A/HRC/21/22
Disaggregation of data according to the criteria of sex, age, urban/rural residence, ethnicity,
marital status, HIV status, number of children, as well as by education, wealth quintile and
geographic region, is critical in this regard.22
29.
A situational analysis should identify duty-bearers and assess institutional
capacities and needs in terms of human, financial and other resources, in both public
and private sectors. Such an analysis will thus assist in the identification of accountability
gaps in sexual and reproductive health, and help to ensure adequate funding and staffing of
facilities, awareness-raising and training, including regarding human rights, and the
potential need to establish or to strengthen accountability mechanisms.
30.
A situational analysis should include a broadly participatory review of the legal
framework and the enactment, modification or rescission of laws, policies, regulations
and guidelines, as required. Express legal recognition of sexual and reproductive health
rights, equality between men and women and health as a human right should be
accompanied by regulations providing for women’s access to services.23 Laws and policies
that impede access to sexual and reproductive health services must be changed, including
laws criminalizing certain services only needed by women; laws and policies allowing
conscientious objection of a provider to hinder women’s access to a full range of services;
and laws imposing third-party authorization for access to services by women and girls.
31.
Under international law, a State is obligated to adopt appropriate measures;24
appropriate measures are evidence-based measures. All measures should be based on
authoritative public health guidance, including international guidelines, that reflect the
highest level of evidence available and are updated regularly as new evidence emerges. 25
Although the State enjoys a margin of appreciation in realizing rights, the Government
must be able to justify publicly policy choices and priorities, and the basis on which they
have been made.26
32.
Essential interventions, services and medicines must be defined in accordance
with core obligations under international law and consistent with the best available
evidence.27 The State may consider additional interventions, services, commodities and
medicines across the reproductive continuum of care to be “essential” within its jurisdiction
insofar as they supplement, rather than displace, those established as priorities according to
the best public health evidence. As evidence evolves, the national plan should be updated
accordingly.
33.
Authoritative public health guidelines include the following interventions – to
which universal access should be effectively ensured in the national plan – as essential
for improving maternal health: family planning services; prevention and management of
sexually transmitted infections, including HIV; management of unintended pregnancies,
including access to safe abortion services, wherever legal, and post-abortion care;
appropriate antenatal care; detection of domestic violence; management of pre-labour
rupture of membranes and preterm labour; induction of labour for prolonged pregnancy;
22
23
24
25
26
27
8
WHO, Keeping Promises, Measuring Results (see footnote 5), p. 12.
WHO, Reproductive health strategy (see footnote 21).
Committee on Economic, Social and Cultural Rights, general comment No. 3, para. 4.
Partnership for Maternal, Newborn and Child Health, A Global Review of the Key Interventions
Related to Reproductive, Maternal, Newborn and Child Health, Geneva, 2011; WHO, Packages of
Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Health,
Geneva, 2010.
Committee on Economic, Social and Cultural Rights, general comment No. 3, para. 4; see also
E/C.12/2000/4, para. 53.
WHO, Packages of Interventions (see footnote 25).
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