A/HRC/39/26 approaches and coordination, including effective referral pathways. 46 Moreover, the provision of health services is complicated by restrictions on movement — of both women and girls, including during pregnancy, as well as humanitarian actors delivering services. 47 46. A human rights-based approach also analyses a programme cycle through the human rights principles of non-discrimination and equality, participation and empowerment, sustainability and international assistance, transparency and accountability. 48 2. Non-discrimination and equality 47. Discrimination against women is a factor in the non-prioritization of those services that are required only by women, including those related to maternal health and sexual and reproductive health more broadly, reflecting societal hierarchies about who matters and who does not. This is further compounded by multiple and intersecting forms of discrimination, including on the basis of age, ethnicity, race, religion and migration status. 49 For example, access to contraception is often limited in humanitarian settings. Where such services do exist, access for adolescent girls and unmarried women and girls is especially difficult because of prevailing gender norms about sexual activity outside marriage in many contexts as well as the influence of attitudes of health workers and service providers. 50 In a similar vein, and as also emphasized by the Global Respectful Maternity Care Council in its submission, pregnant women and girls often experience mistreatment and abuse at both the individual and structural levels, which is often driven by factors such as poor infrastructure, stock-outs and stress, overwork and lack of pay of providers, among others. 48. Applying the principle of non-discrimination and equality therefore means paying particular attention to the women and girls who are most at risk of being left behind. It also helps recognize and address the root causes of violations of sexual and reproductive health and rights and gender-based violence in both the public and private spheres. For instance, in Brazil, the Zika virus outbreak had a particularly acute impact on young women and girls of colour, from the poorest region of the country. 51 The root causes of their vulnerability to Zika, and lack of sexual and reproductive choices, included not only the discrimination they faced based on sex and ethnicity, but also deprivations they faced based on their socioeconomic status and living conditions. 3. Participation and empowerment 49. Women and girls continue to be seen by many institutions primarily as inherently vulnerable victims in need of protection and passive beneficiaries of assistance. Yet women and girls express their agency in many forms, including as human rights defenders, health service providers and first responders, combatants or members of armed groups or resistance movements, environmental activists, survivors and active participants in both formal and informal peace processes. 52 Besides ensuring the effective management of humanitarian action that reflects the views, experiences and needs of women and girls, a human rights-based approach, such as principles for humanitarian action, recognizes that women and girls are entitled to participate in decisions that affect their lives, including in 46 47 48 49 50 51 52 M. Onyango, B. Hixon, S. McNally, “Minimum Initial Service Package for reproductive health during emergencies: time for a new paradigm”, in Global Public Health (2013), pp. 342–356. See also The State of World Population, pp. 43–44 and 68. See submissions by the National Human Rights Commission of Nigeria, WHO, Center for Reproductive Rights, International Planned Parenthood Federation, Marie Stopes International and Women Enabled International. See also Center for Reproductive Rights, “Ensuring sexual and Reproductive health and rights of women and girls affected by conflict” (New York, 2017), pp. 28–29. See for example, A/HRC/32/18, paras. 38–39. The State of World Population, p. 42. Human Rights Watch, Neglected and Unprotected The Impact of the Zika Outbreak on Women and Girls in Northeastern Brazil (2017), p. 8. See Committee on the Elimination of Discrimination against Women, general recommendation No. 30, para. 6. 13