A/HRC/39/26 24. Multiple stakeholders reported on the challenges posed by stigma, stereotypes, sociocultural barriers or discriminatory practices and abuse associated with women’s sexuality and reproductive health care, including by health workers. The particular impact this had on women and girls in situations of vulnerability and marginalization was also underscored. 25. Financial and human resources and infrastructure constraints continued to thwart the full implementation of the guidance, with civil society organizations often required to assist. In their submissions, the Democratic Republic of the Congo, Mauritania, Senegal and UNFPA Burundi reported hardships in garnering financial resources to advance maternal health and/or in ensuring access for women in remote or poverty-stricken areas. The National Human Rights Commission of Nigeria also noted challenges in addressing delays in access to adequate emergency obstetric care and overcrowded maternity wards. Mali, Mauritania, Sweden and the civil society organization Roda also highlighted shortages in the skills supply of health workers providing maternal health care, in particular at the community level. 26. Restrictive funding policies by donors, including on abortion, had an impact on the ability of civil society organizations to effectively address maternal mortality and morbidity using a human-rights based approach. 11 For instance, Family Health Options Kenya reported reduced resources for health programmes directed at marginalized women and girls in two counties as a result of changes in donor policy. 27. According to a number of submissions, there were challenges in ensuring adequate coordination in responses and in the systematic collection of accurate reliable data on maternal mortality and morbidity to inform policies and programmes.12 28. Addressing maternal mortality and morbidity as a human rights concern in humanitarian settings presents particular challenges that require dedicated analysis. Therefore, the remaining sections of the present report focus on the implications of a human rights-based approach to reducing maternal mortality and morbidity in humanitarian settings.13 This non-exhaustive analysis points to the need for further work in this area. V. Application of a human rights-based approach to humanitarian settings A. Overview 1. Sexual and reproductive health in humanitarian settings 29. Women and girls of reproductive age constituted more than a quarter of 100 million people in need of humanitarian assistance in 2015.14 In such settings, women and girls face much higher risks of maternal mortality and morbidity, and some sources suggest that over half of maternal deaths occur in such contexts.15 The nature of these crises is increasingly complex and protracted and the average length of time spent in a refugee camp is 20 years. 16 Some young persons and children have never known life outside of crisis — 11 12 13 14 15 16 Submissions by Swedish Association for Sexuality Education. See also PAI, “Access Denied: Uganda Preliminary Impacts of Trump’s Expanded Global Gag Rule” (Washington, D.C., 2018); and International Women’s Health Coalition, “Taking the Pulse of Trump’s Deadly Global Gag Rule” (6 November, 2017). Submissions by the Democratic Republic of the Congo, El Salvador, Georgia, Mauritania and Roda. As the Human Rights Council recognized in its resolution 35/16, “humanitarian settings” include humanitarian emergencies, situations of forced displacement, armed conflict and natural disaster. Each type of emergency may have specific implications for sexual and reproductive health and rights, which is beyond the scope of the present report. However, the foundations of the human rights-based approach can be applied generally across all emergencies. UNFPA, The State of World Population: Shelter from the Storm (2015), p. 63. WHO, Trends in maternal mortality 1990 to 2015 (2015), pp. 26, xi. The State of World Population, p. 14. 7