A/HRC/43/40 their children in the context of conflict and humanitarian crisis (A/72/164, para. 27). Furthermore, this practice is deeply embedded in patriarchal norms and gender discrimination. The stigma surrounding the topic of sex perpetuates the practice of child marriage as a legitimate way to prevent premarital sex. In parallel, lack of sexual and reproductive health education results in out-of-wedlock pregnancies. 7. Sale of children: illegal adoption 53. Another manifestation of the sale of children examined by the Special Rapporteur is related to illegal adoption. In 2017, she devoted her thematic report (A/HRC/34/55) to adoption that occurs through the commission of illegal acts and illicit practices such as abduction, sale, trafficking, lack of proper consent from the biological parents, fraud and improper financial gain. These acts reflect deficiencies in child protection systems. This situation is exploited by criminal networks, often with the involvement of State officials or as the result of permissive State policies. All actors are driven by the lucrative business of illegal adoption, and the impunity for these crimes only serves to fuel this scourge. 54. In 2018, in one its judgments regarding allegations of illegal adoption facilitated by government officials, the Inter-American Court of Human Rights stated unequivocally that illegal adoption was among the “purposes of exploitation” covered by the definition of trafficking in the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime.42 The Special Rapporteur had submitted an opinion in this case. Reliable figures regarding the sale of children for the purposes of illegal adoption are difficult to establish owing to the hidden nature of those activities. Furthermore, adoption facilitated through illegal channels can appear legal after “official” adoption papers have been received. 55. In addition to the crimes committed by individuals or criminal networks to secure the adoption of a child, the main issue is the enabling environment for such crimes. This includes poverty, conflict, humanitarian crises, a poorly paid and underresourced civil service, corruption, inadequate social protection systems and alternative care systems relying on privately run residential facilities. 56. Today, weak child protection systems at the national level, including obstructed access to birth registration or legislation facilitating relinquishment or abandonment, further enable criminal networks and intermediaries to facilitate illegal adoption, often with the complicity of government officials. The existence of intercountry adoption from countries of origin that are not party to the Hague Convention on Protection of Children and Cooperation in respect of Intercountry Adoption of 1993 is also linked to a higher risk of illegal adoption. The lack of accountability and redress for victims of illegal adoption is another problem highlighted by the Special Rapporteur, largely resulting from the lack of comprehensive national legislation criminalizing illegal adoption as a separate offence. Past cases of large-scale illegal adoption continue to affect survivors in a number of countries. 8. Surrogacy and the sale of children 57. In two thematic reports (A/HRC/37/60 and A/74/162), the Special Rapporteur raised concerns over modern practices of surrogacy and the sale of children against the backdrop of thriving medical tourism, the international and national regulatory vacuum, and the existing disparity in surrogacy laws and practices. However, the Special Rapporteur emphasizes that nothing in her reports should be interpreted as a restriction of women’s autonomy in decision-making or of their rights to sexual and reproductive health. Further research on surrogacy by other human rights mechanisms is needed, in particular as it is related to women’s rights. 58. The Special Rapporteur has observed that domestic laws prohibiting surrogacy are often sidestepped and States are confronted with surrogacy arrangements carried out abroad, leading to issues surrounding, inter alia, rights to identity, access to origins and the family 42 10 Inter-American Court of Human Rights, Case of Ramírez Escobar et al. v. Guatemala, Series C No. 351, Judgment, 9 March 2018. For a summary, see www.ohchr.org/Documents/Issues/Children/ Submission/Resumen_Ramirez_Escobar.pdf.