A/HRC/18/27
of ensuring that adolescent girls and women are not forced to resort to unsafe abortion.34
Ensuring contraception and access to safe abortion and post-abortion care will reduce the
need for women to seek unsafe abortions. In particular, access to contraceptive goods and
services, and comprehensive, evidence-based information about them, are essential to avoid
unwanted pregnancies but do not preclude the need for the provision of safe abortion
services. Annually, it is estimated that 33 million unintended pregnancies occur owing to
failures in contraceptive methods. Women who experience contraceptive failures, for
example, need access to safe services. According to WHO, the numbers of unsafe abortions
are likely to continue to increase unless women’s access to safe abortion and contraception
are put in place and strengthened.35 Regardless of the legality of abortion, humane postabortion services must be provided, including guidance on contraceptive methods to avoid
unwanted pregnancies.
30.
A human rights-based approach implies that States must take steps to eliminate such
barriers to the provision of abortion services and that lead women to resort to unsafe
abortions, including eliminating unacceptable delays in providing medical attention; the
existence of laws that require health personnel to report women who undergo abortion; and
requirements for third-party consent for a woman to obtain abortion, even when her life is
in danger. They must organize health services so that the exercise of conscientious
objection by health professionals does not prevent women from obtaining access to health
services.
E.
Improved monitoring and evaluation
31.
Accountability is at the core of the enjoyment of all human rights, and has two main
components: (a) addressing past grievances; and (b) correcting systematic failure to prevent
future violations. Accountability determines what is working (so it can be repeated) and
what is not (so it can be adjusted).36 The absence of human rights-based accountability
mechanisms for maternal deaths and disability caused by health system failures, socioeconomic disparities and discriminatory social practices is a major impediment to reducing
maternal mortality and morbidity.
32.
When States implement a national public health strategy and plan of action, they
should also develop appropriate indicators to monitor progress made, and to highlight
where policy adjustments may be needed.37 Monitoring helps States to understand the
problems and shortcomings encountered in realizing rights, providing them with the
framework within which more appropriate policies can be devised.38 States should establish
accessible, effective, independent and transparent accountability mechanisms at the national
level, operating in public and private sectors, constantly improving existing programmes
and policies to ensure redress and reparations when pregnancy-related violations occur.
33.
The Special Rapporteur on the right to health has strongly recommended that all
States introduce, as a matter of urgency, a comprehensive, effective registration system and
a system of maternal death audits in order to determine why deaths occurred. Such maternal
34
Including by ensuring family planning, pre-and post-natal care, skilled delivery and emergency
obstetric care. See Committee on Economic, Social and Cultural Rights, general comment No. 14,
para. 14; Committee on the Elimination of Discrimination against Women, general recommendation
No. 24, para. 27; and Maputo Protocol, art. 14, para. 2. See also A/HRC/14/39, para. 25.
35
WHO, “Unsafe abortion” (see footnote 28), p. 1.
36
A/HRC/4/28, para. 46.
37
Ibid., para. 28 (e).
38
Committee on Economic, Social and Cultural Rights, general comment No. 1, para. 8.
10
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