In this report, the Special Rapporteur considers criminal laws and other legal restrictions relating to sexual and reproductive health and the right to health. These include criminal and other legal restrictions on: abortion; conduct during pregnancy; contraception and family planning; and the provision of sexual and reproductive education and information. These restrictions violate the right to health by restricting peoples’ access to quality goods, services and information, as well as violating their right to make their own decisions about their bodies. Moreover, the application of such laws as a means to achieving certain public health outcomes is often ineffective and disproportionate, according to the report. In cases where a barrier is created by a criminal law or other legal restriction, it is the obligation of the State to remove it. In response to countries that are calling for the progressive realisation of the right to health, the Rapporteur argues that the removal of such laws and legal restrictions is not subject to resource constraints; therefore he calls for the immediate scrapping of laws and policies undermining sexual and reproductive health to ensure everyone can enjoy full realisation of their right to health.
Values, Policies and Rights
Recognising the intrinsic role of health in achieving international development goals, the United Nations (UN) General Assembly has adopted a resolution on global health and foreign policy which encourages Member States to plan or pursue the transition towards universal access to affordable and quality health-care services. It urges Member States, civil society and international organisations to incorporate universal health coverage in the international development agenda and in the implementation of the internationally agreed development goals, including the Millennium Development Goals. The Assembly also recognised the importance of universal coverage as part of a transition to a more sustainable, inclusive and equitable economy. The resolution encourages Member States to continue investing in health-delivery systems to increase and safeguard the range and quality of services and meet the health needs of their populations. It calls on Member States to recognise the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalisation, inclusive and equitable growth and sustainable development.
In a landmark case, South Africa’s Constitutional Court ruled on 10 December 2012 in favour of a claimant who contracted tuberculosis (TB) during a stint in Pollsmoor Prison, Cape Town. The Constitutional Court decided that prison authorities had failed to implement adequate TB prevention measures among inmates, arguing that there was a causal link between this and the spread of TB. Section 27, a health rights group, has meanwhile warned prison authorities against neglecting TB prevention in prisons. Crowded cells in the prison leading to the spread of TB are argued to be a violation of prisoners’ right to health.
The authors of this paper draw on the experiences of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organisations in the Western Cape, South Africa. The LN’s work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates important lessons for human rights practice, they argue. These include: actively translating knowledge and awareness into action to make rights real; civil society’s role in holding services accountable in terms of the right to health; the need for civil society to promote rights in general; and the critical importance of networking and solidarity for building civil society capacity to act for health rights. Civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realising services and policies that enable the most vulnerable members of society to advance their health. Rights violations can be redressed through access to information and the creation of safe, participatory spaces. Civil society agency is critical to such action.
How can an integrated and inclusive approach of human rights and sustainable development be applied to financial regulation? CIVICUS argues that it will have to begin by giving the financial sector a role that is subservient to the ‘real’ economy, a real economy that in turn should support ecological sustainability and human rights and not a ‘paper’ economy based on futures trading. It points out that the recent financial crisis shows that market self-regulation does not work, calling for government intervention and regulation. CIVICUS makes three major proposals. First, given that markets in natural resources offer a field to expand paper profits while worsening equity in access to resources and conservation, CIVICUS call for new economic benchmarks and note that the Gross Domestic Product-based (GDP) is not an accurate benchmark of progress. Second, financing should be provided for sustainable modes of production, often small scale endeavours. Third, financial regulation should incentivise investment in production activities vs the paper economy.
This regional assessment showed that the foundations for integration and harmonisation of child and adolescent HIV, TB, malaria policies and programming frameworks are already in place in the SADC region. However, in all countries’ national strategic frameworks/plans and guidelines, there is a need to reinforce child specific issues in prevention, diagnostics, and treatment and care. Major gaps remain in strategic frameworks/plans in articulating the integration of HIV-malaria and TB-malaria programmes, and on linking TB and malaria programmes to basic child services. In addition, policies and programming frameworks on HIV are not harmonised across the region, and monitoring and evaluation of all child- and adolescent-focused health programmes is urgently required. Despite these shortcomings, SADC argues that member states can build on the strong foundations and seize invaluable opportunities to scale up a harmonised continuum of care for the three diseases and integrate them with basic child services. This could have a real impact on child health, survival and development in the region and help SADC member states to achieve Millennium Development Goals 4 (reduce child mortality) and 6 (combat HIV, malaria and other diseases), as well as other regional and international commitments.
Health Systems Trust has summarised South Africa’s National Strategic Plan (NSP) for easy reading. The NSP is a strategic guide for South Africa’s national response to HIV, STIs and TB from 2012 to 2016. It is coordinated by the South African National AIDS Council (SANAC). It aims to inform national, provincial, district and community-level stakeholders with strategic directions when developing implementation plans. The Plan contains baseline data on the various diseases and identifies key populations for HIV and TB response. Its goals are to reduce the number of HIV infections by 50%; ensure at least 80% of patients eligible for antiretroviral treatment are receiving it, with 70% alive and being treated after five years; reduce the number of new infections of TB and deaths by 50%; ensure the rights of individuals living with HIV, TB and STIs are protected; and reduce self-reported stigma associated with HIV and TB by 50%. The Plan also outlines how the goals will be reached, who will oversee implementation of goals and how progress of the NSP will be assessed. Implementing the NSP is estimated to cost R130.7 billion over five years.
Incomes have slipped to their lowest level in a decade since Madagascar’s 2009 coup d’etat, and, in parallel, domestic violence has sharply risen, according to IRIN News. The World Bank’s October 2012 economic update estimates that, since 2008, another four million people have fallen below the poverty level. The rising poverty has exacerbated women’s vulnerability in this deeply traditional society. Locals report more domestic conflict over family resources, as well as increased alcohol and drug abuse. Impoverished women also have fewer options to escape violence and are less able to advocate for the safety of themselves and their children. A spokesperson for a legal aid clinic near Antananarivo said that women often feel they have neither the ability nor the right to end abuse. A community spokesperson also reported that most domestic fights were about money and abusive men were often drunk when assaulting their partners.
More than one in three men surveyed in the Democratic Republic of the Congo's war-torn east admits committing sexual assault, and three in four believe that a woman who "does not dress decently is asking to be raped", according to this study. Some 61.4% of men interviewed said women sometimes deserve to be beaten; 42.7% think that if a woman doesn't show physical resistance when forced to have sex, it's not rape; and 27.9% believe that sometimes women want to be raped. Well over 40% of the men polled asserted that a man should reject his wife when she has been raped. The study was carried out in Congo's North Kivu province. A total of 708 men and 754 women aged between 18 and 59 took part in individual interviews and focus group discussions. The self-reporting of men revealed that 34% admit having carried out some form of sexual violence in conflict, homes or other settings. The study, part of the International Men and Gender Equality Survey, also suggests that many men are themselves victims of violence, including sexual violence, and shows a clear association between exposure to violence and increased likelihood of subsequent perpetration. The authors make recommendations including far greater promotion of gender equality in schools and public policy and a massive campaign of psycho-social care for boys and girls exposed to multiple forms of violence at a young age.
Maternal mortality and morbidity (MMM) and HIV represent interlinked challenges arising from common causes, magnifying their respective impacts and producing related consequences. Accordingly, an integrated response will lead to the most effective approach for both, argue the authors of this paper. HIV and MMM are connected in both outcomes and solutions in sub-Saharan Africa, where HIV is the leading cause of maternal death and prevention of unintended pregnancy and access to contraception have been identified as two of the most important HIV-related prevention efforts. In turn, both are central to reducing unsafe abortion, a major cause of maternal death in Africa. The authors propose that a human rights-based framework will help to identify the shared determinants of MMM and HIV. It should also help to establish the health-related human rights standards to which all women are entitled, as well to outline the indivisible and intersecting human rights principles that inform and guide efforts related to HIV and MMM. The authors point to the Millennium Development Goals (MDGs) as a good example of an agreement with quantifiable goals for achieving human rights while emphasising that no single goal can be achieved without progress on all development goals.