Center for Reproductive Rights
"This publication sets forth the barriers adolescents face in realizing their sexual and reproductive health and rights, discusses recent critical developments in the human rights framework underpinning these rights, and proposes a way forward for guaranteeing all adolescents the full exercise of their sexual and reproductive health and rights. [SRHR]"
As detailed in this publication by the Center for Reproductive Rights, the 1.8 billion adolescents and youth (data from 2017) are often deprived of reproductive rights despite the affirmation of the Committee on the Rights of the Child and the Special Rapporteur on the Right to Health of the importance of adolescents' sexual and reproductive rights and their urging of "states to take a host of specific measures to ensure the full exercise of these rights."
Barriers to access are described as restrictive legal and policy frameworks creating barriers to service; parental authorisation requirements that might induce parental stigma, violence, or abandonment; and need for judicial authorisation. Practical barriers include: societal stigma that prevents treatment seeking; lack of information to understand SRH needs and rights; distance to treatment facilities; cost; lack of confidentiality; and disrespect, abuse and low quality or perceived low quality of care. Circumstances include acts of irreversible surgeries performed on intersex children and children with disabilities, including forced sterilisation. Provider imposed restrictions included pressured or forced submission to SRH examinations, mandatory pregnancy testing, and school-imposed long-term contraception use or withheld contraception in cases of child marriage.
The foundation for states' action to build upon strengthening their current laws, policies and practices in respect to SRHR includes international human rights standards on adolescent SRHR that have been established by the Committee on the Rights of the Child (CRC) in treaties and are reinforced by treaty monitoring bodies, "such as the Committee on the Elimination of Discrimination Against Women (CEDAW Committee), the Committee on Economic, Social and Cultural Rights (ESCR Committee), and the Human Rights Committee." These include: access to safe abortion services; affordable modern contraception, including emergency contraception; and proper care during pregnancy and childbirth. In addition, the Special Rapporteur on the Right to Health's Report on Adolescents and the CRC's General Comment on Adolescents call on states to put measures assuring adolescent SRHR in place, including removing barriers like parental consent to accessing commodities, information, and counselling, as well as assuring that access is free of pressure, violence, or coercion and then providing access to SRH services and measures to empower healthy decisions. The document recommends that "the provider should follow the course of action that is in line with the adolescent’s best interests, with this assessment weighted towards the course of action chosen by the adolescent. This approach should take into account:
- why the adolescent is seeking particular sexual and reproductive health services;
- if the services are most appropriate for the adolescent’s needs;
- whether the adolescent is capable of following the treatment regime, and
- the consequences for the adolescent if the provider denies him or her these services."
The guarantees of adolescent SRHR include:
- The Right to Life, Survival and Development
- The Rights to Equality and Nondiscrimination
- The Right to be Heard
- The Right to be Free from all Forms and Violence and Cruel, Inhuman and Degrading Treatment
- Special Measures of Protection, including respect as rights bearers rather than victims
- Rights and Responsibilities of Parents, Guardians and other Adults working with Adolescents, including non-discrimination, respect, adolescent-friendly services, accurate and comprehensive information provision, and effective communication with adolescents. States should increase capacity builiding training for health professionals and institutions working with adolescents.
States need to ensure that adolescent-friendly health services are accessible in terms of location, hours, and affordability, and have a guarantee of confidentiality and health workers trained in non-discrimination and adolescent treatment. There needs to be meaningful participation by adolescents in programme design, implementation, and monitoring and evaluation.
Redress mechanisms implemented by states should be "effective, immediately accessible, [and] rapidly-responding", so that cases of redress can be: timely due to the time-sensitive nature of reproductive care; protective of women and girls' mental and physical health; accountable to the patient opinion; and well-founded and well-written. They need to be child-friendly in language and presentation so that adolescents are fully informed of what might be done on their behalf. Providers and clinics that deny care should provide denials in writing so that minors can seek redress. Mechanisms should guarantee confidentiality and meaningful participation, a right to appeal, and access to independent decision makers, for example, the European Court of Human Rights, and states should establish national human rights institutions (NHRIs) and ombudspersons for children.
Center for Reproductive Rights website, August 8 2017.