A/HRC/47/38 legal protections and political commitments. Many crises experienced individually by women and girls, such as unplanned pregnancy and sexual violence, infringe on their dignity, restrict their freedoms and are tied to their sexual and reproductive status. They are linked to structural discrimination and fostered by the patriarchal oppression, pervasive gender stereotypes, stigma and taboos that drive gender inequality. Such crises are not officially recognized and continue to be ignored, notwithstanding their systemic nature and the grave consequences for women and girls. 13. The widespread occurrence of forced and early pregnancy caused by sexual abuse, lack of comprehensive sexuality education or harmful practices, 9 such as child marriage, as well as gang violence, have been identified by women and girls as seriously neglected crises. Many sexual and reproductive health concerns involve mental health aspects, which are also neglected and intensify in situations of crisis. The toxification of the planet is a less visible crisis, which has devastating consequences for the sexual and reproductive health of women and girls, contributing to infertility, miscarriages, premature births, early menstruation and menopause, cancers of the reproductive system and decreased lactation, among other things.10 14. A radical shift in the approach to identifying and addressing situations of crisis is needed, one that is gender responsive, intersectional and acknowledges the hidden, yet deep, trauma associated with the non-fulfilment of the sexual and reproductive health rights of women and girls, as well as the life-long and intergenerational impact thereof. Many situations of crisis are predetermined by cumulative layers of pre-existing inequalities and discrimination, which may be starkly exposed and deeply exacerbated by a specific event. 11 As recalled by the Human Rights Council Advisory Committee, patterns of human rights violations provide an early indication of a potential or emerging crisis. 12 During the COVID19 pandemic crisis, women indeed highlighted that for them “the crisis already existed”.13 15. No country in the world has successfully eliminated discrimination against women and girls or achieved full gender equality.14 Laws and policies that deny women and girls their sexual and reproductive health rights are inherently discriminatory. States cannot be truly prepared for or recover from a crisis, if structural inequalities and gaps persist that deny women and girls the full range of sexual and reproductive health services and goods, undermine their autonomy and neglect the underlying determinants of health. 2. Sexual and reproductive health rights 16. The current non-enjoyment of sexual and reproductive health rights by women and girls is a significant challenge to gender equality and reveals deep inequities. An estimated 810 maternal deaths occur each day globally,15 and 25 million unsafe abortions take place annually,16 resulting in approximately 47,000 deaths every year, 17 primarily in developing countries and among members of socioeconomically disadvantaged and marginalized populations. Every 16 seconds there is a stillbirth.18 More than 200 million women who want to avoid pregnancy are not using modern contraception, due to a range of barriers. 19 Millions of women and girls are denied the ability to manage their monthly menstrual cycle safely and with dignity.20 Those outcomes and barriers increase significantly in times of crisis. 9 10 11 12 13 14 15 16 17 18 19 20 See joint general recommendation No. 31 of the Committee on the Elimination of Discrimination against Women/general comment No. 18 of the Committee on the Rights of the Child (2019). E/C.19/2013/9, para. 21. See also Donatella Caserta and others, “Environment and women’s reproductive health”, Human Reproduction Update, vol. 17, No. 3. See Jane McAdam, “The concept of crisis migration”, Forced Migration Review vol. 45, No. 10. A/HRC/28/76, paras. 42–43. Views expressed during the regional consultations held by the Working Group. See A/HRC/38/46. World Health Organization (WHO), “Maternal mortality”, evidence brief, 2019. Ann M. Starrs and others, “Accelerate progress – sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission”, The Lancet, vol. 391, No. 10140. WHO, “Safe abortion: technical and policy guidance for health systems”, 2012. United Nations Children’s Fund (UNICEF), “A neglected tragedy: the global burden of stillbirths”, 2020. Ann M. Starrs and others, “Accelerate progress”. UNICEF, “Guidance on menstrual health and hygiene”, 2019. 5