A/HRC/41/33/Add.1 such violations also applied to women with intellectual and psychosocial disabilities, whose health needs are generally not sufficiently addressed. There are no targeted health programmes for women engaged in sex work/prostitution. 2. Sexual and reproductive health 49. The experts acknowledge the State’s intention to reduce maternal mortality in Honduras – which is still very high, at 129 deaths of women per 100,000 live births 25 – as reflected in a public health campaign that seeks to encourage pregnant women to give birth in hospitals. However, they have received numerous reports that women are being forced to give birth in hospitals and that the failure to do so results in fines. The experts were also informed that midwives who assisted in delivering babies in the community were threatened with fines or incarceration. The experts consider this practice problematic as it does not respect women’s autonomy. In addition, it does not take into account other structural factors that prevent women from visiting the hospital, including transportation costs that are often prohibitive for women living in poverty and rural women. In the light of this, the experts encourage the Government to consider ways to work together with midwives and women in communities in order to develop a common, culturally sensitive approach to the reduction of maternal mortality. 50. Fertility rates in Honduras vary from 2.5 children in urban areas to 3.5 in rural areas (4.1 children for women without a university degree and 1.7 for those with a university degree). Many interlocutors pointed to the lack of accessibility of contraception, particularly in rural areas, which, together with the prohibition of emergency contraception, contributes to a high rate of unwanted pregnancy, including adolescent pregnancy. 26 According to the United Nations Population Fund (UNFPA), Honduras has the second highest rate of adolescent pregnancy among countries in Latin America. One out of four girls has been pregnant at least once before reaching the age of 19 years, and 18 per cent of adolescents’ needs in contraception are not met. In rural areas, the rate of adolescent pregnancy reaches 30 per cent. 27 The experts were informed that many early pregnancies were the result of the crimes of rape and incest. The experts regret that proposed protocols and amendments to the law, which would have enabled exceptions to the absolute bans on abortion and emergency contraception and which could take into account the needs of victims of sexual violence, including child victims, have not been put in place. 51. The Working Group echoes the concerns of the Committee on the Elimination of Discrimination against Women (CEDAW/C/HND/CO/7-8), the Inter-American Commission on Human Rights, 28 and special procedures mandate holders that women’s sexual and reproductive rights are seriously restricted in the country. Honduras is one of the very few States in the world that prohibit abortion in all circumstances, including in cases of rape or incest, where the life and/or health of pregnant women is at risk and in cases of severe fetal impairment. The use, sale, distribution and purchase of emergency contraception is also prohibited and carries the same penalties as abortion itself. As shown by data from the World Health Organization (WHO), restrictive laws on abortion increase maternal mortality and morbidity rates due to unsafe abortions, and are not efficient in reducing the rate of abortion. 29 The Working Group has called for women to be allowed to terminate the pregnancy on request during the first trimester. 30 According to information 25 26 27 28 29 30 12 WHO, “Maternal mortality in 1990–2015: Honduras”, 2015. The adolescent birth rate is 70.8 births per 1,000 women aged 15 to 19 years (UNDP, “Human development indices and indicators: 2018 Statistical Update – briefing note for countries on the 2018 Statistical Update: Honduras”). UNFPA, “Transformando retos en oportunidades”, 20 April 2016. Organization of American States, “CIDH concluye su visita a Honduras y presenta sus observaciones preliminares”, 3 August 2018. WHO, Safe Abortion: Technical and Policy Guidance for Health Systems, 2nd ed. (Geneva, 2012). Working Group on the issue of discrimination against women in law and in practice, “Women’s autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends”, Office of the United Nations High Commissioner for Human Rights, October 2017.