33/24 Follow-up on the application of the technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal mortality and morbidity
Document Type: Final Report
Date: 2016 Jul
Session: 33rd Regular Session (2016 Sep)
Agenda Item: Item2: Annual report of the United Nations High Commissioner for Human Rights and reports of the Office of the High Commissioner and the Secretary-General, Item3: Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development
GE.16-12435(E)
Human Rights Council Thirty-third Agenda items 2 and 3
Annual report of the United Nations High Commissioner
for Human Rights and reports of the Office of the
High Commissioner and the Secretary-General
Promotion and protection of all human rights, civil,
political, economic, social and cultural rights,
including the right to development
Follow-up on the application of the technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal mortality and morbidity*
Report of the Office of the United Nations High Commissioner
for Human Rights
Summary
The present follow-up report provides details of various initiatives related to the
implementation of the technical guidance on the application of a human rights-based
approach to the implementation of policies and programmes to reduce preventable maternal
mortality and morbidity. Information was received from Member States, United Nations
agencies, civil society actors and other relevant stakeholders. The emphasis of the report is
on activities where there is explicit attention given to the technical guidance. The report
also offers initial recommendations towards its usage in assuring compliance with human
rights obligations in implementing the 2030 Agenda for Sustainable Development.
* The annex to the present report is reproduced in the language of submission only.
Contents
Page
I. Introduction ...................................................................................................................................... 3
II. Dissemination and promotion activities ........................................................................................... 3
III. Utilization of the technical guidance ................................................................................................ 5
A. National-level multi-stakeholder processes ............................................................................. 5
B. Legislative reform .................................................................................................................... 7
C. Planning and budgeting ........................................................................................................... 7
D. Ensuring implementation in practice ....................................................................................... 8
E. Monitoring, review, oversight and remedies ........................................................................... 8
IV. Challenges in implementation .......................................................................................................... 10
A. Sustained engagement ............................................................................................................. 10
B. Dissemination .......................................................................................................................... 10
C. Multi-stakeholder engagement ................................................................................................ 10
D. Advocacy and capacity-building.............................................................................................. 11
V. 2030 Agenda for Sustainable Development ..................................................................................... 11
A. Sexual and reproductive health and rights ............................................................................... 12
B. International human rights standards ...................................................................................... 12
C. Participation ............................................................................................................................. 13
D. Focus on inequality and discrimination ................................................................................... 13
E. Indivisibility of human rights .................................................................................................. 14
F. Human rights indicators ........................................................................................................... 15
G. Accountability.......................................................................................................................... 17
VI. Recommendations ............................................................................................................................ 18
Annex ......................................................................................................................................... 19
I. Introduction
1. The technical guidance on the application of a human rights-based approach to the
implementation of policies and programmes for the reduction of preventable maternal
mortality and morbidity (A/HRC/21/22 and Corr.1 and 2), requested by the Human Rights
Council in resolution 18/2, was presented to the Council in September 2012. Following a
first report on implementation (A/HRC/27/20) in September 2014, the Council, in
resolution 27/11, urged all States to take action at all levels, utilizing a comprehensive
human rights-based approach, to address the interlinked root causes of maternal mortality
and morbidity and to consider the recommendations contained in the report. It further
requested the High Commissioner to prepare a follow-up report on how the technical
guidance has been applied by States and other relevant actors. The present report is
submitted in accordance with that request.
2. The present report provides details of various activities and initiatives related to the
implementation of the technical guidance. A note verbale was circulated on 11 December
2015 requesting submissions1 and further information was obtained from relevant
stakeholders via interviews, reports and correspondence. The emphasis has been placed on
activities where explicit attention is given to the implementation of the technical guidance.
Further examples referring more broadly to a rights-based approach have also been used for
illustrative purposes.
3. In 2014, technical guidance on the application of a human rights-based approach to
the implementation of policies and programmes to reduce and eliminate preventable
mortality and morbidity of children under 5 years of age was presented to the Council, and
its implementation was also urged by the Council. Some of the activities detailed in the
present report also drew from that important document. A separate report on
implementation of that technical guidance document is also before the Council at the thirty-
third session (A/HRC/33/23).
4. The second part of the present report is devoted to how the guidance can be utilized
in the implementation of the 2030 Agenda for Sustainable Development. Women’s human
rights, including their sexual and reproductive health and rights, are a key aspect of the
2030 Agenda. As countries develop strategies and plans to implement the 2030 Agenda, the
technical guidance is a tool for assuring compliance with human rights obligations. The
present report offers initial recommendations on such usage of the technical guidance.
II. Dissemination and promotion activities
5. Since June 2014, efforts to ensure wide dissemination of the technical guidance have
continued. At the global level, numerous publications and other documents have referred to
the technical guidance.2 Its dissemination has also been achieved through presentations or
1 For the full list of submissions, see
www.ohchr.org/EN/Issues/Women/WRGS/Pages/FollowUpReport.aspx.
2 See WHO, “Ensuring human rights in the provision of contraceptive information and services”
(2014); UNFPA, “From commitment to action on sexual and reproductive health and rights” (2014);
WHO, “Strengthening the inclusion of reproductive, maternal, newborn and child health in concept
notes to the Global Fund” (2014); WHO, statement on the prevention and elimination of disrespect
and abuse during facility-based childbirth (2014); Alicia Ely Yamin, Power, Suffering, and the
Struggle for Dignity: Human Rights Frameworks for Health and Why They Matter (University of
Pennsylvania Press, 2015).
other promotion activities at a variety of global conferences3 and meetings at the national
level, as indicated in the submissions from the Netherlands and the Information Group on
Reproductive Choice (GIRE) in Mexico. The technical guidance has also been discussed
and promoted by the Office of the United Nations High Commissioner for Human Rights
(OHCHR) and human rights mechanisms as part of advocacy related to the 2030 Agenda.4
6. In September 2015, the Secretary-General issued his updated Global Strategy for
Women’s, Children’s and Adolescents’ Health (2016-2030), which accompanies the 2030
Agenda in order “to end preventable deaths among all women, children and adolescents, to
greatly improve their health and well-being and to bring about the transformative change
needed to shape a more prosperous and sustainable future”.5 Explicitly rooted in human
rights law and anchored in respect for gender equality, the Global Strategy draws from the
principles explained through the technical guidance. Roll-out of the Global Strategy over
the next 15 years, together with implementation of the 2030 Agenda, is one of the most
significant opportunities for further implementation of the technical guidance, as explained
in the latter half of the present report. The Global Strategy established the Independent
Accountability Panel, which is mandated to monitor commitments under the Global
Strategy and contribute to reviewing progress on the Sustainable Development Goals at the
high-level political forum on sustainable development. The Panel will play an important
role in ensuring the implementation of the Global Strategy and alignment of the Sustainable
Development Goals with human rights obligations.
7. Efforts have also been made to translate the technical guidance into more accessible
language and for specific stakeholder groups.6 For example, OHCHR, together with the
United Nations Population Fund (UNFPA), the World Health Organization (WHO), the
Partnership for Maternal, Newborn and Child Health (PMNCH) and the François-Xavier
Bagnoud Center for Health and Human Rights of Harvard University, has developed
practical guidance for health policymakers, national human rights institutions and health
workers (with a further document forthcoming for the judiciary) on key considerations in
applying a rights-based approach to sexual, reproductive, maternal, newborn and under-5
child health. Recognizing that everyone has a role to play in applying a rights-based
approach and building on the technical guidance documents of the Council, the guidance
aims to articulate in more detail the types of issues that should be considered, depending on
where stakeholders are situated.
8. Important campaigns have also been launched, which support many of the principles
outlined in the technical guidance, such as the global Respectful Maternal Care campaign,
led by the White Ribbon Alliance, and the Campaign for the Decriminalization of Abortion
in Africa, launched by the African Commission on Human and People’s Rights.
9. Lastly, human rights treaty bodies have integrated the technical guidance as a tool of
review and analysis. The Committee on Economic, Social and Cultural Rights adopted its
general comment No. 22 (2016) on the right to sexual and reproductive health, which draws
on the technical guidance, in particular in relation to ensuring the availability of medical
and professional personnel and skilled providers trained to perform the full range of sexual
3 For example, it was presented at the Women Deliver Conference (2016) and the Global Maternal
Newborn Health Conference, Mexico (2015), and promoted at the World Humanitarian Summit,
Istanbul (2016).
4 See, e.g., joint statement on the 2030 Agenda. Available at
www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=16490&LangID=E.
5 Available from www.everywomaneverychild.org/global-strategy-2.
6 See, e.g., submissions by Finland, the Center for Reproductive Rights, the International Initiative on
Maternal Mortality and Human Rights and the International Pregnancy Advisory Services (IPAS).
and reproductive health-care services. The Committee has also taken up the technical
guidance in its recommendations to State parties to the International Covenant on
Economic, Social and Cultural Rights, including on the Gambia (E/C.12/GMB/CO/1, para.
27), Nepal (E/C.12/NPL/CO/3, para. 26), Paraguay (E/C.12/PRY/CO/4, para. 29) and
Tajikistan (E/C.12/TJK/CO/2-3, para. 31).
10. The Committee on the Elimination of Discrimination against Women has
incorporated the technical guidance into its concluding observations on the Bolivarian
Republic of Venezuela (CEDAW/C/VEN/CO/7-8, para. 31). The Committee on the Rights
of the Child has referred to it in its conclusions on Colombia (CRC/C/COL/CO/4-5, para.
40 (c)), the Dominican Republic (CRC/C/DOM/CO/3-5, para. 52 (b)), Eritrea
(CRC/C/ERI/CO/4, para. 56 (g)), the United Republic of Tanzania (CRC/C/TZA/CO/3-5,
para. 59 (f)) and the Bolivarian Republic of Venezuela (CRC/C/VEN/CO/3-5, para. 57 (c)).
III. Utilization of the technical guidance
A. National-level multi-stakeholder processes
11. Following the Council’s call to apply the technical guidance, OHCHR has been
working with partners in selected countries to facilitate multi-stakeholder processes on
sexual, reproductive, maternal and child health. That work has built on a regional workshop
held in Malawi in November 2013, where national stakeholders from Malawi, South Africa,
Uganda and the United Republic of Tanzania came together to build a common
understanding about rights-based approaches and identify opportunities to apply the
technical guidance at the national level.
12. Human rights assessments have since been undertaken and multi-stakeholder
dialogues convened to discuss the assessments in Uganda (in 2014), Malawi (in 2015) and
the United Republic of Tanzania (in 2016). In Zambia, a multi-stakeholder dialogue was
convened in 2015. Those dialogues have triggered practical actions to support the
application of rights-based approaches. The three processes profiled below provide an
overview of how such initiatives may start or deepen discussions on some of the major
challenges at the national level.7 Critically, the entry point provided by the utilization of the
technical guidance built upon pre-existing initiatives related to health and human rights in
all three countries.
13. A key outcome of these processes, as reported by relevant stakeholders in
interviews, was a strengthened or newly built multi-stakeholder process on the application
of a human rights-based approach to sexual, reproductive, maternal and child health.
Crucially, actors outside the health sector were involved in planning and implementation in
this area and health-sector actors developed enhanced understanding about human rights
and their significance to health-related processes.
14. It was also emphasized that the processes had enhanced public and multisectoral
participation in planning, strengthened accountability and pushed stakeholders to look
beyond a purely biomedical approach in order to address inequalities and root causes of
impediments to sexual, reproductive, maternal and child health.
15. In Malawi, the human rights assessment, led by the Ministry of Health, OHCHR,
UNFPA, WHO, the United Nations Children’s Fund (UNICEF) and the United Nations
7 The United Republic of Tanzania is not profiled here because the dialogue only occurred in May
2016.
Entity for Gender Equality and the Empowerment of Women (UN-Women), converged
with a separate national inquiry on sexual and reproductive health and rights initiated by the
Malawi Human Rights Commission and supported by UNFPA. Because of the
complementarity of the two reports, they were considered together at a multi-stakeholder
dialogue in October 2015. Actors from various areas of the Malawian society attended the
meeting, including government officials from several ministries, members of Parliament,
district health officers, justice system personnel, United Nations agencies, service
providers, civil society organizations and the media. During this dialogue, several evidence-
based policy responses were identified and responsibilities assigned to key actors to take
action, ultimately strengthening accountability at various levels.
16. As a result of this engagement, sexual and reproductive health and rights feature
prominently in the Human Rights Action Plan of Malawi, as well as in the joint work plan
of the United Nations and the Malawi Human Rights Commission. One of the main areas
for action is efforts to bring the human rights discussion to the district level, where many of
the barriers to effective enjoyment of rights were observed. UNFPA is also placing
particular priority on ensuring contraceptive choice and the availability and accessibility of
contraceptive goods and services. Another key area for action in Malawi concerns law
reform, including ongoing efforts to reform the abortion law and advocate for a
comprehensive law on sexual and reproductive health and rights.
17. In Uganda, the multi-stakeholder meeting held in November 2014 took place within
the context of multiple initiatives to improve sexual and reproductive health and rights.
Under the leadership of the Ministry of Health, a task force has been established on a
human rights-based approach for planning and implementation, creating additional
advocacy opportunities.
18. A variety of capacity-building initiatives have emanated from the technical guidance
roll-out process in Uganda. OHCHR has prioritized building the capacity of civil society to
monitor violations of sexual and reproductive health and rights, the provision of a human
rights database customized for the documentation of cases to inform strategic litigation and
policy advocacy, and capacity-building for health workers on rights-based approaches to
health. Additionally, UNFPA, OHCHR and WHO formed a reference group to work with
the Ugandan Human Rights Commission to build its institutional capacity to monitor and
report on sexual and reproductive health and rights.
19. In recognition of the need to pay particular attention to individuals and communities
who are often excluded in planning processes in this area, the Ministry of Health has agreed
to ensure that maternal death reviews will be conducted not only at the health-facility level
but also at the community level. As a result, there is now improved understanding that the
unmet health needs and rights of those not coming to health facilities must be analysed in
order to ensure effective redress. Illustratively, and in accordance with the technical
guidance, the White Ribbon Alliance has prioritized monitoring access to services in
various regions with community-based monitoring action teams. Moreover, awareness of
the technical guidance raised through the multi-stakeholder process has also led to
increased attention paid to access to sexual and reproductive health services for adolescents,
with the Ministry of Health updating its adolescent health strategy and introducing data
collection for 10-14 year olds.
20. Another key area of action by OHCHR and civil society organizations in Uganda
following the multi-stakeholder process is engagement with the judiciary to enhance
understanding of the justiciability of economic, social and cultural rights, including the
right to health, which would strengthen the possibility of effective accountability for
preventable maternal deaths.
21. In Zambia, in 2015, there was an effort to replicate the technical guidance processes
carried out in other countries. In that regard, at the initiative of UNFPA, a preliminary
meeting was convened with various stakeholders, including the Population Council, the
National Human Rights Institution, the Women and Law in Southern Africa Research and
Education Trust and OHCHR to discuss the current status of sexual and reproductive health
and rights in Zambia and identify priority areas for the future. These entail: an independent
human rights assessment; the facilitation of an orientation meeting with government
officials; civil society organizations raising awareness about human rights-based
approaches to sexual and reproductive health; the subsequent facilitation of a multi-
stakeholder national dialogue to disseminate the preliminary findings of the assessment,
receive feedback and secure consensus on policy and programme directions; and the
development of a country report on a rights-based approach to sexual and reproductive
health programming in Zambia.
22. Those three multi-stakeholder processes illustrate the critical importance of the
engagement, initiative and leadership of a variety of partners, including the Government,
civil society, health workers, parliamentarians, statisticians, the judiciary and the United
Nations, capitalizing on the strategic advantage of differently situated stakeholders.
B. Legislative reform
23. Several stakeholders also report using the technical guidance or the human rights
principles enshrined therein as an assessment or monitoring tool to examine and amend
existing legislation. Submissions from States, such as Georgia, Greece, Madagascar, Mali
and the Republic of Moldova, highlighted how their national laws are aligned with the
technical guidance.
24. Civil society groups also reported using the technical guidance in their advocacy for
law reform. For instance, in the United States of America, the Center for Reproductive
Rights reports drawing upon the technical guidance to present a “menu” of options at the
state level to work towards human rights compliance. The International Pregnancy
Advisory Services (IPAS) indicates that the technical guidance has informed its work with
the Government of Sierra Leone to address the high rate of maternal mortality, including
from unsafe abortion, and to advocate for law reforms, such as a bill legalizing abortion
currently awaiting approval.
C. Planning and budgeting
25. Several stakeholders report using the technical guidance or the human rights
principles enshrined therein as an assessment or monitoring tool to examine, amend and
adopt policies and programmes with particular attention given to vulnerable population
groups, for instance in El Salvador, the European Union, Madagascar, Peru and Slovakia.
In Chile and the Republic of Moldova the engagement of and collaboration and
partnerships between multiple stakeholders was also emphasized. The submissions received
from Colombia, Finland, Lithuania and the Netherlands explained that a human rights-
based approach is explicitly incorporated into health policies. Some States, such as Qatar,
have indicated the usefulness of the guidance, where others, such as Burundi, signalled its
value in the elaboration of future policies.
26. The technical guidance has also been utilized in efforts to promote and implement
human rights-based approaches to budgeting for maternal health. For instance, SAHAYOG
and the National Alliance for Maternal Health and Human Rights in India, drawing
considerably on the technical guidance, provided reports, expert briefings, data and policy
recommendations to the country’s Parliamentary Standing Committee on Health and
Family Welfare. Following their intervention, the Committee provided budget oversight on
the departmental demand for grants 2015/16 of the Ministry of Health and Family Welfare,
which subsequently took into account the human rights principles of equality and non-
discrimination, and made a number of rights-based recommendations to the Ministry. As a
consequence, the Ministry increased the special component of the budget earmarked for
marginalized indigenous populations.
D. Ensuring implementation in practice
27. Important efforts have also been made to work with health-service providers in
implementing rights-based approaches to sexual and reproductive health. For example, a
coalition of organizations, including the Ministry of Health of Jalisco, the National
Committee for the Promotion of Safe Motherhood, the Committee for the Promotion of
Safe Motherhood in Jalisco, the Simone de Beauvoir Leadership Institute and OHCHR
have used the technical guidance in Jalisco, Mexico, to address high maternal mortality
rates. Through the project, training sessions have been organized for 60 social workers who
subsequently produced 10 research protocols on sexual and reproductive service provision
and human rights within their health facilities. These protocols, currently being
implemented, enabled the social workers to break down stereotypes, be critical of
institutional practices that violate women’s human rights and strengthen monitoring and
accountability.
28. In addition to the guidance mentioned above (para. 7), one of which is focused on
health workers, UNFPA has partnered with WHO to develop a detailed implementation
guide, in terminology commonly used by health-care providers and programme managers,
on ensuring human rights within contraceptive service delivery.8
29. In South Africa, the Society of Midwives of South Africa is using the technical
guidance in its efforts to build the capacity of midwives to apply a human rights-based
approach and to promote the special role of midwives in sexual and reproductive health as
distinct from general nurses, including their separate training, registration and management.
The Society has developed the “Trainers handbook on applying human rights-based
approaches to midwifery”, which draws on and contextualizes the technical guidance,
conducted workshops to empower its executive members and strategic educators to
introduce this work in their respective training institutions and carried out advocacy for
midwifery. Thus far, the handbook has been piloted with 30 midwives in courses facilitated
by two of the trained educators. The workshops and training courses also helped sharpen
advocacy efforts and collaboration with the National Department of Health and the Minister
of Health to ensure explicit and independent recognition of midwives in the South African
Nursing and Midwifery Act 2015.
E. Monitoring, review, oversight and remedies
30. The technical guidance was used extensively by multiple stakeholders in Brazil to
monitor follow-up to communication No. 17/2008, Da Silva Pimentel v. Brazil, on which
the Committee on the Elimination of Discrimination against Women had adopted its views
on 25 July 2011, the first decision of an international human rights treaty body on a
maternal death as a human rights violation.
8 UNFPA and WHO, Ensuring Human Rights within Contraceptive Service Delivery: Implementation
Guide (2015).
31. A number of the recommendations in this case focus on non-repetition of those
human rights violations and suggest reforms to how the State administers maternal health
care. Four years after the decision was issued, the Center for Reproductive Rights indicated
that it had convened a follow-up commission to assess implementation of those
recommendations. Inspired by the technical guidance, the commission was able to craft
robust recommendations for further reform of the Brazilian maternal health system, which
the Center is currently using in ongoing advocacy.
32. IPAS has noted that, with its national partners, it has used a human rights-based
approach to monitor the progress of the Government of Brazil in taking effective measures
to implement the Committee’s decision. Using the technical guidance as a framework,
IPAS has also worked with Brazilian civil society organizations to assess the quality of
post-abortion care in five Brazilian states. Researchers used a human rights-based approach
and based their interview questions on the technical guidance and presented the final report
in October 2015 in a thematic hearing before the Inter-American Commission on Human
Rights.
33. The Information Group on Reproductive Choice (GIRE) in Mexico highlighted that
the technical guidance has been instrumental in its focus on social justice to build capacity
of rights holders to demand a State response when their rights have been violated, making
use of complaints to public human rights bodies, both at local and national levels, with the
objective of achieving comprehensive reparations for violations. The organization has
developed specific research and reports on women’s reproductive rights in Mexico aimed at
drawing attention to violations, making recommendations to different authorities and
influencing policy decisions related to reproductive health and rights.
34. Stakeholders in Peru have also utilized the technical guidance to support
participatory monitoring methods. For example, Foro de la Sociedad Civil en Salud
(ForoSalud) has focused its efforts on building the capacity of indigenous women to ensure
the quality of care at health facilities; direct citizen monitoring of health facilities;
documentation and production of reports on the monitors’ findings; the monthly analysis of
those findings with the Regional Ombudsperson’s Office, ForoSalud members and the
Departmental Officer for Integral Health Insurance; and the creation of “dialogue spaces”
for indigenous women leaders and health providers and authorities. Those efforts have led
to improved understanding within the Ombudsperson’s Office of health rights and
increased accountability of public health facilities as a result of regular monitoring by
indigenous women, who are now able to present their monitoring findings to the Ombuds
officers.
35. As another example of monitoring human rights violations related to maternal
health, Amnesty International published a report in 2014 that examined some of the barriers
to antenatal care faced by women and girls in South Africa.9 The report, which utilized the
technical guidance as a tool for analysis, adopted a qualitative and inclusive research
methodology and identified key barriers that cause delays to or avoidance of antenatal care.
A significant result was the shift in perception among the community concerned from
viewing maternal health care as an issue of poor service delivery to be endured to one of
human rights to be challenged. It is reported that the authorities have visited some of the
sites mentioned in the report to investigate its key findings.
9 Amnesty International, “Struggle for maternal health: barriers to antenatal care in South Africa”
(2014).
IV. Challenges in implementation
36. The numerous examples given above present an encouraging picture regarding the
implementation of the technical guidance and human rights-based approaches more
broadly. The guidance is being utilized by a wide diversity of stakeholders, often
collaboratively, across various sectors and in a range of different contexts. The ownership
at the country level by multiple stakeholders in certain contexts has, in particular, been a
positive development.
37. Despite these positive experiences, there are many challenges that hinder further
implementation of the guidance.
A. Sustained engagement
38. It has been four years since the technical guidance was presented to the Council.
Specific results have been seen in terms of influencing the understanding of human rights in
the context of maternal health and sexual and reproductive health more broadly. That has
had an impact on the content of policies, strategies and work plans in certain countries.
39. Local- and national-level implementation of the guidance requires concerted and
dedicated political and financial efforts to identify relevant barriers, devise solutions and
build the capacity of a variety of actors. That sort of sustained engagement over long
periods of time is often difficult to achieve. Furthermore, stakeholders observed that, while
there is momentum behind certain multi-stakeholder processes, in several contexts civil
society organizations are expected to lead the process, but they are often restricted by the
resources available and the extent to which their collaborative efforts can influence State
actors to implement human rights-based approaches.
B. Dissemination
40. Many stakeholders have expressed concern that there is little knowledge or
ownership of the technical guidance among key decision-makers at the national level.
Though dissemination has improved since 2012, lack of awareness of the guidance and the
Council’s call for its implementation remains a significant challenge.
41. Although the Council process related to maternal mortality and morbidity is a
comparatively positive example of the Council’s work being implemented at the national
level, more effort is needed to link its important work, as well as that of regional human
rights mechanisms, to national-level implementation efforts and vice versa. As the Council
celebrates its tenth anniversary, it is an auspicious moment to consider modalities for
reducing the gap between international-level and regional processes and national-level
action.
C. Multi-stakeholder engagement
42. The present report places particular emphasis on the importance of multi-stakeholder
processes. Those processes require a considerable investment in terms of time, as well as
human and financial resources. In some contexts, when faced with the complexity of
meaningful participation, different actors may opt for shortcuts, which are deemed to
achieve the same result. In a human rights-based approach, the process of deliberation
among a wide variety of stakeholders, including health providers, and reaching
marginalized women and adolescent girls is critical for building an environment of
empowerment where rights may be claimed.
43. The often entrenched nature of health-care systems in many States makes holistic,
cross-sectoral change difficult. Such change is further complicated where lines of
accountability are sometimes unclear. In those contexts, where actors at the federal, state,
and local levels, as well as private sector actors, all influence laws and policies around
maternal health and are involved in service delivery, better coordination and sharing of
information, as well as more stakeholder involvement, is needed. While many stakeholders
play a role in applying a rights-based approach, the ultimate responsibility for ensuring that
human rights are upheld remains with the central Government, which should ensure a
conducive environment for all duty-bearers to meet their obligations and rights-holders to
claim their rights.
D. Advocacy and capacity-building
44. There remains a need to build awareness about maternal mortality and morbidity as
an issue of fundamental human rights, not primarily as a biomedical problem. Contributions
from certain stakeholders and discussions surrounding the implementation of the technical
guidance reveal continuing resistance to recognizing that reducing preventable maternal
mortality is a pressing human rights concern, just as important as traditional civil and
political rights protections. More efforts are required to enhance understanding of the
indivisibility of human rights.
45. There is also a need for further efforts to build capacity on the practical application
of rights-based approach in different contexts and by different actors. The processes in
which the technical guidance has been utilized have consistently pointed to the need for
first building common understanding of what it means to apply a rights-based approach,
which is fundamental for building partnerships for realizing rights.
V. 2030 Agenda for Sustainable Development
46. The 2030 Agenda, read together with the Secretary-General’s renewed Global
Strategy, presents a solid foundation for the realization of human rights, especially sexual
and reproductive health and rights. Building on that foundation will require careful
attention to be given to translation of those global agendas to national implementation
efforts.
47. The Sustainable Development Goals have been heralded as a transformative agenda
and human rights-based approaches are a path towards that transformation – from charity to
empowerment, from needs to rights. The process of identifying rights-holders and their
entitlements and duty-bearers and their obligations requires inclusive deliberative processes
at the local, national and international levels that interrogate who is denied or unable to
claim their rights and why, who has power and why and how priorities are set and for
whose benefit. That shift demands critical questioning of complex power structures that
entrench discrimination and inequality, followed by efforts to dismantle those systems and
build more just and equal societies.
48. As countries launch into the implementation of the Sustainable Development Goals,
the technical guidance is an invaluable instrument to guide efforts with a view to ensuring
compliance with human rights obligations and delivering on the promise of a
transformative agenda.
A. Sexual and reproductive health and rights
49. The technical guidance is grounded in recognition of sexual and reproductive health
and rights, including the right to survive pregnancy and childbirth in good health.
Recognizing that includes recognizing whether women live or die in childbirth is integrally
related to the status of women and girls in society; their ability to make informed decisions
about if, when and whether to engage in sexual intercourse, to marry or to have children;
their access to quality health services and information, including comprehensive sexuality
education; and their access to resources to be able to realize their human rights.
50. This broad understanding of sexual and reproductive health and rights is supported
in the political agreements of the 1990s, such as the Programme of Action of the
International Conference on Population and Development and the Beijing Platform for
Action, but was restricted in the Millennium Development Goals to maternal health only.
The 2030 Agenda represents an important improvement in recognizing a more holistic
approach to women’s human rights, including rights related to sexual and reproductive
health, which must be retained in its implementation.
B. International human rights standards
51. Applying a rights-based approach in the implementation of the Sustainable
Development Goals to reduce maternal mortality and morbidity, and realize women’s
human rights more broadly, requires attention to be paid to the international human rights
standards that bind all States. While the Sustainable Development Goals, and their
predecessors the Millennium Development Goals, offer important targets for collective
action, the ultimate goal must be full realization of human rights. The declaration of the
2030 Agenda is explicit in this requirement, emphasizing that the Agenda is to be
implemented in a manner that is consistent with the rights and obligations of States under
international law.
52. One critical action is ensuring common understanding of the content of international
human rights standards and corresponding State obligations. With respect to sexual and
reproductive health and rights, because those rights span many areas, the standards are
located in numerous treaties, as explained in the first report of the High Commissioner to
this Council on preventable maternal mortality and morbidity (A/HRC/14/39). As
mentioned above, the Committee on Economic, Social and Cultural Rights adopted general
comment No. 22 (2016) on the right to sexual and reproductive health. That authoritative
interpretation of article 12 of the Covenant, which should be read together with the work of
other human rights mechanisms, specifies States’ obligations in the domain, and should
serve as a reference point for States as they implement the Sustainable Development Goals.
In the general comment, the Committee specifies that the right to sexual and reproductive
health entails a set of freedoms and entitlements. The freedoms include the right to make
free and responsible decisions and choices, free of violence, coercion and discrimination,
regarding matters concerning one’s body and sexual and reproductive health. The
entitlements include unhindered access to a whole range of health facilities, goods, services
and information, which ensure all people full enjoyment of the right to sexual and
reproductive health.
53. These human rights standards are relevant across contexts. Importantly, the
Sustainable Development Goals departed from the approach under the Millennium
Development Goals of only focusing on progress made by developing countries and
articulated a universal agenda for all countries, which is a crucial opportunity to examine
inequalities among various groups within countries, in accordance with the technical
guidance.
C. Participation
54. Throughout the technical guidance, participation of all affected groups is particularly
emphasized. Such participation must permeate all aspects of implementation of the
Sustainable Development Goals, from devising policies and programmes to budget
allocation, implementation, monitoring and review. Special efforts may be required to build
environments that foster participation and active engagement of affected groups,
particularly women and girls. That will include elimination of discriminatory laws and
practices that silence or diminish women’s voices or threaten their security; making
processes accessible to women and girls in terms of taking account of their other
responsibilities at work, home or school, as well as building their capacity to engage
effectively; and ensuring that freedoms of expression, association and assembly are fully
protected. Furthermore, participatory processes must result in programming that is
responsive to those priorities expressed.
D. Focus on inequality and discrimination
55. A rights-based approach, as explained in the technical guidance, demands explicit
focus on those groups that are most marginalized and excluded. Such priority attention to
the elimination of discrimination is mirrored in the call in the 2030 Agenda to leave no one
behind. One of the most consistent criticisms of the Millennium Development Goals was
the fact that, in many cases, the focus on aggregate progress neglected the people who were
in the most deprived situations. For example, while the overall rates of skilled attendance at
birth were shown to increase from 59 per cent in 1990 to 71 per cent in 2014, women in the
lowest quintile groups and living in rural areas are still much less likely to access such
care.10 Indeed, women belonging to particularly marginalized groups and experiencing
multiple and intersecting forms of discrimination are often the most at risk of suffering poor
health and human rights violations. Recognizing who is deprived of the enjoyment of their
rights and building policies and programmes on the foundation of that recognition is a
fundamental element of a rights-based approach and should be fully integrated in the
implementation of the Sustainable Development Goals.
56. To ascertain who is experiencing discrimination and inequality, reliable,
disaggregated data must be available and the 2030 Agenda has a strong focus on an
expansive list of groups to be given special attention. In addition to data disaggregation,
measures must be taken to ensure that all marginalized groups are accounted for, especially
those experiencing multiple forms of discrimination, who may be invisible in official
statistics used to measure progress. For example, data collected to ascertain “met need for
contraception” only includes women who are married or in union, but not other women or
adolescents who are sexually active. Data collection and analysis must be understood
within the context of many societies where there is a resistance to challenging gender
norms and women’s and girls’ sexuality is considered something to be controlled. Other
groups who may be invisible in official statistics include young adolescents (10-14 years
old), migrants in an irregular situation, persons with disabilities, indigenous peoples and
persons whose status is criminalized.
10 “Millennium Development Goals report 2015” (New York, 2015), pp. 39-40.
E. Indivisibility of human rights
57. Applying a rights-based approach is directed towards the realization of all human
rights – civil, cultural, economic, political and social – recognizing that human rights are
indivisible. The 2030 Agenda covers issues related to all human rights and should be seen
as an indivisible agenda, which will require integration across different sectors and must
resist approaches rigidly divided by sector.11
58. Reducing maternal mortality and morbidity in accordance with human rights
obligations will require efforts on multiple targets of the Sustainable Development Goals.
While target 3.1 is the most directly concerned with maternal mortality as a distinct issue,
true progress in reducing maternal mortality requires action across the entirety of Goal 3
concerning healthy lives. Focused attention is needed to ensure a holistic and integrated
approach to ensuring health systems that include universal health care, including sexual and
reproductive health, comprehensive service provision, a functioning referral system and
mechanisms for accountability. That approach will require actions to strengthen health
systems and support health workers. Delivering on Goal 3 also requires dedicated efforts to
eliminate discrimination in health care and uphold professional standards of conduct and
ethics and respect for informed consent and patient privacy and confidentiality.
59. Furthermore, progress in reducing maternal mortality is integrally linked to women’s
and girls’ status in society, which requires action across all of the other Sustainable
Development Goals. For example, target 5.1 on the elimination of discrimination against
women should include examination of laws that require women to obtain third party
consent (of their husband, parent or multiple medical professionals) in order to access
sexual and reproductive health services or information, as well as laws that criminalize
adult consensual sex, and which criminalize sexual and reproductive health services only
required by women, such as abortion or emergency contraception. Eliminating violence,
including violence against women (targets 16.1 and 5.2), is fundamental to addressing
patterns of maternal mortality and morbidity, as violence, including sexual violence, at
home and in the community, including crisis situations, has a direct impact on women’s and
girls’ ability or willingness to access health services. Eliminating child and forced marriage
(target 5.3) is critical, as that is a major contributor to girls and adolescents becoming
pregnant before they are physically or mentally mature enough and associated mortalities
and morbidities. Other Sustainable Development Goals cover critical social and underlying
determinants of health, such as decent work, access to housing and safe water and
sanitation, which are fundamental to women’s human rights, including sexual and
reproductive health and rights, and as emphasized in the technical guidance.
60. Another example is Sustainable Development Goal 4 on education. Enabling girls to
remain in school rather than arranging their marriage, and ensuring that their education
includes comprehensive sexuality education to enable informed decision-making about
their reproduction and sexuality, are indispensable interventions to support improved
enjoyment of sexual and reproductive health and rights and reduced maternal mortality and
morbidity.
61. The preceding section has highlighted the importance of paying attention to
inequalities in applying a rights-based approach to maternal mortality, which is integrally
linked to the targets set under Goal 10 of the Sustainable Development Goals on reducing
11 OHCHR has developed a table that links all of the Sustainable Development Goals to the relevant
human rights obligations, which demonstrates the need for such a holistic approach. Available from
http://ohchr.org/Documents/Issues/MDGs/Post2015/SDG_HR_Table.pdf.
inequalities. Further efforts are needed to establish methodologies that effectively capture
multiple and intersecting forms of discrimination and inequality.
62. Reducing preventable maternal mortality and morbidity from a human rights
perspective also requires accountability when rights have been violated and access to an
effective gender-sensitive remedy. Target 16.3 on rule of law and equal access to justice
speaks to an important aspect of accountability, which is often neglected in interventions
focused only on the health dimensions of maternal mortality.
F. Human rights indicators
63. The importance of identifying appropriate indicators has been mentioned throughout
the present section. However, because the indicator framework will play a major role in
determining how the targets and goals get interpreted, additional attention must be paid to
this important issue. The submission made by the Statistical Commission
(E/CN.3/2016/2/Rev.1) represents a commendable effort to embrace the ambitious vision of
the 2030 Agenda, including with respect to human rights. Combined with the indicators that
have been proposed under the Global Strategy,12 there is a strong basis for measuring State
effort and results in reducing maternal mortality and morbidity in accordance with human
rights obligations.
64. However, even if adopted in their entirety, those globally identified indicators will
not suffice to provide an understanding of whether women and girls are truly enjoying their
human rights, especially their sexual and reproductive health rights. Assessing the
enjoyment of human rights cannot be reduced to collection of data, no matter how robust
the information gathered. Human rights monitoring and documentation methodologies,
which include qualitative indicators and context-specific analysis, are critical
complementary tools to indicator selection and measurement to enable a fuller
understanding of whether States are meeting their human rights obligations. In that regard,
it is crucial that analysis of progress on Sustainable Development Goals indicators is
considered together with wider human rights reporting, for example, to United Nations
treaty bodies and the universal periodic review or through national processes led by
national human rights institutions.
65. The Sustainable Development Goals indicator framework should be anchored in
human rights standards. The recently adopted general comment No. 22 of the Committee on
Economic, Social and Cultural Rights provides an important foundation for understanding
the breadth of the issues to be covered. In the annex to the present report, a table is
presented laying out proposed indicators with cross-references to the core content of the
right to sexual and reproductive health. Some additional indicators, which could be read
into existing proposed Sustainable Development Goals and Global Strategy indicators, or
could be integrated in national adaptation processes, could include:
(a) Existence of discriminatory laws that criminalize or place other barriers to an
individual’s access to sexual and reproductive health services, goods and information;
(b) Percentage of health-care facilities in a country that offer a minimum package
of sexual and reproductive health services;
(c) Indicators to assess the availability and quality of basic and comprehensive
emergency obstetric care;
12 Every Woman Every Child, “Indicator and monitoring framework for the Global Strategy for
Women’s, Children’s and Adolescents’ Health” (2016).
(d) Existence of a national plan on sexual and reproductive health;
(e) Specific budget system in place to track the proportion of public sector and
total resources dedicated to sexual and reproductive health services;
(f) Medical terminations of pregnancy as a proportion of live births;
(g) Proportion of complaints received on the right to health that have been
investigated and adjudicated by the national human rights institution, ombudsperson or
other mechanisms and the proportion of those to which the Government has effectively
responded.
66. Furthermore, the indicators selected should include a mix of structure, process and
outcome indicators, as well as qualitative and quantitative indicators. That is important in
order to account for the measures required to establish an enabling environment for the
realization of rights; for example through examination of legal frameworks, budgetary
allocations and key interventions for women’s health, such as skilled attendance at birth. It
is also key to assess whether rights are being realized in practice, for example, through
reduced adolescent birth rates and the availability of a range of modern contraceptives, as
well as to capture the actual experience of individuals, for example by documenting
experience of discrimination, disrespect and abuse in health-care settings.
67. In prioritizing indicators, the technical guidance specifies that “quantitative
indicators should be (a) continuously or frequently measurable in order that the actions
taken by an administration may be measured in a timely manner; (b) objective, to permit
comparison across time and countries and/or subregions; (c) programmatically relevant, to
enable priority setting and identification of accountability gaps; and, ideally, (d) subject to
local audit to promote accountability to populations served” (A/HRC/21/22 and Corr.1 and
2, para. 71). Well-established indicators should be re-examined against those criteria. For example, maternal mortality rates do not meet the criteria because they are inadequate for
assessing whether policies are working. Additionally, for the indicator of skilled attendance
at birth to be meaningful and objective, there must be a common standard of what qualifies
as “skilled”, an area where there is important ongoing work.
68. Attention is also required to ensure that indicators do not incentivize action that
would undermine enjoyment of human rights. For example, indicators pertaining to
contraceptive usage should not obscure the fundamental importance of choice of modern
methods and informed consent by women and girls.
69. In addition, where indicators are identified as important from a human rights
perspective but methodologies for collecting such data remain underdeveloped, that must
be taken as a signal to give greater attention to those potential methodologies rather than an
insurmountable barrier. For example, the lack of comprehensive and emergency obstetric
care remains a critical factor contributing to the death of women in pregnancy and
childbirth, and provision of such care is considered a core obligation of States under human
rights law. The United Nations has developed indicators to capture the availability of
emergency obstetric care;13 however, current systems of data collection have prevented
meaningful use of those indicators for monitoring access. More effort must be directed to
overcoming those obstacles in order to find suitable ways of understanding to what extent
women and girls are able to access the care they require in order to survive pregnancy and
childbirth in good health and with dignity.
13 WHO, UNFPA, UNICEF and Averting Maternal Death and Disability, Monitoring Emergency
Obstetric Care: A Handbook (2009).
70. The “data revolution” for sustainable development must fully embrace not only
human rights-sensitive indicators, but also a human rights-based approach to the collection,
production, analysis and dissemination of data. That requires attention to be given to the
following human rights principles: participation of all population groups, in particular the
marginalized, in the data collection process; the disaggregation of data to prevent
discrimination based on grounds prohibited by international human rights law; self-
identification, without reinforcing further discrimination of these groups; transparency to
guarantee the right to information; respecting the privacy of respondents and the
confidentiality of their personal data; and accountability in data collection and use.14
G. Accountability
71. The “circle of accountability” concept put forth in the technical guidance explains
that accountability must be at the heart of a rights-based approach, not an afterthought once
a violation has occurred. In the implementation of the Sustainable Development Goals,
specific attention must be given to assessing existing accountability mechanisms for
women’s sexual and reproductive health and rights, building accountability into
interventions and strategies, monitoring the functioning and effectiveness of those
mechanisms and processes and taking remedial action to ensure that they are responsive to
individual’s rights. Establishing and maintaining such accountability mechanisms requires
dedicated and sustained resources. Ensuring effective participation of rights-holders in all
aspects of implementing the 2030 Agenda is fundamental to establishing an effective
system of accountability.
72. The technical guidance further emphasizes the need for accountability through
multiple forms of review and oversight, including administrative (e.g., internally within
health facilities), social (e.g., community-based oversight), political (e.g., oversight of
parliaments over the executive branch of government), legal (e.g., oversight by the
judiciary or national human rights institutions) and international (e.g., reporting to
international human rights mechanisms). Identifying responsibilities also requires looking
beyond individuals to capture systemic failures and looking beyond domestic State
authorities to the role of the private sector and donors.
73. As mentioned above, details for the “follow-up and review” framework of the
Sustainable Development Goals are still under discussion at the time of writing the present
report. A robust multi-stakeholder accountability framework is needed. At the global level,
the high-level political forum on sustainable development will review progress through
both country reviews and thematic reviews. Those reviews should systematically draw
upon information and recommendations from the United Nations human rights
mechanisms, ensuring that implementation of the 2030 Agenda is consistent with binding
human rights obligations. Close coordination with the Independent Accountability Panel
established under the Global Strategy will be critical for providing additional, more detailed
information specifically on the health and rights of women, children and adolescents.
Participatory, inclusive and transparent monitoring mechanisms are also needed at the
national and regional levels to enable people to provide diverse perspectives on progress
towards the targets of the Sustainable Development Goals, as well as compliance with
human rights standards. It is equally important that the actions of private actors, including
private hospitals, pharmaceutical companies and public and private-donor institutions, are
14 OHCHR, “A human rights-based approach to data : leaving no one behind in the 2030 development
agenda” (2016).
monitored for their contribution to achieving the Sustainable Development Goals in
accordance with human rights obligations (see General Assembly resolution 70/1, para. 67).
VI. Recommendations
74. The High Commissioner notes with appreciation the many examples of how the
technical guidance has been used by a wide variety of stakeholders to ensure rights-
based approaches to maternal health. Given its significant value to national
implementation of the 2030 Agenda, the High Commissioner recommends that the
Council remain seized of this important issue.
75. The following recommendations are made to States and other stakeholders, as
relevant, to:
(a) Build recognition, at the national and international levels, that
preventable maternal mortality and morbidity is a fundamental human rights issue
and, particularly in this context, enhance understanding among all stakeholders of the
indivisibility of all human rights;
(b) Disseminate the technical guidance and associated tools as widely as
possible, including to all ministries and public institutions at all levels relevant, and to
rights-holders and other organizations working in related areas;
(c) Report on the implementation of the technical guidance through existing
human rights mechanisms at the regional and international levels, as well as in the
context of the monitoring and accountability framework of the Sustainable
Development Goals;
(d) Strengthen awareness and build the capacities of various stakeholders,
including policymakers, legislators, national human rights institutions, the judiciary,
United Nations agencies and health workers, on the application of rights-based
approaches to sexual and reproductive health, by organizing, inter alia, briefings,
trainings, webinars or other meetings;
(e) Convene and support multi-stakeholder meetings, which involve health
workers and marginalized women and girls, to discuss the application of a rights-
based approach to sexual and reproductive health and identify opportunities within
national-level processes and prioritize concrete areas and plans for action;
(f) Appoint a national body with responsibility for ensuring the
implementation of rights-based approaches, including as outlined in the technical
guidance, across all sectors and at all levels;
(g) Affirm the centrality of human rights and reinforce linkages between
international and regional processes, including the 2030 Agenda and the Global
Strategy for Women’s, Children’s and Adolescents’ Health;
(h) Adopt human rights-sensitive indicators at the national level to monitor
progress and impact, including in the context of the implementation of the 2030
Agenda, complement indicator analysis with human rights reporting and ensure a
human rights-based approach to the collection, production, analysis and
dissemination of data;
(i) Assess existing accountability mechanisms for women’s sexual and
reproductive health and rights in the implementation of the Sustainable Development
Goals, building accountability into interventions and strategies, monitoring the
functioning and effectiveness of those mechanisms and processes and taking remedial
action to ensure they are responsive to human rights.
Annex
Indicators for assessing compliance with human rights obligations,
especially related to sexual and reproductive health and rights
Core content of the right to sexual
and reproductive health from the
Committee on Economic, Social and
Cultural Rights, general comment
No. 22 (2016) on sexual and
reproductive healtha
Relevant indicators in the
Statistical Commission report
(E/CN.3/2016/2/Rev.1)b
Additional indicators in the Global
Strategy indicator and monitoring
frameworkc
Non-exhaustive list of additional
indicators that could be
incorporated into national-level
adaptation (with reference
to where indicator has been
proposed, where feasible)d
To repeal or eliminate laws,
policies and practices that
criminalize, obstruct or
undermine access by
individuals or a particular
group to sexual and
reproductive health facilities,
services, goods and
information
5.1.1 Whether or not legal
frameworks are in place to
promote, enforce and
monitor equality and non-
discrimination on the basis
of sex
- Existence of
discriminatory laws which
criminalize or place other
barriers to an individual’s access to sexual and
reproductive health
services, goods and
information
To adopt and implement a
national strategy and action
plan, with adequate budget
allocation, on sexual and
reproductive health, which is
devised, periodically
reviewed and monitored
through a participatory and
transparent process,
disaggregated by prohibited
ground of discrimination
5.6.2 Number of countries
with laws and regulations
that guarantee women aged
15-49 access to sexual and
reproductive health care,
information and education
16.6.1 Primary government
expenditures as a
percentage of original
approved budget,
disaggregated by sector (or
by budget codes or similar)
Current country health
expenditure per capita
(including specifically on
reproductive, maternal,
newborn, child and
adolescent health) financed
from domestic sources
- Existence of a costed
national plan on sexual and
reproductive health
(OHCHR right to health
indicators)
- Specific budget tracking
system in place on
proportion of public sector
and total resources
dedicated to sexual and
reproductive health services
(adapted from OHCHR
right to health indicators)
To guarantee universal and
equitable access to
affordable, acceptable and
quality sexual and
reproductive health services,
goods and facilities, in
particular for women and
disadvantaged and
marginalized groups
5.6.1 Proportion of women
aged 15-49 who make their
own informed decisions
regarding sexual relations,
contraceptive use and
reproductive health care
3.1.1 Maternal deaths per
100,000 live births
3.1.2 Proportion of births
attended by skilled health
personnel
3.3.1 Number of new HIV
infections per 1,000
uninfected population (by
age group, sex and key
populations)
Proportion of women aged
15-49 who received four or
more antenatal care visits
Proportion of women who
have postpartum contact
with a health provider
within two days of delivery
Percentage of people living
with HIV who are currently
receiving antiretroviral
therapy, by age and sex
Proportion of women aged
20-49 who report they were
screened for cervical cancer
- Indicators to assess the
availability and quality of
basic and comprehensive
emergency obstetric care
(WHO, UNFPA, UNICEF,
Averting Maternal Death
and Disability, emergency
obstetric care indicators]
- Percentage of health care
facilities in a country that
offer a minimum package
of sexual and reproductive
health services (WHO,
Ending Preventable
Maternal Mortality)
Core content of the right to sexual
and reproductive health from the
Committee on Economic, Social and
Cultural Rights, general comment
No. 22 (2016) on sexual and
reproductive healtha
Relevant indicators in the
Statistical Commission report
(E/CN.3/2016/2/Rev.1)b
Additional indicators in the Global
Strategy indicator and monitoring
frameworkc
Non-exhaustive list of additional
indicators that could be
incorporated into national-level
adaptation (with reference
to where indicator has been
proposed, where feasible)d
3.7.1 Percentage of women
of reproductive age (aged
15-49) who have their need
for family planning
satisfied with modern
methods
3.7.2 Adolescent birth rate
(aged 10-14; aged 15-19)
per 1,000 women in that
age group
3.c.1 Health worker density
and distribution
10.2.1 Proportion of people
living below 50 per cent of
median income,
disaggregated by age group,
sex and persons with
disabilities
10.3.1 Percentage of the
population reporting having
personally felt
discriminated against or
harassed within the last
12 months on the basis of a
ground of discrimination
prohibited under
international human rights
law
Prevalence of anaemia in
women aged 15-49,
disaggregated by age and
pregnancy status
Out of-pocket health
expenditure as percentage
of total health expenditure
To enact and enforce the
legal prohibition of harmful
practices and gender-based
violence, including female
genital mutilation, child and
forced marriage and
domestic and sexual
violence, including marital
rape, while ensuring privacy,
confidentiality and free,
informed and responsible
decision-making, without
coercion, discrimination or
fear of violence, in relation to
the sexual and reproductive
needs and behaviours of
individuals
5.2.1 Proportion of ever-
partnered women and girls
aged 15 years and older
subjected to physical,
sexual or psychological
violence by a current or
former intimate partner, in
the last 12 months, by form
of violence and by age
group
5.2.2 Proportion of women
and girls aged 15 years and
older subjected to sexual
violence by persons other
than an intimate partner in
the last 12 months, by age
group and place of
occurrence
Proportion of rape survivors
who received HIV post-
exposure prophylaxis
within 72 hours of an
incident occurring
- Legal recognition of
marital rape
Core content of the right to sexual
and reproductive health from the
Committee on Economic, Social and
Cultural Rights, general comment
No. 22 (2016) on sexual and
reproductive healtha
Relevant indicators in the
Statistical Commission report
(E/CN.3/2016/2/Rev.1)b
Additional indicators in the Global
Strategy indicator and monitoring
frameworkc
Non-exhaustive list of additional
indicators that could be
incorporated into national-level
adaptation (with reference
to where indicator has been
proposed, where feasible)d
5.3.1 Percentage of women
aged 20-24 who were
married or in a union before
age 15 and before age 18
5.3.2 Percentage of girls
and women aged 15-49 who
have undergone female
genital mutilation/cutting,
by age group
16.2.3 Proportion of young
women and men aged 18-29
who experienced sexual
violence by age 18
16.6.2 Proportion of the
population satisfied with
their last experience of
public services
To take measures to prevent
unsafe abortions and to
provide post-abortion care
and counselling for those
in need
- Medical terminations of
pregnancy as a proportion
of live births (OHCHR right
to health indicator)
To ensure all individuals and
groups have access to
comprehensive education and
information on sexual and
reproductive health that are
non-discriminatory, non-
biased, evidence-based, and
that take into account the
evolving capacities of
children and adolescents
Proportion of men and
women aged 15-24 with
basic knowledge about
sexual and reproductive
health services and rights
- Percentage of schools that
provided comprehensive
sexuality education in the
previous academic year
(High Level Task Force for
the International
Conference on Population
and Development
indicators)
To provide medicines,
equipment and technologies
essential to sexual and
reproductive health,
including based on the WHO
Model List of Essential
Medicines
3.b.1 Proportion of the
population with access to
affordable medicines and
vaccines on a sustainable
basis
- Indicators related to the
availability of essential
medicines
Core content of the right to sexual
and reproductive health from the
Committee on Economic, Social and
Cultural Rights, general comment
No. 22 (2016) on sexual and
reproductive healtha
Relevant indicators in the
Statistical Commission report
(E/CN.3/2016/2/Rev.1)b
Additional indicators in the Global
Strategy indicator and monitoring
frameworkc
Non-exhaustive list of additional
indicators that could be
incorporated into national-level
adaptation (with reference
to where indicator has been
proposed, where feasible)d
To ensure access to effective
and transparent remedies and
redress, including
administrative and judicial
ones, for violations of the
right to sexual and
reproductive health
16.3.1 Proportion of victims
of violence in the previous
12 months who reported
their victimization to
competent authorities or
other officially recognized
conflict resolution
mechanisms
Governance index (voice,
accountability, political
stability and absence of
violence, government
effectiveness, regulatory
quality, rule of law, control
of corruption)
Proportion of countries that
have ratified human rights
treaties related to women’s, children’s and adolescents’ health
- Proportion of received
complaints on the right to
health investigated and
adjudicated by the national
human rights institution,
ombudsperson, or other
mechanisms and the
proportion of these
responded to effectively by
the Government (OHCHR
right to health indicators)
a Assessing compliance with human rights obligations would necessitate examining State action beyond the core content of the
right to sexual and reproductive health. However, identifying indicators for the core content of the right provides an important
baseline to be observed by all States. b The report specifies that “Sustainable Development Goal indicators should be disaggregated, where relevant, by income, sex,
age, race, ethnicity, migratory status, disability and geographic location, or other characteristics, in accordance with the Fundamental
Principles of Official Statistics.” c The Framework includes the issue of disaggregation in its recommendations, specifying that “for many indicators the
disaggregation by age, sex, socioeconomic status and other dimensions is critical to ensure that no one is left behind, including in
humanitarian and other fragile settings. This will require special attention to data collection, analysis and communication for most
indicators.” d OHCHR key messages on the 2030 Agenda explain that “data should be collected and disaggregated by all grounds of
discrimination prohibited under international human rights law, which will require developing new partnerships, methods and data
sources, including non-traditional data sources and data gatherers including civil society”. Additionally, special efforts should be
made to ensure information is collected on the situation of 10-14 year olds.