A/HRC/41/47 leprosy as social beings whose world is constructed within a historical and cultural frame of reference, and childhood is considered as a period in which children function as a category of a social group immersed in unequal power relations that constrain their autonomy, agency and recognition as rights bearers. 12 Children are also regarded as contributors to social thinking and policymaking, and the child’s right to protection, as well as to participation, is emphasized. III. Overview: leprosy in women and children A. Leprosy in women 25. An overall male-over-female preponderance in the incidence of leprosy has dominated epidemiological reports of the disease. In 2017, out of the 210,671 new cases reported by 150 countries to the World Health Organization (WHO), only 82,922 (39.3 per cent) were women. Moreover, there are no disaggregated data for women with grade 2 disability13 at the time of diagnosis.14 26. For decades, biomedical readings of such discrepancy placed biology at the centre of the explanation, overlooking the fact that women in different regions of the world generally have less access to health care. Such interpretation of available data may subsidize longprevailing non-equitable and discriminatory access by women to their rights. 27. The recognition of women’s central role in family health care – especially reproductive and children’s health – contributed to gender-sensitive approaches in public health. At present, the WHO Global Leprosy Strategy (2016–2020) recognizes women as a priority group. Notwithstanding, generalized underreporting prevails. Lack of a gender framework and gender-sensitive indicators, as well as critical analysis of available data (namely, how the data are collected, its quality – completeness and accuracy – and what they represent) are contributing factors to knowledge gaps. 28. Independent studies in demarcated territories reveal that active-case finding of leprosy at the community level balances the sex ratio, which ascertains generalized underdetection. Independent studies also point to delays in diagnosis and possible higher risk of women to developing leprosy-related physical impairments and disability, which calls for official reporting of disaggregated data on physical impairments at the time of diagnosis for women.15 29. Some of the institutional barriers to diagnosis and prevention of physical impairments in women result from institutional mediating factors, such as discriminatory legal frames; underfinancing of health care and poorly implemented policies for prevention, care and rehabilitation; status of leprosy services integration into primary care; the reach of health services; and the gender of the health-care workforce in primary care services. 30. However, non-addressed social barriers are also a leading cause of deficient access by women to the highest attainable standard of health (A/HRC/32/44). Some of the aforementioned barriers are harmful traditional beliefs and practices; the low status assigned to women, which is at the root of women’s widespread self-concealment of the 12 13 14 15 6 J. Qvortrup and others, eds., Childhood Matters: Social Theory, Practice and Politics (Avebury, United Kingdom, Aldershot, 1994). Grade 2 disability refers to visible impairment. The grading system used by the Global Leprosy Programme consists of grade 0, meaning no impairment; grade 1, meaning loss of sensation in the hand, eye or foot; and grade 2, meaning visible impairment. In the present report, the Special Rapporteur uses the terms “impairment” to refer to the loss of functioning or detriment to the health of persons affected by leprosy, and “disability” to refer to the social responses of discrimination and exclusion due to leprosy-related impairments. This distinction is based upon the social model of disability, which is embraced by the Special Rapporteur in her work. WHO, Weekly Epidemiological Record, vol. 93, No. 35 (31 August 2018), pp. 445–456. R. Sarkar and P. Swetalina, “Leprosy and women”, International Journal of Women’s Dermatology, vol. 2 (2016), pp. 117–121.