Monday, December 31, 2018

Health 15/20

 Chapter  6A-2

199. As was recognized in the American Declaration on the Rights of Indigenous Peoples, at Article XVIII, “Indigenous peoples have the collective and individual right to the enjoyment of the highest attainable standard of physical, mental, and spiritual health.” According to the Committee on Economic, Social and Cultural Rights, this right to health contains certain interrelated and essential elements: availability, accessibility, acceptability, and quality. 484 Indigenous communities in general are grappling with deteriorating health conditions, stemming from insufficient and limited availability and accessibility to health care services. Health care facilities tend to be located far away from communities, and too often, the services offered are culturally inappropriate. For instance, during its visit to Guatemala in 2013, the IACHR was able to observe for itself serious geographic obstacles to providing effective health care services to indigenous communities;485 and during its hearing on Indigenous Women in the Americas, it received information with regards to the precariousness of services for indigenous women in Oaxaca, Mexico, the nearest facilities located many hours away from their communities, as well as lacking emergency services and interpreters.486 In the case of Brazil, indigenous women leaders have informed the Commission that in the State of Maranhão, many pregnant women are not receiving medical services due to the lack of equipment and infrastructure487. In addition, facilities in remote areas tend to be insufficiently equipped to adequately treat some of the illnesses to which indigenous communities are exposed as a consequence of the presence of extractive or development industries on their territories. For example, the Commission was informed of the lack of specialized medical response teams and materials in Espinar, in the region of Cusco, Peru to treat the consequences on health of the exposure of many community members to contamination arising from the exploitation of their territories.488 

200. Even though health care coverage among indigenous peoples has undergone an overall expansion, there are still disparities between the indigenous and non-indigenous populations. According to the State of Peru, access to health for indigenous women remains limited.489 The former Special Rapporteur on the Rights of Indigenous Peoples, James Anaya, noted that indigenous peoples in Brazil endure poor health conditions, malnutrition, dengue fever, malaria, hepatitis, tuberculosis, and parasites; indigenous women present a disproportionately high incidence of cervical cancer, most likely as a result of the failure to practice early detection, and given their inadequate pre and postnatal care.490 The current UN Special Rapporteur on the Rights of Indigenous Peoples, Victoria Tauli-Corpuz, in her 2016 report on her mission to Brazil, stated that the prevalence of violence against indigenous women, the high levels of suicide in indigenous communities, as well as the illegal adoption of indigenous boys and girls in Brazil reflect the continuous lack of culturally appropriate services for indigenous women in the country491. As for the situation in Colombia, former UN Rapporteur James Anaya has reported that: “indigenous groups do not appear to have the same access to and enjoy the same quality care as the majority of Colombians.”492 He voiced special concern because indigenous women in Colombia face difficulties in accessing sexual and reproductive health services, especially when they are victims of forced displacement.493 

201. For its part, the requirement of acceptability for health services demands that health-related facilities, goods, and services be respectful of the culture of peoples and communities. 494 As such, it is vital for States to make interpreters available in order to enable full access to health services.495 It is also important to emphasize that indigenous women’s health is not only a women’s individual responsibility, but also a collective responsibility of the members of the community, given that their health and well-being has a bearing on the cultural, spiritual, and social life in the community.496 In order to meet this need, an intercultural approach has been promoted in the Americas, which entails the support and fostering of indigenous medicine systems; and the establishment of health care models that respect and implement systems of traditional knowledge-based health care.497 

202. Article 25 of ILO Convention N° 169 establishes the States’ obligation to make adequate health care services available to indigenous peoples, or provide them with the necessary means for them to organize and provide these services under their own responsibility and control. In addition, the American Declaration on the Rights of Indigenous Peoples has established, in Article XVIII, that indigenous peoples “have the right to their own health systems and practices, as well as to the use and protection of the plants, animals, minerals of vital interests, and other natural resources for medicinal use in their ancestral lands and territories.” In this regard, the Committee on the Elimination of Racial Discrimination has stressed the importance of States developing, in close consultation with indigenous communities, a comprehensive and culturally appropriate strategy for indigenous peoples to receive quality health care. 498 Given the special situation of vulnerability experienced by indigenous women and girls, it is essential to take into account their specific particularities in developing these strategies. According to ECLAC, the indigenous women’s movement of Latin America has raised the need to build mechanisms of participation and of inclusion of indigenous women and peoples to make sure that appropriate and quality health services are provided, employing an intercultural approach to overcome linguistic differences, and discriminatory treatment.499 

203. The IACHR has previously indicated that cultural factors stand as barriers to accessing health services for women. When indigenous women are involved, health services tend to be offered without taking into account their expectations, traditions, and beliefs which, coupled with the negative quality of the services indigenous women often receive, can discourage women from using these services.500 Access to health can be significantly impaired by cultural insensitivity or disrespectful treatment by medical staff, which can simply make women and their families decide not to seek the medical care they require.501 It should be noted as well that indigenous persons, and women in particular, often encounter discrimination when they access medical services at health care facilities. When they have preserved their own languages as their only means of communication, they also face a language barrier with health care system workers.502 For example, the IACHR received information indicating that Colombian indigenous women have claimed that a lack of interpreters is one reason why they do not seek health care in hospitals and health care facilities.503 

204. As for reproductive health, while some indigenous communities are reticent to deal with the topic because of the role played by women in their communities, many indigenous women wish to exercise their sexual and reproductive rights.504 The IACHR has noted previously that, along with other groups of women, indigenous women encounter the greatest obstacles in accessing information on sexual and reproductive health. These barriers have lead to massive human rights violations, for instance in cases where sterilization was practiced without consent, curtailing their rights to humane treatment, private and family life, and to a live free from of violence and discrimination.505 States have the obligation to ensure women’s right to access information on this topic, taking into consideration the potential specific needs of indigenous women.

205. One of the main health problems afflicting indigenous women is maternal mortality and morbidity, which continues to affect them to a greater extent than it affects non-indigenous women.507 According to the Pan American Health Organization, the maternal mortality rate in Guatemala is still high, with 139.7 deaths for every 100,000 live births, which are mostly reported among indigenous women. 508 ECLAC reports that the risk of death of indigenous women in giving birth in Mexico is nine times higher in predominantly indigenous municipalities with a high marginalization and geographic-social isolation index as compared to those with most access to services.509 ECLAC reports similar rates for other Latin American States.510 

206. The IACHR finds that States have certain fundamental obligations requiring immediate priority measures to be taken in the area of maternal health, and one of them is to prioritize efforts and resources to ensure access to maternal health services for women who tend to be at a higher risk, such as indigenous women.511 The Inter-American Court ruled in the case of the Sawhoyamaxa Indigenous Community v. Paraguay that States have the obligation to adopt special measures to ensure mothers’ right to accessing adequate medical care, especially during pregnancy, labor, and nursing.512 

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