Reproductive rights

Definition

All indi­vid­u­als have a human right to con­trol deci­sions regard­ing con­tra­cep­tion, abor­tion, ster­il­iza­tion, and child­birth. Repro­duc­tive rights refer to that free­dom. As a threat to sex­ual and repro­duc­tive health, the HIV pan­demic is shaped by the com­pre­hen­sive­ness and enforce­ment of repro­duc­tive rights. Inte­gra­tion of sex­ual and repro­duc­tive ser­vices with HIV pre­ven­ta­tive and cura­tive ser­vices is key to every stage of the global HIV response. This inte­gra­tion is espe­cially impor­tant for key and vul­ner­a­ble pop­u­la­tions with inter­sec­tional dis­ad­van­tages, which includes women who inject drugs, who are exposed to part­ner vio­lence, and who are deprived of hous­ing.

Repro­duc­tive rights man­date the inte­gra­tion of abor­tion-related care, con­sis­tent con­dom use, pro­mot­ing pre-expo­sure pro­phy­laxis, access to infor­ma­tion and care to reduce ver­ti­cal trans­mis­sion like access to anti­retro­vi­ral dur­ing preg­nancy, Cae­sarean sec­tion, and lim­ited breast­feed­ing with vol­un­tary HIV test­ing and coun­selling. This inte­gra­tion is essen­tial to ensure that every indi­vid­ual has the abil­ity to make inde­pen­dent, informed, and con­fi­den­tial choices about one’s sex­ual and repro­duc­tive health. To achieve this, the entire repro­duc­tive health and HIV ecosys­tems have to coop­er­ate with one another achiev­ing har­mony between a sen­si­tive and syn­er­gised health sec­tor with gen­der-sen­si­tive and rights-based polit­i­cal cli­mate. Com­mu­ni­ties must come together to ensure that the needs of the key and vul­ner­a­ble pop­u­la­tions are met.

Prece­dents in the Lan­guage Com­pendium call for the repeal of dis­crim­i­na­tory laws and poli­cies that increase women and girls’ vul­ner­a­bil­ity to HIV and to address vio­la­tions of their sex­ual and repro­duc­tive health and rights. The Lan­guage Com­pendium also reflect prece­dents rec­og­niz­ing that sex­ual and gen­der-based vio­lence, includ­ing inti­mate part­ner vio­lence, the unequal socioe­co­nomic sta­tus of women, struc­tural bar­ri­ers to women’s eco­nomic empow­er­ment and insuf­fi­cient pro­tec­tion of the sex­ual and repro­duc­tive health and repro­duc­tive rights com­pro­mise the abil­ity of women and girl’s to pro­tect them­selves from HIV infec­tion and aggra­vate the pan­demic. These prece­dents also call for increas­ing national lead­er­ship, resource allo­ca­tion, and other mea­sures to enhance, among oth­ers, sex­ual and repro­duc­tive health-care ser­vices.

Precedents

2021 Global AIDS Strategy 2021-2026

• “Repeal dis­crim­i­na­tory laws and poli­cies that increase women and girls’ vul­ner­a­bil­ity to HIV and address vio­la­tions of their sex­ual and repro­duc­tive health and rights.” (para­graph 153(h))

2021 Political declaration on HIV and AIDS

• “Rec­og­nize that sex­ual and gen­der-based vio­lence, includ­ing inti­mate part­ner vio­lence, the unequal socioe­co­nomic sta­tus of women, struc­tural bar­ri­ers to women’s eco­nomic empow­er­ment and insuf­fi­cient pro­tec­tion of the sex­ual and repro­duc­tive health and repro­duc­tive rights, in accor­dance with the Pro­gramme of Action of the Inter­na­tional Con­fer­ence on Pop­u­la­tion and Devel­op­ment, the 1995 Beijing Declaration and Platform for Action and the out­come doc­u­ments of their review con­fer­ences, of women and girls com­pro­mise their abil­ity to pro­tect them­selves from HIV infec­tion and aggra­vate the impact of AIDS.” (para­graph 29)

• “Increas­ing national lead­er­ship, resource allo­ca­tion and other evi­dence - based enabling mea­sures for proven HIV com­bi­na­tion pre­ven­tion, includ­ing con­dom pro­mo­tion and dis­tri­bu­tion, pre-expo­sure pro­phy­laxis, post-expo­sure pro­phy­laxis, vol­un­tary male med­ical cir­cum­ci­sion, harm reduc­tion, in accor­dance with national leg­is­la­tion, sex­ual and repro­duc­tive health-care ser­vices, includ­ing screen­ing and treat­ment of sex­u­ally trans­mit­ted infec­tions, enabling legal and pol­icy envi­ron­ments, full access to com­pre­hen­sive infor­ma­tion and edu­ca­tion, in and out of school.” (para­graph 30(a))

• “Reaf­firm the com­mit­ment to sex­ual and repro­duc­tive health and repro­duc­tive rights, in accor­dance with the Pro­gramme of Action of the Inter­na­tional Con­fer­ence on Pop­u­la­tion and Devel­op­ment, the 1995 Beijing Declaration and Platform for Action and the out­come doc­u­ments of their review con­fer­ences, and reaf­firm the right of every human being to the high­est attain­able stan­dard of phys­i­cal and men­tal health, includ­ing sex­ual and repro­duc­tive health.” (para­graph 9)

2020 Resolution on violence against women migrant workers

• “Encour­ages Gov­ern­ments to ensure the appro­pri­ate use of vol­un­tary and con­fi­den­tial HIV test­ing and preg­nancy test­ing to pre­vent unwar­ranted bar­ri­ers prior to and dur­ing migra­tion.” (para­graph 23)

2019 Political declaration of the HLM on UHC

• “Ensure, by 2030, uni­ver­sal access to sex­ual and repro­duc­tive health-care ser­vices, includ­ing for fam­ily plan­ning, infor­ma­tion and edu­ca­tion, and the inte­gra­tion of repro­duc­tive health into national strate­gies and pro­grammes, and ensure uni­ver­sal access to sex­ual and repro­duc­tive health and repro­duc­tive rights as agreed in accor­dance with the Pro­gramme of Action of the Inter­na­tional Con­fer­ence on Pop­u­la­tion and Devel­op­ment and the Bei­jing Plat­form for Action and the out­come doc­u­ments of their review con­fer­ences.” (para­graph 68)

2011 Political Declaration on HIV and AIDS

• “Rec­og­nize that access to sex­ual and repro­duc­tive health has been and con­tin­ues to be essen­tial for HIV and AIDS responses and that Gov­ern­ments have the respon­si­bil­ity to pro­vide for pub­lic health, with spe­cial atten­tion to fam­i­lies, women and chil­dren.” (para­graph 41)

• “Facil­i­tat­ing access to sex­ual and repro­duc­tive health-care ser­vices.” (para­graph 59(k))

2006 Political Declaration on HIV/AIDS

• “Pledge to elim­i­nate gen­der inequal­i­ties, gen­der-based abuse and vio­lence; increase the capac­ity of women and ado­les­cent girls to pro­tect them­selves from the risk of HIV infec­tion, prin­ci­pally through the pro­vi­sion of health care and ser­vices, includ­ing, inter alia, sex­ual and repro­duc­tive health, and the pro­vi­sion of full access to com­pre­hen­sive infor­ma­tion and edu­ca­tion; ensure that women can exer­cise their right to have con­trol over, and decide freely and respon­si­bly on, mat­ters related to their sex­u­al­ity in order to increase their abil­ity to pro­tect them­selves from HIV infec­tion, includ­ing their sex­ual and repro­duc­tive health, free of coer­cion, dis­crim­i­na­tion and vio­lence; and take all nec­es­sary mea­sures to cre­ate an enabling envi­ron­ment for the empow­er­ment of women and strengthen their eco­nomic inde­pen­dence; and in this con­text, reit­er­ate the impor­tance of the role of men and boys in achiev­ing gen­der equal­ity.” (para­graph 30)

Expert precedents

2022 Report of the Independent Expert on SOGI: Practices of Exclusion

• “Women are tar­gets of dis­crim­i­na­tion and vio­lence around the world, and the recog­ni­tion of their sex­ual and repro­duc­tive rights–that is, their abil­ity to take deci­sions in rela­tion to their bod­ies and sex­u­al­ity–is a pre­req­ui­site for ensur­ing their full enjoy­ment of rights.” (para­graph 20)

2006 Report of the Special Rapporteur on the Right to Health

• “The right to the high­est attain­able stan­dard of health enti­tles women to ser­vices in con­nec­tion with preg­nancy and the post-natal period, and to other ser­vices and infor­ma­tion on sex­ual and repro­duc­tive health. These enti­tle­ments encom­pass the key tech­ni­cal inter­ven­tions for the pre­ven­tion of mater­nal mor­tal­ity, includ­ing access to a skilled birth atten­dant, emer­gency obstet­ric care, edu­ca­tion and infor­ma­tion on sex­ual and repro­duc­tive health, safe abor­tion ser­vices where not against the law, and other sex­ual and repro­duc­tive health-care ser­vices.” (para­graph ii(a)(13))

Evidence

2022 WHO Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention, Diagnosis, Treatment and Care for Key Populations

• “All hor­monal con­tra­cep­tive meth­ods and intrauter­ine devices (IUDs) now fall into Cat­e­gory 1 of the MEC for women at high risk of HIV. Thus, women at high risk of HIV can use all meth­ods of con­tra­cep­tion with­out restric­tion.” (p. 41)

2021 State of World Population

• “When women and ado­les­cent girls have more choice in sex­ual and repro­duc­tive health care, mul­ti­ple pos­i­tive health out­comes result, includ­ing greater under­stand­ing of how to pre­vent HIV, and a greater like­li­hood of hav­ing the num­ber of pre­na­tal vis­its rec­om­mended by the World Health Orga­ni­za­tion as well as giv­ing birth with the help of a doc­tor, nurse or mid­wife.” (p. 10)

2021 WHO Updated Recommendations on HIV Prevention, EID and ART

• “A review that included 11 arti­cles and abstracts specif­i­cally rel­e­vant for vagi­nal rings con­tain­ing dapivirine for HIV pre­ven­tion found that the use of vagi­nal rings was highly accept­able (71–98% in ran­dom­ized con­trolled tri­als and 62–100% in obser­va­tional stud­ies), and the vast major­ity of par­tic­i­pants across stud­ies reported that the rings are easy to insert and remove.” (p. 10)

• “Sup­port­ing this evi­dence are stud­ies demon­strat­ing that women’s needs and pref­er­ences for sex­ual and repro­duc­tive health are het­ero­ge­neous. Expand­ing PrEP options to include a long-act­ing, woman-con­trolled option, such as the dapivirine vagi­nal ring, could help to meet unmet HIV pre­ven­tion needs for women.” (p. 7)