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Statement on human rights-based approach to mistreatment
and violence against women in reproductive health services,
with a focus on childbirth and obstetric violence


74th session of the General Assembly

Third Committee

Item 70 (b and c); Human Rights

4 October 2019

New York

Mr. Chairperson,

Distinguished delegates,

Ladies and gentlemen,

It is an honour to present my thematic report on adopting a human rights-based approach to mistreatment and violence against women in reproductive health services, with a focus on childbirth and obstetric violence, to the General Assembly in my capacity as Special Rapporteur on violence against women, its causes and consequences.

Let me begin by briefly outlining some of the activities I have undertaken in the last year. 

In June 2019 I presented my thematic report to the Human Rights Council, which analyses 25 years of the mandate, the current challenges it faces and the way forward (A/HRC/41/42), along with two country visit reports on Canada (A/HRC/41/42/Add.1) and Nepal (A/HRC/41/2/Add.2).  In October and November 2019, I will undertake two official country visits to Bulgaria and Ecuador, and I would like to take this opportunity to thank both Governments for their invitations.

In my report to the Human Rights Council I noted that a new system wide global approach is necessary to eliminate violence against women and girls, and as such, would strengthen the implementation of States human rights obligations under the UN and regional women's human rights instruments to prevent and combat violence against women and impose zero tolerance on any such violence.  I believe that the institutional establishment of the Platform of UN and regional independent women's human rights mechanisms on the elimination of violence against women (MEVAW)[1], that could speak with one voice on specific topics of joint concern, would contribute to this much needed system wide approach and would strengthen implementation efforts on the elimination of gender based violence against women and girls.

In this regard, I have been continuing to lead the aforementioned Platform, which I initiated in 2017, that brings together representatives of seven UN regional independent mechanisms on violence and discrimination against women.[2] The aim of the Platform is to enhance cooperation between these mechanisms, with a view to harmonizing strategies and undertake joint actions to protect women's human rights and eliminate violence against women.  Since last October the Platform has met on two occasions: during the sixty-fourth session of the Commission on the Status of Women, held in New York in March 2019, and most recently before the Council of Europe Conference on Women's Rights at the Crossroads, in May 2019, at which all mechanisms participated. We are planning to hold our next meeting in Africa.

During the last year the Platform has issued a number of joint statements, including on the International Day on the Elimination of Violence against Women; on the current push back against women's rights; on the draft ILO Convention on violence against women and harassment in the work place; and most recently on Intimate partner violence against women as an essential factor in the determination of child custody.[3]

Distinguished delegates, allow me to now turn to my thematic report

Let me begin by thanking the WHO for the support provided to the mandate in preparing this report through the organization of an expert group meeting on the topic.

Women are subjected to mistreatment and violence even during the most delicate moments of their lives, such as when having a child. In 2015, the World Health Organization released a statement on the "prevention and elimination of disrespect and abuse during facility-based childbirth", which draws attention to the different types of abuse that women face during facility-based childbirth and clearly mentioned that such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity and freedom from discrimination.

Since 2015, new social movements demanding women's rights in reproductive health services and during childbirth (such as Break the silence, and Me too during childbirth), have arisen in numerous countries and have shed light on the patterns of mistreatment and violence that women suffer, demonstrating that mistreatment and violence during childbirth is widespread and engrained in health systems all over the world. For the purpose of this report, I issued a call for submissions and I was shocked by the high number of submissions received, over 120, from individuals, the UNFPA, non-governmental organizations and academics, which not only means that there is a need to speak about this issue, but there is also an urgent need for States to take action.  As one of the non-governmental organizations that submitted information noted: "violence against women in childbirth is so normalized that it is not (yet) considered violence against women". Such violence is therefore yet to be considered as a human rights violation against women, which is the aim of this report.

Ladies and gentlemen,

Widespread violence and mistreatment of women during childbirth are human rights violations.  They are not isolated incidents or sporadic episodes experienced by women in the course of their lives, but it is part of a continuum of the gender based violence that occurs in the wider context of structural inequality, discrimination and patriarchy, and is also the result of a lack of proper education and training as well as lack of respect for women's dignity, equal status, and human rights.

In my report, I addressed the root causes of these forms of mistreatment and violence, with women becoming victims of failing health systems bound by time constraints and cost cutting exercises, as well as the labor conditions of health workers. Discriminatory laws and harmful gender stereotypes on women's natural role in society and motherhood play a part during childbirth and contribute to limiting women's autonomy and agency. These harmful stereotypes are further justified by the belief that childbirth is an event that requires suffering on the part of the woman and leads to a "normalization" of the abuse. Additionally, I addressed the unequal power base within provider-patient relationships as another root cause of mistreatment and violence, as well as abuse of the doctrine of medical necessity, which is often used to justify mistreatment and abuse during childbirth.

In my report, I recommended that States uphold their human rights obligations, including the Convention on the Elimination of Discrimination against Women and the International Declaration of the Elimination of Violence against Women which called on States to pursue, by all appropriate means and without delay, a policy of eliminating discrimination and gender-based violence against women, including in the field of health. This is an obligation of an immediate nature and delays cannot be justified on any grounds, including economic, cultural or religious grounds. I further recommend that States develop appropriate human rights-based laws, policies, national women reproductive health strategies, and that they ensure the proper application of informed consent and conduct an independent investigation into women's allegations of mistreatment and gender-based violence in health-care facilities and publish the results and recommendations.

I also recalled that under international law, States cannot escape their responsibility to address violations committed by health institutions, since acts or omissions by non-State actors, such as private actors empowered by the law of the State, are attributable to the State.  States should further establish human rights-based accountability mechanisms to ensure redress for victims of mistreatment and violence, including financial compensation, acknowledgement of wrongdoing, formal apology, and guarantees of non-repetition.

Excellences,

Mistreatment and violence against women in reproductive health care and during childbirth can leave long-lasting scars on a woman. The taboo and silence that have surrounded this issue have allowed for these violations to continue. I hope that my report will shed some light on these manifestations of violence and guide States and health practitioners in addressing and eradicating them.

Let me also mention that yesterday the Parliamentary Assembly of the Council of Europe adopted Resolution 2306/2019 on obstetrical and gynecological violence based on the report of Ms. Maryvone Blondin on the same topic.  The resolution also makes reference to my report and reflects many of the issues I have raised in it.  While it is coincidence that both reports are being examined a few days apart, it also represents a growing need to give recognition to this taboo form of gender based violence that is afflicting women across the globe, and that must be addressed and eradicated.

Distinguished delegates,

The global phenomenon of femicide or gender based killings continue to take the lives of women all over the world.  In my annual statement to celebrate the International Day for the Elimination of Violence against Women, on 25 November 2018, I, along with other Platform   mechanisms, reiterated the call to all States to establish a femicide watch or a "gender-related killing of women watch" and called for States to send me data on femicide. I received submissions from a number of countries, including Argentina, Australia, Austria, Azerbaijan, Canada, Colombia, Costa Rica, Croatia, Ecuador, El Salvador, France, Georgia, Guatemala, Italy, Mexico, Nicaragua, Norway, Portugal, Qatar, Slovenia, Spain, Sweden, Switzerland, Turkey and the United Kingdom of Great Britain and Northern Ireland.  Over the course of the next two years, I aim to continue to support   the implementation of the recommendations in my 2016 report to the General Assembly and the establishment of Femicide prevention watches in all States.

Distinguished delegates

During this past year I have also noted the current disconnect between the United Nations Trust Fund on violence against women and this mandate, and in my report to the Human Rights Council I called for the establishment of cooperation between the mandate and the UN Trust Fund as envisaged in its founding General Assembly resolution (50/166) of 1996 that requests the Fund to cooperate closely, among others, with the Special Rapporteur on violence against women (para 3). 

In July 2019, the Human Rights Council adopted resolution 41/17.  In addition to renewing the mandate, the resolution also "encourages relevant United Nations agencies, funds and programmes, in particular the United Nations Entity for Gender Equality and the Empowerment of Women, the United Nations Trust Fund in support of actions to eliminate violence against women, the treaty bodies and the special procedure mandate holders, within their respective mandates, and civil society actors, including non-governmental organizations, as well as the private sector, to cooperate fully with the Special Rapporteur on violence against women, its causes and consequences, in the fulfilment of her mandate". As such, I again reiterate my call for the establishment of such cooperation and seek your support in that regard.

Ladies and gentlemen,

As we approach the 25 year review of the Beijing Platform for Action in 2020, we must ensure that that the progress that has been made in placing violence against women firmly on the international agenda as a violation of women's human rights and a form of gender-based discrimination is not lost but upgraded.  Indeed it should be considered as a priority concern that should be addressed each year by the Commission on the Status of Women.  The Platform of independent mechanisms on the elimination of violence against must be integrated into the BPA review process.  The Platform is currently working on the development of a publication on the role of independent mechanisms on the elimination of violence against women in the implementation of the Beijing Declaration and Platform for Action.

Thank you

[1] https://www.ohchr.org/EN/Issues/Women/SRWomen/Pages/CooperationGlobalRegionalMechanisms.aspx

[2] Along with the mandate of the Special Rapporteur, the Platform includes: the Committee on the Elimination of Discrimination against Women; the Inter-American Commission on Human Rights Special Rapporteur on the Rights of Women; the Working Group on the issue of discrimination against women in law and in practice; the African Commission on Human and Peoples' Rights Special Rapporteur on the Rights of Women in Africa; the Committee of Experts of the Follow-up Mechanism to the Belém do Pará Convention; and the Council of Europe Group of Experts on Action against Violence against Women and Domestic Violence.

[3] https://www.ohchr.org/Documents/Issues/Women/SR/StatementVAW_Custody.pdf