Special Report

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.

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.

“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.