Interpreting International Humanitarian Law to Guarantee Abortion and Other Sexual and Reproductive Health Services in Armed Conflict.

The provision of basic sexual and reproductive health services in humanitarian settings, including armed conflict, is extremely limited, causing preventable mortalities and morbidities and violating human rights. Over 50% of all maternal deaths occur in humanitarian and fragile settings. International humanitarian law falls short in guaranteeing access to the full range of sexual and reproductive health information and services for all persons. Guaranteeing access to sexual and reproductive health services under international humanitarian law can increase access to services, improving the health and well-being of civilians in conflict zones. This paper sets forth ways in which international human rights law on sexual and reproductive health and rights should be incorporated into the forthcoming International Committee of the Red Cross Commentary on Geneva Convention IV, regarding the protection of civilians, to ensure services in the context of armed conflict.

Operationalizing a Human Rights-Based Approach to Address Mistreatment against Women during Childbirth.

A growing body of evidence reveals that the mistreatment of pregnant women during facility-based childbirth is occurring across the globe. As human rights bodies have increasingly recognized, numerous human rights are implicated in the context of mistreatment of women in childbirth, including the rights to be free from torture and other ill-treatment, privacy, health, non-discrimination, and equality. This paper builds on a previous paper published in this journal by Rajat Khosla, Christina Zampas, and others, and the new body of evidence describing the types of mistreatment that occur during childbirth, to unpack the drivers of the mistreatment of women during childbirth and how they are understood and addressed within human rights. Tracing recent developments, it examines how the United Nations Special Rapporteur on violence against women and the Parliamentary Assembly of the Council of Europe have addressed this issue. Understanding the drivers and human rights dimensions of the mistreatment of women during childbirth can contribute to accelerating progress toward universal health coverage, including access to reproductive health services, as mistreatment is a key barrier to women's access to such services. The article concludes by offering guidance to states on a human rights-based approach to addressing mistreatment against women during facility-based childbirth.

The human rights impact of gender stereotyping in the context of reproductive health care.

Gender stereotypes surrounding women's reproductive health impede women's access to essential reproductive healthcare and contribute to inequality more generally. Stereotyping in healthcare settings impedes women's access to contraceptive information, services, and induced abortion, and lead to involuntary interventions in the context of sterilization. Decisions by human rights monitoring bodies, such as the Inter-American Court of Human Rights' case, IV v. Bolivia, which was a case concerned with the involuntary sterilization of a woman during childbirth, highlight how stereotypes in the context of providing health care can operate to strip women of their agency and decision-making authority, deny them their right to informed consent, reinforce gender hierarchies and violate their reproductive rights. In the present article, IV v. Bolivia is examined as a case study with the objective being to highlight how, in the context of coercive sterilization, human rights law has been used to advance legal and ethical guidelines, including the International Federation of Gynecology and Obstetrics' (FIGO) own guidelines, on gender stereotyping and reproductive healthcare. The Inter-American Court's judgment in IV v. Bolivia illustrates the important role FIGO's guidance can play in shaping human rights standards and provides guidance on the service provider's role and responsibility in eliminating gender stereotypes and upholding and fulfilling human rights.

International Human Rights and the Mistreatment of Women During Childbirth.

International human rights bodies have played a critical role in codifying, setting standards, and monitoring human rights violations in the context of sexual and reproductive health and rights. In recent years, these institutions have developed and applied human rights standards in the more particular context of maternal mortality and morbidity, and have increasingly recognized a critical human rights issue in the provision and experience of care during and after pregnancy, including during childbirth. However, the international human rights standards on mistreatment during facility-based childbirth remain, in an early stage of development, focused largely on a discrete subset of experiences, such as forced sterilization and lack of access to emergency obstetric care. As a consequence, the range of mistreatment that women may experience has not been adequately addressed or analyzed under international human rights law. Identifying human rights norms and standards related to the full range of documented mistreatment is thus a first step towards addressing violations of human rights during facility-based childbirth, ensuring respectful and humane treatment, and developing a program of work to improve the overall quality of maternal care. This article reviews international human rights standards related to the mistreatment of women during childbirth in facility settings under regional and international human rights law and lays out an agenda for further research and action.

Legal and ethical standards for protecting women's human rights and the practice of conscientious objection in reproductive healthcare settings.

The practice of conscientious objection by healthcare workers is growing across the globe. It is most common in reproductive healthcare settings because of the religious or moral values placed on beliefs as to when life begins. It is often invoked in the context of abortion and contraceptive services, including the provision of information related to such services. Few states adequately regulate the practice, leading to denial of access to lawful reproductive healthcare services and violations of fundamental human rights. International ethical, health, and human rights standards have recently attempted to address these challenges by harmonizing the practice of conscientious objection with women's right to sexual and reproductive health services. FIGO ethical standards have had an important role in influencing human rights development in this area. They consider regulation of the unfettered use of conscientious objection essential to the realization of sexual and reproductive rights. Under international human rights law, states have a positive obligation to act in this regard. While ethical and human rights standards regarding this issue are growing, they do not yet exhaustively cover all the situations in which women's health and human rights are in jeopardy because of the practice. The present article sets forth existing ethical and human rights standards on the issue and illustrates the need for further development and clarity on balancing these rights and interests.

Conscientious objection to sexual and reproductive health services: international human rights standards and European law and practice.

The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations to national governments as well as to international and regional bodies on how to regulate conscientious objection so as to both respect the practice of conscientious objection while protecting individual's right to reproductive health care.

Forced and coerced sterilization of women in Europe.

Human rights provisions in laws set by international treaties and national legislatures make individuals' informed and freely given consent a precondition to the legality of their sterilization. Nevertheless, evidence shows that sterilizations have been undertaken by forceful means or coerced acceptance, to which women do not genuinely consent. The women are often members of ethnic minorities in their countries, such as Roma women, or adolescent or disabled women. Some European governments have acknowledged their responsibility for human rights abuses by forced and coerced sterilization of vulnerable women, and committees established by international human rights treaties to monitor states' compliance with their standards are increasingly vigilant to expose and condemn wrongful sterilization. For instance, the committee monitoring compliance with the Convention on the Elimination of All Forms of Discrimination against Women and the Council of Europe's Commissioner for Human Rights provide guidance for the prevention of violations.

Human rights begin at birth: international law and the claim of fetal rights.

In the Universal Declaration of Human Rights, the foundation of human rights, the text and negotiating history of the "right to life" explicitly premises human rights on birth. Likewise, other international and regional human rights treaties, as drafted and/or subsequently interpreted, clearly reject claims that human rights should attach from conception or any time before birth. They also recognise that women's right to life and other human rights are at stake where restrictive abortion laws are in place. This paper reviews the International Covenant on Civil and Political Rights, the Convention on the Rights of the Child, and the Convention on the Elimination of All Forms of Discrimination Against Women, the European Convention for the Protection of Human Rights and Fundamental Freedoms, the Inter-American Human Rights Agreements and African Charter on Human and People's Rights in this regard. No one has the right to subordinate another in the way that unwanted pregnancy subordinates a woman by requiring her to risk her own health and life to save her own child. Thus, the long-standing insistence of women upon voluntary motherhood is a demand for minimal control over one's destiny as a human being. From a human rights perspective, to depart from voluntary motherhood would impose upon women an extreme form of discrimination and forced labour.