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

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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

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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.

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2. Context2.1. 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.

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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)

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• 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.)

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• 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

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• 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.

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• 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.

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• 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

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• 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.

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

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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

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• 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

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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)

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• 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).

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• 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).

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• 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)

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• 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)

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• 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.

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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)

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• 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)

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• 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)

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

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• 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.

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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.

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• 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)

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• 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.)

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• 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)

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• 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)
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• 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.)

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• ...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.)

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• 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)

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• 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)

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• 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.)

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• (...) 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.)

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• 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)

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• 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)

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5. Human Rights and HIV/AIDS5.1. 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.

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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.)

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• 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)

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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.)

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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.

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• 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.