Saturday, July 9, 2016

Elements of the right to sexual and reproductive health 4/16

11. The right to sexual and reproductive health is an integral part of the right of everyone to the highest attainable physical and mental health. Following the elaboration in the Committee’s general comment No. 14, comprehensive sexual and reproductive health care contains the four interrelated and essential elements described below. 13


12. An adequate number of functioning health-care facilities, services, goods and programmes should be available to provide the population with the fullest possible range of sexual and reproductive health care. This includes ensuring the availability of facilities, goods and services for the guarantee of the underlying determinants of the realization of the right to sexual and reproductive health, such as safe and potable drinking water and adequate sanitation facilities, hospitals and clinics.

13. Ensuring the availability of trained medical and professional personnel and skilled providers who are trained to perform the full range of sexual and reproductive health-care services is a critical component of ensuring availability.

14 Essential medicines should also be available, including a wide range of contraceptive methods, such as condoms and emergency contraception, medicines for abortion and for post-abortion care, and medicines, including generic medicines, for the prevention and treatment of sexually transmitted infections and HIV.15 14. Unavailability of goods and services due to ideologically based policies or practices, such as the refusal to provide services based on conscience, must not be a barrier to accessing services. An adequate number of health-care providers willing and able to provide such services should be available at all times in both public and private facilities and within reasonable geographical reach.16


15. Health facilities, goods, information and services related to sexual and reproductive health care17 should be accessible to all individuals and groups without discrimination and free from barriers. As elaborated in the Committee’s general comment No. 14, accessibility includes physical accessibility, affordability and information accessibility.

Physical accessibility

16. Health facilities, goods, information and services related to sexual and reproductive health care must be available within safe physical and geographical reach for all, so that persons in need can receive timely services and information. Physical accessibility should be ensured for all, especially persons belonging to disadvantaged and marginalized groups, including, but not limited to, persons living in rural and remote areas, persons with disabilities, refugees and internally displaced persons, stateless persons and persons in detention. When dispensing sexual and reproductive services to remote areas is impracticable, substantive equality calls for positive measures to ensure that persons in need have communication and transportation to such services.

17. Publicly or privately provided sexual and reproductive health services must be affordable for all. Essential goods and services, including those related to the underlying determinants of sexual and reproductive health, must be provided at no cost or based on the principle of equality to ensure that individuals and families are not disproportionately burdened with health expenses. People without sufficient means should be provided with the support necessary to cover the costs of health insurance and access to health facilities providing sexual and reproductive health information, goods and services.18

Information accessibility
18. Information accessibility includes the right to seek, receive and disseminate information and ideas concerning sexual and reproductive health issues generally, and also for individuals to receive specific information on their particular health status. All individuals and groups, including adolescents and youth, have the right to evidence-based information on all aspects of sexual and reproductive health, including maternal health, contraceptives, family planning, sexually transmitted infections, HIV prevention, safe abortion and post-abortion care, infertility and fertility options, and reproductive cancer.

19. Such information must be provided in a manner consistent with the needs of the individual and the community, taking into consideration, for example, age, gender, language ability, educational level, disability, sexual orientation, gender identity and intersex status. 19 Information accessibility should not impair the right to have personal health data and information treated with privacy and confidentiality.

20. All facilities, goods, information and services related to sexual and reproductive health must be respectful of the culture of individuals, minorities, peoples and communities and sensitive to gender, age, disability, sexual diversity and life-cycle requirements. However, this cannot be used to justify the refusal to provide tailored facilities, goods, information and services to specific groups.

21. Facilities, goods, information and services related to sexual and reproductive health must be of good quality, meaning that they are evidence-based and scientifically and medically appropriate and up-to-date. This requires trained and skilled health-care personnel and scientifically approved and unexpired drugs and equipment. The failure or refusal to incorporate technological advances and innovations in the provision of sexual and reproductive health services, such as medication for abortion, 20 assisted reproductive technologies and advances in the treatment of HIV and AIDS, jeopardizes the quality of care.

13 In paragraph 12 of general comment No. 14, the Committee defined normative elements of state obligations to guarantee the right to health. These standards also apply to the underlying determinants, or the preconditions of health, including access to sexuality education and sexual and reproductive health information. See also Committee on the Rights of the Child general comment No. 15, which applied those norms to adolescents. States parties should provide health services that are sensitive to the particular needs and human rights of all adolescents. 
14 See Committee on Economic, Social and Cultural Rights general comment No. 14, para. 12 (a); and A/HRC/21/22 and Corr.1 and 2, para. 20. 
15 Essential medicines are defined by WHO as “those that satisfy the priority health care needs of the population” and that “are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and community can afford”. See Committee on Economic, Social and Cultural Rights general comment No. 14; and WHO, Model List of Essential Medicines, 19th ed. (2015).
16 International Planned Parenthood Federation – European Network v. Italy, complaint No. 87/2012 (2014), resolution adopted by the Committee of Ministers of the Council of Europe on 30 April 2014. 
17 Reference in the present document to health facilities, goods and services includes the underlying determinants. 
18 See, generally, Committee on Economic, Social and Cultural Rights general comment No. 14, para. 19.
19 Council of Europe Commissioner for Human Rights, “Human rights and intersex people”, issue paper (2015). 20 WHO, Safe Abortion: Technical and Policy Guidance for Health Systems, 2nd ed. (2012).

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