of ratifying nations.19 As part of a country reportingsystem, each nation periodically submits a report to thecommittee on their efforts to meet their treaty obligationsThe committee discusses the report with country representatives and also hears testimony from UN agencies, nongovernmental organizations (NGOs), and, in some cases, individuals

At the end of this quasi-judicial process, the committee issuesan ofcial report highlighting areas of concern and recommending specic changes. These reports are submitted to theUN General Assembly.3,19 The country reporting process givesthe monitoring committees and civil society an opportunityto inuence a governments actions through dialogue and theforce of world opinion. The committees rely on the good faithof member states to comply with treaty obligations.

The treaty-monitoring committees also are responsiblefor interpreting broadly worded treaty provisions. In recentyears, several committees have issued general commentsor general recommendations that detail standards forgovernments to follow in meeting their treaty obligationsregarding womens reproductive rights (see Table 1, page 2)By demonstrating how rights apply to particular reproductivehealth issues and by dening government obligations, thesecomments and recommendations have fostered compliancewith the treaties.19

Regional systems of human rights treaties and monitoringbodies have their own reporting and complaints procedureswhich may set higher standards for human rights and theirimplementation than international agreements.4,5 Theycan address complaints more efciently since they includecourts that have the power to issue binding decisions (see box

Empowering Women in Senegal

Human rights education can prompt changes inindividual attitudes and behaviors that improve repro-ductive health. Tostan, a nongovernmental organization

based in Senegal, begins its 10-month adult educationprogram with a module on democracy and human rights,including the right to education, health, and protectionfrom violence and discrimination.15 Modules on problem-solving, personal and community hygiene, and womenshealth issues follow. Students are encouraged to applytheir problem-solving skills to improve conditions in thecommunity. Participating villages have organized clean-up brigades, constructed latrines, promoted childhoodvaccinations and prenatal care, and the like.

Tostans greatest impact has come from empow-ering women, who gain the condence to speak outin meetings, take on leadership roles, participate in

community and family decision-making, and questiontraditional practices. After analyzing the health impactsof traditional practices in Tostan classes, the women ofMalicounda-Bambara publicly vowed to abandon FGMin 1997. Their landmark declaration, together withTostans continuing village education programs, spurreda grassroots consultation and decision-making processthroughout Senegal. As a result, more than 1,100villages in Senegal and now also in Burkina Faso havedeclared an end to FGM in public ceremonies. Manycommunities also have announced their intention toeliminate two other widespread practices that violatewomens rights and threaten reproductive health: early,forced marriages and domestic violence.


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stafng facilities or training personnel to offer reproductivehealth services. It also requires action at the local pointof care, for example, in supervising the technical qualityof care, arranging for privacy, and maintaining reliablesupplies of contraceptives. Health care providers whointeract directly with clients carry special responsibilitiessuch as respecting condentiality, helping clients makefully informed decisions, and avoiding bias against certainservices or clients.3

Clients and community. Health care clients andcommunity members also can play a role in realizing theirown reproductive rights. For example, clients may requestprivacy at clinics, ask providers for information, and takethe initiative in making reproductive health decisionsClients also can hold providers and programs accountableby complaining if, for example, a provider breaches condentiality regarding STI/HIV test results.6 Community memberscan inuence reproductive rights by helping set the socianorms that shape individual behavior. Their attitudes

determine, for example, whether it is socially acceptable forwomen to go alone to a clinic, for men to beat their wives, orfor girls to be circumcised.

Fighting Coerced Sterilizations in Peru

Individual cases of human rights violations can focusattention on systemic problems and help governmentsimplement broad changes in health care policies andpractices. For example, a pattern of coercive steriliza-tions in Peru in the mid-1990s led womens rightsorganizations to pursue the case of Mara MamritaMestanza Chvez in the courts.23 This poor, ruralwoman submitted to tubal ligation in 1998 after

health center staff repeatedly pressured her, includingthreatening to report her to the police for having morethan ve children. Furthermore, health personnel didnot examine her before the operation, did not give hera consent form until the day after the operation, andrefused follow-up care when she developed complica-tions. She died at home about a week later.

After the Peruvian court system refused to open theinvestigation, several rights organizations petitionedthe Inter-American Commission on Human Rights aboutMestanzas case. The commission negotiated a friendlysettlement agreement in which the government of Peruadmitted violating its international rights obligations.

The current government apologized for the actions ofthe previous regime. They agreed to pay damages toMestanzas family and to punish those responsible,and they worked to change the laws, policies, andpractices that led to unsafe and coerced sterilizations.Women throughout Peru gained when the governmentembraced specic recommendations to improve pre-operative evaluations, health personnel training, thehandling of patient complaints, and informed consentprocedures.

below). Because regional systems are more sensitive to localcultural and religious concerns, their authority also tends tobe accepted more readily by governments.20

International and regional discourse on human rights ishaving an increasing impact at the national level. Governmentofcials, legislators, and judges in many countries often arebasing their policies, laws, and court rulings on internationaland regional human rights treaties, comments issued bytreaty monitoring committees, and the programs of actionadopted at international conferences.12,19

National government. The international treaty systemimposes three obligations on national governments: torespect, protect, and fulll human rights.

Respect for rights means not interfering with peoplesability to enjoy their rights, for example, by not prohib-iting adolescents from getting contraceptives.21

Protecting rights means taking action against thosewho violate human rights, for example, by prosecutingthe perpetrators of rape and domestic violence.21,22

Fullling rights means taking legislative, budgetary,and judicial actions that allow people to fully realizetheir rights, for example, by building a public healthinfrastructure with enough facilities and providersto offer affordable and comprehensive reproductivehealth services throughout the country.21To meet their three obligations, national governments

must adopt appropriate policies and laws (see box, page 6).Many constitutions, bills of rights, and laws set bindingstandards for human rights, but their content and the degreeof support for reproductive rights is inuenced by nationalpolitics and varies widely.6

To truly fulll reproductive rights, governments also

must address societal conditions that hinder women fromenjoying their reproductive rights. Policies, laws, and justicesystems that empower women and promote gender equityare needed. For example, governments can work to increaseeducational, economic, and political opportunities for womenand promote equitable, violence-free relationships betweenmen and women.11

Implementing these policies and laws poses a difcultchallenge. Governments must allocate resources to enforcelaws and policies, and they also must hold ofcials accountablefor their actions. In southern Africa, for example, govern-ments have responded to the problem of violence againstwomen by revising their laws but have failed to allocatemoney for enforcement or educate police ofcers, prosecutors,and judges about the law. As a result, many ofcials continueto make decisions based on personal beliefs about gender-based violence.12

Health care system.Public health programs are respon-sible for supplementing available private health servicesto ensure that everyone has access to a complete rangeof affordable, acceptable, and good-quality reproductivehealth information, services, and commodities. Thisobligation requires action at the policy-making and uppermanagerial levels, for example, in building, equipping, and


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Implementing a Rights-Based Approach

By drawing on the principles of human rights to guide policy,program design, and service delivery, reproductive healthprograms can protect clients and increase effectiveness.

A rights-based perspective has the potential to challenge

conventional practice and produce new insights into howthe health care system can improve clients well-being.Policies and programs. Reproductive health managers

should assess the impact of current or proposed policies andprograms on clients reproductive rights.16 For example, anassessment of anti-trafcking laws and policies in Nepalfound they violated womens rights, in part because theyprohibited women from voluntarily migrating in search ofeconomic opportunities and in part because they forciblyrescued women who chose to work in the sex trade.24

The focus of a rights assessment should be on the servicedelivery process, including clients access to information andservices, the technical quality of care, and the interaction

between clients and providers. It is important to searchsystematically for potential problems. For example, inves-tigating who does not use the health care system and whyis a good way to discover how well a program is meeting itsobligation to provide universal access to care.1

Safe motherhood needs assessments in both Mali andMozambique are taking this kind of rights-based approach.27,2These assessments look at how well the nation is fullling itsinternational human rights treaty obligations, how the deniaof rights contributes to maternal mortality, and what actionsmust be taken to respect womens rights and reduce maternamortality. The Mali assessment, for example, concluded thegovernment needed to improve both access to and the qualityof emergency obstetric care and recommended changes infunding, supplies and equipment, referral systems, medicaltraining, health care standards, and monitoring as well asidentifying legal and policy measures the government shouldtake to address gender inequality.27

A human rights audit also can be conducted at the facility

level. For example, a team focused on maternal mortalitymight follow a pregnant or laboring womans progress througha facility and consider how each element in the servicedelivery processfrom a clinics physical layout and policiesto the providers actionssupports or violates her rights.1

Training and supporting providers. Health workersneed training to understand and embrace the concept ofreproductive rights. Providers may feel threatened by andresist a rights-based approach, however, since it fundamentally changes their relationship with clients and can beseen as a loss of power.1 This makes educational materialsprotocols, supervision, and other strategies that reinforcerights training essential.

Both preservice education and in-service training forproviders at all levels should introduce human rights conceptsand the international treaty system, explain how they applyto health care, and discuss how and why providers shouldensure that their practices reinforce human rights.25 Trainingcurricula on reproductive rights typically stress respect forclients, confidentiality, informed consent, autonomousdecision making, quality of care, and avoiding bias.8 Rightseducation is most effective when it advises providers whatto do in specic situations.22

Every element of the health care system should conveythe same, consistent pro-rights message as the trainingcurriculum. Health professional associations, academic institutions, and licensing bodies can reinforce rights education

by incorporating those principles in their ethical guidelinesand performance standards.25 The International Federation ofGynecology and Obstetrics (FIGO) has created a Study Groupon Womens Sexual and Reproductive Rights to propose thesekinds of standards for the health profession.22

Empowering clients and community members.Humanrights education directed to the community can instill a senseof entitlement to reproductive rights, empower health careclients to claim their rights when seeking services, and changesocial norms that support rights abuses such as FGM and

Advocating Legal Reform and Social Action

Reproductive rights depend as much on the law andthe social setting as on the health care system. Lawsgovern, for example, the age at which girls may marry,requirements for HIV testing, whether women needtheir husbands authorization to get family planningservices or emergency obstetric care, and the punish-ments for sexual assault or performing FGM.7 Culturaltraditions, religious beliefs, educational and economicopportunities, and social norms also are inuential.They determine how vulnerable women are to violenceas well as their ability to negotiate when and under what

circumstances sexual intercourse takes place. They alsoaffect access to reproductive health services.Health providers can help foster reproductive rights

by campaigning for legal reform and social change. Theirexpertise makes them credible and effective advocates,who can convincingly explain the impact of law, policy,and societal factors on reproductive health.21,22 Asmembers of health professional associations, providersalso can participate in the UN system for monitoringhuman rights treaties by preparing alternate reportson reproductive rights in their countries.25

Human rights education can prepare health profes-sionals to engage lawmakers and government ofcials

and to collaborate with human rights advocates,womens groups, and community organizations. InEl Salvador, Guatemala, and Nicaragua, for example,health professionals joined journalists, governmentofcials, lawyers, religious leaders, and representa-tives from womens groups in workshops on sexual andreproductive rights. The participants mixed viewpointsand disciplines helped them understand the issues,identify key concerns for their own countries, anddevelop effective advocacy strategies.26


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of health facilities providing obstetric care and the qualityof those services.13,15

Conclusion

Effectively addressing reproductive health problems calls foran integrated, rights-based approach that draws on the eldsof health, ethics, law, and human rights.3,33 By collaboratingwith experts in all these elds, reproductive health programscan address the social, cultural, economic, legal, and policyfactors that affect womens and mens reproductive healthas well as medical and public health concerns. By stressing

fundamental human values, a rights-based approach alsocan energize efforts of reproductive health programs to meetclients needs and offer good quality care. With the tenthanniversaries of the Cairo and Beijing conferences fastapproaching, it is time for reproductive health programs torevisit the conferences rights-based agendas and redoubletheir efforts to realize their health and human rights goals

1. Freedman, L.P. Using human rights in maternal mortality programs: Fromanalysis to strategy. International Journal of Gynecology & Obstetrics 755160 (2001).

domestic abuse. Reproductive health programs have testedmany different approaches:

The International Planned Parenthood Federation(IPPF) has designed and distributed posters onClients Rights and Young Peoples Rights to encourageclients to claim their rights to condentiality, privacy,information, and other elements of good care.

A cervical cancer prevention program in San Martin,Peru, incorporated client rights and empowermentinto an interactive educational session, with the goalof increasing womens self-esteem and hence theirability to overcome psychological and cultural barriersto screening.29

Community-based rights programs in India coverreproductive rights along with literacy training,economic development, and other activities toempower women in every aspect of their lives. Theyhave encouraged women to reject early marriagesand seek health care without waiting for mens

approval.9Reproductive rights education faces special obstacles.It is sometimes difcult to translate rights concepts intolanguage that is relevant to a local culture, and commu-nities used to thinking collectively may nd the focus on theindividual uncomfortable.30 Rights concepts also challengelong-established cultural and religious traditions, includingpatriarchal power structures and sexual taboos, and may askpeople to act in ways that they nd uncomfortable. Recognizingthese difculties, CARE decided not to use the language ofinternational treaties when it took a rights-based approach toending the long-standing and culturally embedded traditionof FGM in Ethiopia and Kenya. Instead, the projects asked

the community to dene rights and responsibilities and lettheir understanding guide program strategies to bring aboutnecessary social change.31

Monitoring reproductive rights. Process indicatorsdeserve as much attention as outcomes in monitoring a rights-based approach to reproductive health, for three reasons.First, many reproductive rights focus on how health care isdelivered. What matters, for example, is whether adolescentshave access to and are allowed to make an informed choiceof contraceptive methods, not which methods they chooseand how effectively they use them.27 Second, the interna-tional treaty system recognizes that fullling many rights,including the right to health, will take time. In the short run,the treaty monitoring bodies ask nations to take reasonable,

identiable steps toward their realization. Third, data onmany reproductive health outcomes in many countries issimply not available or not reliable.32

Consequently, a rights-based evaluation of a programto reduce maternal mortality should not focus on changesin maternal mortality rates and ratios alone. Programmanagers also should assess whether states are providingneeded maternal health services, including emergencyobstetric care, which can help prevent maternal deaths.Important indicators include the number and distribution

Reproductive rights brochure, courtesy of UNFPA India (2003).


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ADVISORY BOARD

Giuseppe Benagiano, M.D., Ph.D., Secretary General, International Federationof Gynecology & Obstetrics, Italy Gabriel Bialy, Ph.D., Special Assistant,Contraceptive Development, National Institute of Child Health & HumanDevelopment, U.S.A. Willard Cates, Jr., M.D., M.P.H., President, FamilyHealth International, U.S.A. Lawrence Corey, M.D., Professor, LaboratoryMedicine, Medicine, and Microbiology and Head, Virology Division, Universityof Washington, U.S.A. Horacio Croxatto, M.D., President, Chilean Instituteof Reproductive Medicine, Chile Judith A. Fortney, Ph.D., Senior Scien-tist, Family Health International, U.S.A. John Guillebaud, M.A., FRCSE,

MRCOG, Medical Director, Margaret Pyke Centre for Study and Training inFamily Planning, U.K. Atiqur Rahman Khan, M.D., Technical AssistanceInc. , Bangladesh Roberto Rivera, M.D., Corporate Director for InternationalMedical Affairs, Family Health International, U.S.A. Pramilla Senanayake,MBBS, DTPH, Ph.D., international consultant on sexual and reproductivehealth, Sri Lanka and U.K. Melvin R. Sikov, Ph.D., Senior Staff Scientist,Developmental Toxicology, Battelle Pacic Northwest Labs, U.S.A. IrvingSivin, M.S., Senior Scientist, Population Council, U.S.A. Richard Soderstrom,M.D., Clinical Professor OB/GYN, University of Washington, U.S.A. MartinP. Vessey, M.D., FRCP, FFCM, FRCGP, Professor, Department of Public Health& Primary Care, University of Oxford, U.K.

ISSN:0737-3732

Outlook is published by PATH. Selected issues are available inChinese, French, Indonesian, Portuguese, Russian, and Spanish.Outlook features news on reproductive health issues of interest todeveloping-country readers. Outlook is made possible in part by agrant from the United Nations Population Fund. Content or opinionsexpressed in Outlook are not necessarily those ofOutlooks funders,individual members of the Outlook Advisory Board, or PATH.

PATH is a nonprot, international organization dedicated toimproving health, especially the health of women and children.

Outlook is sent at no cost to readers in developing countries; subscrip-tions to interested individuals in developed countries are US$40 peryear. Please make checks payable to PATH.

Jack Kirshbaum, EditorPATH1455 NW Leary WaySeattle, Washington 98107-5136 U.S.A.Phone: 206-285-3500 Fax: 206-285-6619Email: [email protected]: www.path.org/resources/pub_outlook.htm

PROGRAM FOR APPROPRIATE TECHNOLOGY IN HEALTH (PATH), 2003. ALL RIGHTS RESERVED.

Printed on recycled paper

This issue was written by Adrienne Kols. It was edited andproduced by Jack Kirshbaum and Kristin Dahlquist.

In addition to selected members ofOutlooks Advisory Board,the following individuals reviewed this issue: Ms. A. Angarita,Dr. R. Cook, Dr. M. Fathalla, Dr. S. Gruskin, and Ms. K. Hall-

Martinez. Outlook appreciates their comments and suggestions.

2. Ralph, R.E. Challenges in promoting womens reproductive and sexualrights. In: Murphy, E. and Ringheim, K., eds. Reproductive Health, Genderand Human Rights: A Dialogue. Seattle, Washington: PATH (2001).

3. Cook, R. J., Dickens, B.M., and Fathalla, M.F.Reproductive Health and HumanRights: Integrating Medicine, Ethics and Law. Oxford: Clarendon Press (2003).

4. Carbert, A., Stranchieri, J., and Cook, R.J. A Handbook for Advocacy in theAfrican Human Rights System: Advancing Reproductive and Sexual Health. Nairobi, Kenya: Ipas African Regional Ofce (February 2002).

5. Human Security Network. Understanding Human Rights: Manual on HumanRights Education. Graz, Austria: European Training and Research Centre forHuman Rights and Democracy (ETC) and the Federal Ministry for ForeignAffairs of Austria (2003). www.etc-graz.at/human-security/manual/.

6. Jacobson, J.L. Transforming family planning programmes: Towards aframework for advancing the reproductive rights agenda. Reproductive

Health Matters 8(15): 2132 (2000).7. Center for Reproductive Law and Policy (CRLP).Reproductive Rights 2000:

Moving Forward. New York: CRLP (2000). www.reproductiverights.org/pub_bo_rr2k.html.

8. Asia Pacic Council of AIDS Service Organisations (APCASO). HIV/AIDSand Human Rights: A Training Manual for NGOs, Community Groups and

People Living with HIV/AIDS. Kuala Lumpur, Malaysia: APCASO (2002).9. Petchesky, R. P. Human rights, reproductive health and economic justice: why

they are indivisible.Reproductive Health Matters 8(15):1217 (2000).10. Mann, J. M. Medicine and public health, ethics and human rights. In: Mann, J.M.

et al., eds.Health and Human Rights: A Reader. New York: Routledge (1999).11. Liljestrand, J. and Gryboski, K.. Women Who Die Needlessly: Maternal

Mortality as a Human Rights Issue. In: Murphy, E. and Hendrix-Jenkins,

A., eds. Reproductive Health and RightsReaching the Hardly Reached.Seattle, Washington: PATH (2002).12. Fried, S. T. Violence against women.Health and Human Rights 6(2): 89111

(2003).13. Yamin, A.E. and Maine, D.P. Maternal mortality as a human rights issue:

measuring compliance with international treaty obligations.Human RightsQuarterly 21(3):563607 (1999).

14. International Planned Parenthood Federation (IPPF).IPPF Charter on Sexualand Reproductive Rights. Vision 2000. London: IPPF (1996).

15. Tostan.2002 Annual Report. This, Senegal: Tostan (2002). www.tostan.org/2002_AnnualReport.pdf.

16. Gostin, L. and Mann, J. Toward the development of a human rights impactassessment for the formulation and evaluation of public health policies.Healthand Human Rights 1(1):5880 (1994).

17. Gruskin, S. Violence prevention: Bringing health and human rights together.Health and Human Rights 6(2):110 (2003).

18. Ellsberg, M., Liljestrand, J., and Winkvist, A. The Nicaraguan Network ofWomen Against Violence: using research and action for change.Reproductive

Health Matters 5(10):8292 (1997).

19. Center for Reproductive Rights (CRR).Bringing Rights to Bear: An Analysis of

the Work of UN Treaty Monitoring Bodies on Reproductive and Sexual Rights.New York: CRR (2000). www.reproductiverights.org/pub_bo_tmb.html.

20. Bunch, C. Beijing, backlash, and the future of womens human rights.Healthand Human Rights 1(4):449453 (1995).

21. Cook, R. J. and Dickens, B.M. Considerations for formulating reproductivehealth laws. Geneva: World Health Organization (2000). www.who.intreproductive-health/publications/RHR_00_1/RHR_00_1_abstract.htm.

22. Cook, R.J. and Dickens, B.M. The FIGO study group on womens sexual andreproductive rights. International Journal of Gynecology & Obstetrics 675561 (1999).

23. Center for Reproductive Rights (CRR). Reproductive rights in the Inter-American System for the Promotion and Protection of Human Rights. BriengPaper 26. New York: CRR (October 2002).

24. Costello Daly, C. et al.Prevention of Trafcking and the Care and Support ofTrafcked Persons in the Context of an Emerging HIV/AIDS Epidemic in NepalJoint Report of Horizons and the Asia Foundation. New Delhi, India: PopulationCouncil (2001). www.popcouncil.org/pdfs/horizons/trafcking1.pdf.

25. Edouard, L. and Olatunbosun, O. Sexual and reproductive rights: statementsrhetoric, and responsibilities.British Journal of Family Planning 26(1):4447(2000).

26. McNaughton, H.L. et al. Forging alliances toward a vision of sexual andreproductive rights in Central America. Dialogue 6(2). Chapel Hill, NorthCarolina: Ipas (2002).

27. Center for Reproductive Rights (CRR) and Association des Juristes Malienne(AJM). Claiming Our Rights: Surviving Pregnancy and Childbirth in MaliNew York and Bamako, Mali: CRR and AJM (2003). www.reproductiveright.org/pub_bo_mali.html#report.

28. World Health Organization (WHO). Gender and reproductive rights [webpage]. (2003). www.who.int/reproductive-health/gender/index.html.

29. Personal communication with Jenny Winkler, PATH (November 2003).30. Harcourt, W. Building alliances for womens empowerment, reproductive rightand health.Development 46(2):612 (2003).

31. Igras, S. et al.Integrating Rights-Based Approaches Into Community-BasedHealth Projects: Experiences From the Prevention of Female Genital Cutting Project in East Africa. CARE (August 2002). www.careusa.org/caresworkwhatwedo/health/downloads/integrating_rights_based_approaches.pdf.

32. Rahman, A. and Pine, R.N. An international human right to reproductivehealth care: toward denition and accountability.Health and Human Rights1(4):400427 (1995).

33. See the miniseries Reproductive Health and Rights in the Lancet 363(January 3, 2004) for more articles on this subject.

We note with sorrow the death of Dr. LouisLasagna, longtime member of the Outlook Advisory Board, who gave support and goodcounsel to PATH from its earliest years.

Documents

Human Rights in the Modern Era