A/HRC/44/48/Add.1 changes in legislation, policies and practices based on scientific evidence and a human rights-based approach. Existing legislation should be reviewed to decriminalize abortion and guarantee the therapeutic interruption of pregnancy through access to services, at the least when the pregnancy is the result of rape or incest, in cases of fetal impairment and when the life and health of the mother are in danger. In that respect, the Special Rapporteur reminds Ecuador of the numerous recommendations made by United Nations human rights mechanisms, including the Committee on the Elimination of Discrimination against Women, which recommended that Ecuador “decriminalize abortion in cases of rape, incest and severe foetal impairment, in line with the Committee’s general recommendation No. 24 on women and health” (CEDAW/C/ECU/CO/8-9, para. 33 (c)). 51. The Special Rapporteur was informed that the criminalization of women for abortion in the country occurs primarily in cases of obstetric emergencies arising from an abortion or home birth, which are treated by the judicial system as abortion by consent, murder or wrongful death. Women who need health care after a miscarriage or who seek an abortion are allegedly reported to the authorities by the health-care personnel. In line with the recommendations of the Committee on the Elimination of Discrimination against Women, the Special Rapporteur calls on Ecuador to respect the obligation of confidentiality in the health-care system, adopt evidence-based protocols, develop human rights training for health-care providers on their obligations to provide legal abortions, particularly on the grounds of threats to life or physical and mental health, and to respect the privacy and confidentiality of women who use sexual and reproductive health services (ibid., para. 33 (b)). Access to modern methods of contraception and family planning 52. The fertility rate is highest in women with no schooling (4.4), followed by women in the poorest economic quintile (4.1), indigenous women (4.4) and Afro-Ecuadorian women (4.0). Indigenous and Afro-Ecuadorian women also had the highest rates of non-use of contraceptives (30.7 per cent and 34.0 per cent, respectively). 23 Women in rural areas have more children, especially in the Amazon region. The unmet demand for modern contraception methods in Ecuador is 7 per cent on average. It is even higher in some population groups, in particular for indigenous women and Afro-Ecuadorian women. There seems to be a lack of family planning, as two thirds of pregnancies are unwanted. 24 The Special Rapporteur was informed that as a result of the budget cuts in the health sector, there had been no consolidated international purchases of modern contraception methods for 2019, which could lead to shortages in the short or medium term, with serious consequences such as an increase in unwanted pregnancies, abortions, obstetric complications and maternal death. He recommends that the authorities ensure the provision of quality family planning and counselling, as well as the availability of modern contraceptive methods, including through increased budgetary allocations. Access to sexual education 53. The Special Rapporteur was informed that Ecuador faces significant shortcomings in the provision of comprehensive sexual and reproductive information and education for children and adolescents in schools, in families and in other settings. According to information received, the Ministry of Education does not have a comprehensive sexual education programme aligned with international standards. In 2019, the Ministry of Education developed comprehensive sexual education curriculum proposals, including methodologies and educational materials, within the framework of the national policy of pregnancy prevention for girls and adolescents for the period 2018–2025. However, those proposals have not yet been implemented, although it is foreseen that they will be in 2020. The Special Rapporteur supports these efforts and recommends that age-appropriate, comprehensive and scientifically accurate education on sexual and reproductive health should be a compulsory element of the school curriculum. 23 See www.salud.gob.ec/encuesta-nacional-de-salud-y-nutricion-ensanut/. https://ecuador.unfpa.org/sites/default/files/pub-pdf/PLAN%20NACIONAL%20DE%20SS%20Y% 20SR%202017-2021.pdf and www.salud.gob.ec/encuesta-nacional-de-salud-y-nutricion-ensanut/. 24See 12