54. Violations of the right to sexual and reproductive health can occur through the direct
action of States or other entities that are insufficiently regulated by States. Violations
through acts of commission include the adoption of legislation, regulations, policies or
programmes that create barriers to the realization of the right to sexual and reproductive
health in the State party or in third countries, or the formal repeal or suspension of
legislation, regulations, policies or programmes that are necessary for the continued
enjoyment of the right to sexual and reproductive health.
55. Violations through acts of omission include the failure to take appropriate steps
towards the full realization of everyone's right to sexual and reproductive health and the
failure to enact and enforce relevant laws. Failure to ensure formal and substantive equality
in the enjoyment of the right to sexual and reproductive health constitutes a violation of this
right. The elimination of de jure as well as de facto discrimination is required for the equal
enjoyment of the right to sexual and reproductive health.42
56. Violations of the obligation to respect occur when the State, through laws, policies
or actions, undermines the right to sexual and reproductive health. Such violations include
State interference with an individual’s freedom to control his or her own body and ability to
make free, informed and responsible decisions in this regard. They also occur when the
State removes or suspends laws and policies that are necessary for the enjoyment of the
right to sexual and reproductive health.
57. Examples of violations of the obligation to respect include the establishment of legal
barriers impeding access by individuals to sexual and reproductive health services, such as
the criminalization of women undergoing abortions and the criminalization of consensual
sexual activity between adults. Banning or denying access in practice to sexual and
reproductive health services and medicines, such as emergency contraception, also violates
the obligation to respect. Laws and policies that prescribe involuntary, coercive or forced
medical interventions, including forced sterilization or mandatory HIV/AIDS, virginity or
pregnancy testing, also violate the obligation to respect.
58. Laws and policies that indirectly perpetuate coercive medical practices, including
incentive- or quota-based contraceptive policies and hormonal therapy, as well as surgery
or sterilization requirements for legal recognition of one’s gender identity, constitute
additional violations of the obligation to respect. Further violations include state practices
and policies that censor or withhold information, or present inaccurate, misrepresentative or
discriminatory information, related to sexual and reproductive health.
59. Violations of the obligation to protect occur when a State fails to take effective steps
to prevent third parties from undermining the enjoyment of the right to sexual and
reproductive health. This includes the failure to prohibit and take measures to prevent all
forms of violence and coercion committed by private individuals and entities, including domestic violence, rape (including marital rape), sexual assault, abuse and harassment,
including during conflict, post-conflict and transition situations; violence targeting lesbian,
gay, bisexual, transgender and intersex persons or women seeking abortion or post-abortion
care; harmful practices such as female genital mutilation, child and forced marriage, forced
sterilization, forced abortion and forced pregnancy; and medically unnecessary, irreversible
and involuntary surgery and treatment performed on intersex infants or children.
60. States must effectively monitor and regulate specific sectors, such as private
health-care providers, health insurance companies, educational and child-care institutions,
institutional care facilities, refugee camps, prisons and other detention centres, to ensure
that they do not undermine or violate enjoyment by individuals of the right to sexual and
reproductive health. States have an obligation to ensure that private health insurance
companies do not refuse to cover sexual and reproductive health services. Furthermore,
States also have an extraterritorial obligation43 to ensure that transnational corporations,
such as pharmaceutical companies operating globally, do not violate the right to sexual and
reproductive health of people in other countries, for example through non-consensual
testing of contraceptives or medical experiments.
61. Violations of the obligation to fulfil occur when States do not take all necessary
steps to facilitate, promote and provide for the right to sexual and reproductive health
within maximum available resources. Such violations arise when States fail to adopt and
implement a holistic and inclusive national health policy that adequately and
comprehensively includes sexual and reproductive health or when a policy fails to
appropriately address the needs of disadvantaged and marginalized groups.
62. Violations of the obligation to fulfil also occur when States fail to progressively
ensure that sexual and reproductive health facilities, goods and services are available,
accessible, acceptable and of good quality. Examples of such violations include the failure
to guarantee access to the full range of contraceptive options so that all individuals are able
to utilize an appropriate method that suits their particular situation and needs.
63. In addition, violations of the obligation to fulfil occur when States fail to take
affirmative measures to eradicate legal, procedural, practical and social barriers to the
enjoyment of the right to sexual and reproductive health and to ensure that health-care
providers treat all individuals seeking sexual and reproductive health care in a respectful
and non-discriminatory manner. Violation of the obligation to fulfil also occur when States
fail to take measures to ensure that up-to-date, accurate information on sexual and
reproductive health is publicly available and accessible to all individuals, in appropriate
languages and formats, and to ensure that all educational institutions incorporate unbiased,
scientifically accurate, evidence-based, age-appropriate and comprehensive sexuality
education into their required curricula.
42 See Committee on Economic, Social and Cultural Rights general comment No. 16, para. 41.
43 Maastricht Principles on Extraterritorial Obligations of States in the Area of Economic, Social
and Cultural Rights.
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