A/HRC/42/24 B. Participation and empowerment 55. All experts agreed that participation and empowerment are critical to ensuring accountability to women and girls affected by crisis. In this context, humanitarian preparedness, response and transition should always emphasize informed consent, choice and autonomy of women and girls in their sexual and reproductive health. 56. Addressing paternalistic approaches in emergencies and ensuring informed women’s and girls’ consent to and choice of the services they receive is key and requires further unpacking. In many cases it is not always clear, especially in the absence of language translation and awareness by providers of the local sociocultural context, that women and girls in fact fully understand what it is that they are “agreeing” to. In practice, the power imbalance leans towards the provider who makes the assessment of what the individual patient needs. This is particularly acute when it comes to adolescents. Human rights treaty bodies have explained that the onus of proving consent lies with the provider and must never be placed on a patient. Third-party authorization requirements are another challenge that was identified in this context. 57. Working with communities and understanding their views and demands concerning service provision was highlighted as an essential component of participation. This also includes partnerships and supporting and empowering local women’s organizations and rights defenders. Actors operating in humanitarian contexts often fail to notice and quantify the human element; the spirit, cohesion and resilience of communities’ responses to emergencies, including family and neighbourhood networks, which could be drawn on and reinforced before, during and after crisis. 58. Examples were shared where awareness of and demand and need for contraception by affected populations drove provision, ensuring that contraception was provided at an early stage beyond what was required in the Minimum Initial Service Package. Access to contraception is a life-changing intervention, and it is needed throughout all stages of a crisis. Examples were also shared of innovative initiatives which provided the space for girls to be programme designers and implementers. 59. Inclusive and participatory, multi-stakeholder approaches should be implemented starting at the preparedness and planning stages, in particular along with communities and first responders, to ensure that different stakeholders can participate meaningfully, including in their own language, and are clear about everyone’s roles and responsibilities when crisis hits. These initiatives should also be specifically targeted to population groups that are most at risk of being left behind and disproportionately impacted by a crisis. Human rights analysis can play a role in helping identify these populations groups, including the reasons for their possible marginalization, and help devise effective, inclusive responses. 60. In the same vein, experts underlined that reaching all affected communities remains a challenge, including due to insecurity, lack of infrastructure and remoteness. Reaching women and girls can be particularly challenging as in practice, consultation with communities frequently starts with a meeting of elders or traditional leaders, who are often all men. Experts underlined the important impact of reaching and meaningfully engaging also with women and girls in such communities, as emphasized by the technical guidance. This not only ensures that services reflect their experiences and needs; it also empowers them to understand and claim their sexual and reproductive health and rights. At the same time, experts also noted the need to understand the risks in the local context, including how humanitarian actors and activities could in fact do harm at the community and family level, including by potentially putting women and girls in situations of vulnerability. 61. In this context, working with men and boys, including male religious and community leaders, was also considered a good practice. They can be the support mechanism for women and girls seeking sexual and reproductive health services and play important roles in helping overcome sociocultural obstacles to the provision of services perceived as sensitive and addressing the stigma women, girls and providers may face. 11