A/HRC/39/26 without electricity or water, and without the capacity to deliver essential services such as emergency obstetric care. 39 43. Accessibility also encompasses the right to seek, receive and impart information and ideas concerning sexual and reproductive health and rights. This information must be accurate and provided in an accessible format to everyone affected by a crisis, taking into account age, language and disability and other relevant factors. As the organization IPAS also highlighted in its submission, in addition to broad information and awareness-raising campaigns, young people in all contexts also require age-appropriate, culturally acceptable, evidence-based and reliable comprehensive sexuality education. 44. Given the above, all sexual and reproductive health services, goods, facilities and information must keep the individual health users and their experiences, views and needs central at all times. They must also be: scientifically and medically appropriate and of good quality; sensitive to gender and life-cycle requirements; designed to respect confidentiality and improve the health status of those concerned; and in line with medical ethics and culturally appropriate to the individual (acceptable). For instance, a full range of contraceptive options must be ensured, along with efforts to ascertain the preferred choices of women and girls, as programme experience in some countries suggest that women often opt for long-acting methods when they are available and of good quality. In most humanitarian settings, short-term methods of contraception appear to be the norm if contraceptive services are offered at all.40 Importantly, paternalistic approaches by health workers, informed by personal ideology rather than health evidence, are contrary to human rights requirements, which rather value respect for the autonomous decision-making of women and girls about their sexual and reproductive health. Acceptability and quality also demand respect for the health user’s privacy and confidentiality, including informing them how their information is kept confidential and ensuring availability of safe spaces for counselling, examination and treatment to promote informed decision-making free from coercion or the presence and influence of third parties. 45. Despite progress, the reality of humanitarian crises means that women and girls continue to face serious barriers in accessing quality services owing to collapsed health systems, prohibitive costs, lack of information and decision-making power, lack of privacy, insecurity, restrictions in movement and fear of further violence for seeking out care. 41 The Minimum Initial Service Package is often not fully implemented, and access for certain groups, such as adolescents remains a challenge. 42 For instance, women and girls, including survivors of sexual violence, may face insurmountable obstacles to gaining access to safe abortion services, due to misconceptions on the part of service providers about the legality of abortion,43 or the view that abortion is not considered essential medical care. 44 In the context of sexual and gender-based violence, factors such as stigma, insecurity, few confidential safe spaces, mandatory reporting requirements and unclear referral pathways discourage victims/survivors from seeking appropriate medical care.45 There also remains a lack of prioritization and related lack of awareness of the Minimum Initial Services Package among key actors, as well as challenges in terms of resources, logistics, siloed 39 40 41 42 43 44 45 12 www.savethechildren.org/content/dam/usa/reports/advocacy/sowm/sowm-2014.pdf, p. 35; see also submission by UNFPA in the Democratic Republic of the Congo. The State of World Population, p. 65. Ibid., pp. 38–40; and submissions by WHO and International Planned Parenthood Federation. See, for example, submission by WHO; and Inter-Agency Working Group, 2017 Evaluation of the Use of Inter-Agency Reproductive Health Kits for Crisis Situations (2017), pp. 14–16. Available at http://iawg.net/wp-content/uploads/2018/01/Report-on-the-Use-of-the-IARH-Kits_11.2017.pdf. According to UNFPA, “99 per cent of the world’s population lives in countries where abortion is permitted under certain circumstances.” The State of World Population, p. 68. See also, UNAMI/OHCHR, para. 46. See T. McGinn and S. Casey “Why don’t humanitarian organizations provide safe abortion services?” in Conflict and Health (2016); A. Radhakrishan, “Protecting safe abortion in humanitarian settings: overcoming legal and policy barriers”, in Reproductive Health Matters (Nov. 2017), pp. 40–47. See, for example, A/HRC/31/46 (2016), para. 38.