Special Report

Survivors Art Foundation

Special Report

International Health Awareness Network Symposium
United Nations, March 16, 1999

Sorosh Roshan, M.D., M.P.H
Clarita Herrera, M.D.
Satty Gill Keswani, M.D.
Joyce E. Braak, M.D.
Mahnaz Sarachi, Ph.D.
Mary Ruth Buchness, M.D.
Padmini Murthy, M.D.
Rosalinda Rubinsteain, M.D.

March 16, 1999, United Nations

Morning Session: 9:00 a.m. – 1:00 p.m. United Nations Conference Room #4
Keynote Speaker: Jo Ivey Boufford, M.D.
Dean, Robert F. Wagner Graduate School of Public Service, NYU; U.S. Rep. on the Executive Board of World Health Organization
“Health Machinery for the 21st Century: Mainstreaming Health in all Government Policies”

Afternoon Session: 2:30 p.m. – 5:30 p.m. United Nations Conference Room #4
Keynote Speaker: Ms. Mary Robinson
United Nations High Commissioner for Human Rights
“Women’s Rights to Health”

Reception: 6:00 p.m. – 8:00 p.m. Delegates Dining Room
Keynote Speaker: Mr. Olara Otunnu
Special Representative of the United Nations Secretary-General
“The Impact of Armed Conflict on Children”

Sponsored By:
The International Health Awareness Network (IHAN)
American Medical Women’s Association (AMWA)
The Permanent Mission of Bangladesh to the United Nations
The Permanent Mission of the Philippines to the United Nations
The Permanent Mission of Ireland to the United Nations
Institute for Research on Women’s Health
Survivors Art Foundation
Women’s Federation for World Peace
Medical Women International Association

For more information about the International Health Awareness Network, please see http://www.ihan.org.

International Health Awareness Network (IHAN)
United Nations Conference, December 8, 1998

“Women’s Rights to Health and Development”, in honor of the 50th Anniversary of the Universal Declaration of Human Rights

Featuring a speech from the Office of the High Commissioner for Human Rights on Women’s Human Rights to Health, located below the program.

The program opened with a Welcome by Sorosh Roshan, M.D., President (IHAN) The International Health Awareness Network, and the Survivors Art Foundation International Liaison to the Advisory Board.

Opening remarks: by H.E.Ambassador Anwarful Cowdhury, Permanent Representative of Bangladesh to the United Nations

Keynote Speakers:

1. “Women’s Rights to Development” by Ms. Rebaca Rios-Kohn, Principal Advisor for the Bureau for Development, UNDP

2. “United Nations Commission on the Status of Women’s Achievements on Women’s Health and Development” given by Joyce E. Braaks, MD, President of the Institute in Women’s Health Research

3. “Women’s Rights to Health” given by Maarig Kohonen, Human Rights Officer, from the Office of the UN High Commissioner for Human Rights, NY Office

Women’s Human Rights to Health
by Maarig Kohonen

“Women’s rights are human rights” is a slogan which seems so self-evident and logical to many of us – yet it took the United Nations system a very long time, nearly 50 years, to come to terms with this simple concept and to translate these words into action. It is within this framework that I would like to share with you the following thoughts.

When health is considered from a human rights perspective, and not as a mere social good or medical concern, rights and responsibilities take on a whole new meaning and need to be defined accordingly; as the Beijing Declaration and Program of Action clearly stated, a comprehensive life-cycle approach to women’s health must be advocated in order to address the many root cause at different levels face women and children. this linkage between women’s human rights and health has been pioneered through collaborative efforts of women’s health and women’s rights advocates, as in the UDHR, all people have the right to the highest attainable standard of physical and mental health (Art. 25) most fundamental human right of women is the right to life which is intrinsically linked to the well-being and health of women and girls – every minute, a woman dies somewhere in the developing world as a result of pregnancy and child birth, whereas in countries all over the world women die as a result of gender-based violence committed against them.

States and societies have an obligation to protect the human rights of women in order to guarantee their right to life, their physical and mental integrity and their safety and security of person by virtue of being human; it should be noted that we are presently undergoing a significant conceptual and ideological shift from the well-established non-discrimination and equal rights of women with men, as well as rights of women as actors in the development process, to the realization that women have the right to their human rights not because they should be equal to men but because they are humans in their own right – the fulfillment of their rights is needed, in the first place, in order to respect women’s human dignity.

The human rights of women to health are already codified in international human rights instruments which are legally binding upon all States who have ratified these treaties: Art. 12 of CEDAW states: Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning. States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.

The Committee monitoring CEDAW is also currently working on a general recommendation to Art. Many other provisions of CEDAW have implicit or indirect bearing on women’s human rights relating to health: Art. 1 ( non-discrimination), Art. 5 (eliminating prejudices and customary traditions), Art. 6 (suppress trafficking and prostitution), Art. 10 (participate in sports and physical education and equal access to educational information, including information and advise on family planning), Art. 11 (right to social security, right to protection of health and safety in working conditions), Art. 14 (rural women’s rights, including equal access to adequate health care facilities, information, counseling and services in family planning), Art. 16 (elimination of discrimination in marriage – early marriages) other CEDAW general comments are also relevant (HIV/AIDS and violence against women) in addition to CEDAW which specifically addresses the situation of women and girls, all other international human rights instruments can and should be used to provide legal protection for the human rights of women to health (ICCPR, ICESCR both provide non-discrimination clauses on the basis of which provisions relating to health, safety at work and social security issues can be directly related to health).

Convention on the Rights of the Child, for example, also extends the prohibition of sex-based discrimination to all the rights it contains. In addition, a number of articles of the CRC specifically address the girl-child. While such specific references to women and their rights are lacking in the Convention on the Elimination of Racial Discrimination and the Convention against Torture, the provisions of both these instruments are clearly relevant to the situation of many women (i.e., custodial violence against women, including rape, as a form of torture, inhuman and degrading treatment in accordance with the Convention) and are, of course, applicable equally to both women and men.

Clearly, women’s health is not only about physical and mental well-being but it is a complex state which is determined by the political, economic and social context in which they live; major barriers to women’s achievement of the highest standard of physical, mental and emotional heath are gender-based discrimination and violence against women.

Discrimination in the areas of: access to health care and information, traditional practices affecting the health of women and children, lack of statistics on health status of women and girls, etc. it has been repeatedly recognized by the international community at the 1993 World Conference on Human Rights in Vienna and at the 1995 Beijing World Conference on Women, it is violence against women and the girl-child which constitutes one of the most persistent obstacles to the full enjoyment of their human rights.

As the Special Rapporteur on violence against women, Ms. Radhika Coomaraswamy, has described it, violence against women is deeply rooted in the historically unequal power relations between women and men, which is expressed in its most violence forms as physical, sexual and psychological violence against women.

As a result of this slow merging process, the human rights movement has developed significantly in a number of ways, upon which the Special Rapporteur has built in her work: erosion of the private and public spheres traditionally separating criminal matter from human rights issues (ie. consideration of domestic violence and rape as human rights violations, including as forms of torture) recognition of State responsibility for violations committed by non-State actors (based on the premises that States can be held responsible if they are not ensuring that non-State actors are brought to justice for violations committed), establishment of a due diligence standard for States to prevent, investigate and, in accordance with national law, punish acts of violence against women.

The Special Rapporteur on violence against women has addressed in her reports the issues of health and violence against women. In this context, it is important to emphasize that health and violence against are very closely related to women’s health and women’s right to access to health services, their right to their bodily integrity (including to be free from female genital mutilation and other traditional practices harmful to their health), their reproductive rights and their right to freely determine the number and spacing of their children are all human rights concepts which have existed for a long time but have only recently featured on the international agenda as firm commitments. Of course, as you might have heard, the debate around reproductive and sexual rights of women has generated much controversy, at the World Conference in Beijing and in Cairo particularly – but these are issues which must be pursued with vigour and by the international women’s movement and the human rights community together.

Another mechanism of the United Nations human rights machinery, namely the Special Rapporteur on traditional practices affecting the health of women and children of the Sub-Commission on Prevention of Discrimination and Protection of Minorities, has been addressing a particularly relevant topic in the area of human rights of women, health and violence against women. One concrete example of the close relationship between health and human rights as strategies to achieve common goals, is the case of female genital mutilation. This is a politically very sensitive matters since it touches the very core of the culture and tradition of some communities (mainly on the African continent but also increasingly amongst immigrant communities in Western countries).

From our experience, and although the international community has recognized without a doubt that States should not invoke any custom, tradition or religious consideration to avoid their obligations with respect to the elimination of violence against women , it has worked more effectively and proven less controversial to evoke the serious health consequences suffered by young girls (many as young as 5 years old) when they are forced to undergo the gruesome ordeal of female genital mutilation (an operation often carried out by traditional birth attendants without anaesthesia or surgical instruments, often only with a piece of glass or their fingernails) – than to evoke the issues of violations of their human rights. Naturally, from a human rights perspective it is important to ensure that the necessary national legislation is in place to prohibit such harmful traditional practices but this is only effective when coupled with systematic awareness-raising campaigns (focusing both on health matters and on human rights issues). Dialogues must be conducted with policy-makers, health professionals as well as with the communities at large, including the women and men – in particular, in dialogue with religious leaders and village elders/chiefs, the most effective entry point for constructive efforts has been the health angle, only later followed by the human rights considerations.

I would also like to add that, in connection with an increasing trend to medicalize the practise of female genital mutilation, ie. to carry out the operation in clinical conditions to reduce the health risks, the World Health Organization continues to advise unequivocally that female genital mutilation must not be institutionalized, nor should any form of female genital mutilation be performed by any health professionals in any setting, including hospitals or other health establishments. The prevalence of son preference (which has been defined as the preference of parents for male children which often manifests itself in neglect, deprivation or discriminatory treatment of girls to the detriment of their mental and physical health), more marked in Asian societies and historically rooted in the patriarchal system, early marriages and dowry-related violence all constitute violations of women’s human rights in their most violent form, namely violence against women.

Innovative and forward-looking recommendations which the Special Rapporteur on violence against women has made in her reports, I have selected some which I thought to be of most interest to you, in order to provide some food for thought and a basis for an interesting discussion. The Special Rapporteur advocates the adoption of special comprehensive domestic violence legislation (combining criminal and civil proceedings), which includes, inter alia, a provision that the State must provide emergency services for women victims of violence which include:
– 72 hour crisis intervention centres
– constant access and intake to services
– immediate transportation from the victim’s home to a medical centre, shelter or a safe haven
– immediate medical attention
– emergency legal counselling and referrals
– crisis counselling to provide support and assurances of safety
– confidential handling of all contacts with victims of domestic violence and their families.

The Special Rapporteur on violence against women attaches particular importance to the provision of comprehensive and easily-accessible services for women victims of violence. All to frequently a woman victim of sexual abuse or rape has to travel far to reach a police station, after which she has to undergo a forensic examination (at a medical-legal clinic often situated very far from the police station), then return to the police station with the examination results, from where she is referred to social services, a shelter (if available) or women’s support groups and NGOs who provide legal assistance, if needed. Due to the increased efforts involved on part of women to report the violence they have undergone and the often complicated bureaucratic procedures, exacerbated by insensitive public officials, many women survivors give up somewhere on the way (from Alexandra Township, Johannesburg, South Africa, where a 15-year old girl who had been raped in her own house, was gang-raped again by different perpetrators on her way from the police station to the medical-legal clinic). This is why the Special Rapporteur strongly advocates, in all her reports, the establishment of one-stop centres which would provide the whole range of police, medical, social, psychological and legal services in one place. Such one-stop centres were originally established in Malaysia but the positive experience and increased reporting incidents gained from these centres has lead to this experience being repeated in many countries already.

The Special Rapporteur also recommends that hospital staff be appropriately trained to recognize and report cases of violence against women and that police officers be permanently attached to hospitals and medical centres where high incidents of violence against women are detected. This would encourage women to officially file complaints since they do not have to make an additional trip to the police station. The Special Rapporteur has also advocated that State incorporate mandatory gender-sensitization training in medical and legal education. Such training such be carried out for medical personnel working with victims of rape and other forms of sexual violence against women, particularly State forensic pathologists. Similar recommendation for training and awareness-raising on gender and violence against women are also targeted at law enforcement officials and the judiciary, in order to ensure that criminal justice systems across the board are receptive to women’s concerns.

The Special Rapporteur has also identified the need for special services to be made available for women victims of trafficking and forced prostitution, which should include training for alternative income generating activities and rehabilitation and reintegration programmes to support women who have managed to escape from their captors. The Special Rapporteur also encourages the development of State programmes with regard to health education, including awareness-raising on HIV/AIDS, as well as health facilities which are equipped to be responsive to the general needs of women victims with regard to STDs and HIV/AIDS infection in particular.

In connection with reproductive health and violence against women, the Special Rapporteur recommends that legislation regulating pre-natal sex-determination be adopted in order to eliminate discriminatory abortions of female foetuses (as is the case in many countries where son preference still persists). All customs and practices that promote son preference, devalue female children and encourage sex-selective abortions and female infanticide should be eliminated. Special Rapporteur on sale of children, child prostitution and child pornography Commission on Human Rights, in her reports and during her field missions, has also addressed the importance of health related issues and violence against girl-children. One of her most forceful recommendations concerns the vital importance of awareness-raising on HIV/AIDS, as well as on sex education in schools from an early age – she is basing herself on her experiences which show that children, especially young girls, who are involved in or forced into commercial sexual exploitation of children run highest risks of being infected by STDs or HIV/AIDS. The establishment of easily-accessible, free of charge health centres in areas where young women and girls are involved in prostitution is one of the priorities to be addressed in any intervention strategies. 1998 is not only a commemoration of all that has been achieved in the area of human rights in the last 50 years but also the time for a rigorous examination of progress achieved in the implementation of the shared commitments made in Vienna 5 years ago.

The five-year review of the Vienna Declaration and Programme of Action provides a benchmark for assessing the extent to which the goal of universal ratification of treaties as well as other related commitments are being implemented. Challenges: violence against women continues to persist in all its forms worldwide (causes, as outlined by the SR on violence against women: historically unequal power relations, etc.) economic and social rights of women continue to be violated cultural norms and traditions continue to hinder the full enjoyment of universally accepted human rights of women (in particular, discrimination against the girl-child continues to be widespread and systematic in many countries) women and children continue to be most severely affected by situations of armed conflicts and constitute the majority of the world’s refugee population.

Possible ways forward:
– avoid proliferation of new and implement existing standards of human rights expansion of State accountability to actions by private actors (ie. due diligence standard and erosion of distinction between public and private spheres)
– recognize women as humans who deserve their rights, not because women then are useful in the development and peace process, but because of their human dignity
– develop gender-impact analyses in order to combat negative effects that globalization has on the status of women worldwide (i.e. feminization of poverty, violence against women migrant workers, trafficking and forced prostitution)
-adopt life-cycle approach to protecting human rights of women
-strengthen the status of women in post-conflict society and their role in
peace-building, reconciliation and reconstruction.

For more information about the International Health Awareness Network, please see http://www.ihan.org.

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