A/HRC/47/38 24. Legal safeguards and protocols that ensure privacy, confidentiality and free and informed consent and decision-making, without coercion, discrimination or fear of violence, are necessary to guarantee the equal enjoyment of sexual and reproductive health rights for women and girls.37 The stigma often assigned to sexual and reproductive health conditions, such as obstetric fistula, menstruation, abortion, adolescent pregnancy and sexually transmissible infections, is rooted in discriminatory gender stereotypes and patriarchal norms that must be dismantled through appropriate policies and interventions. 38 2. Failure by States to prioritize sexual and reproductive health rights 25. States are consistently failing to comply with the full scope of their human rights obligations in relation to sexual and reproductive health rights before and during situations of crisis. The Working Group is deeply concerned that, of the countries reporting on the 2020 review and appraisal of the implementation of the Beijing Declaration and Platform for Action, only 20 per cent indicated that they had provided women and girls, including refugees, in humanitarian settings with access to sexual and reproductive health services. 39 26. Responses to crisis too often lack a gender perspective and do not adequately meet the distinct needs of women and girls. The life-saving value of many vital sexual and reproductive health services are not recognized, and services are deprioritized or not provided at all.40 Discrimination against women underpins the lack of prioritization of those services, “reflecting societal hierarchies about who matters and who does not”.41 Measures adopted by States during a crisis, such as the diversion of financial and human resources away from sexual and reproductive health care and the imposition of restrictions on services, thereby deeming them non-essential, amount in practice to a retrogression, which is incompatible with States’ human rights obligations.42 Such restrictions often continue to undermine access to sexual and reproductive health care after a crisis ends, 43 and, in the majority of cases, reconstruction programmes and recovery plans fail to prioritize sexual and reproductive health.44 During the COVID-19 pandemic, delivery of a broad range of essential sexual and reproductive health services and goods has been suspended or postponed, including: contraceptive information and services; safe abortion services and post-abortion care; mammograms, cervical cancer detection and testing and treatment for HIV and other sexually transmitted infections; support services for women and girls subjected to female genital mutilation; and fertility treatments. 45 Treatments for gender dysphoria have also been disrupted, with serious psychological consequences for those concerned.46 27. The Working Group emphasizes the crucial role of various actors in the provision of sexual and reproductive health care. All sectors of society – individuals, including health professionals, families, local communities, intergovernmental and non-governmental organizations, civil society organizations, as well as the private business sector – have responsibilities regarding the realization of the right to health. 47 The State, besides exercising the obligations of due diligence over the actions of private individuals and non-State actors that might impair the sexual and reproductive health rights of women and girls, must provide 37 38 39 40 41 42 43 44 45 46 47 8 Committee on Economic, Social and Cultural Rights, general comment No. 22 (2016); and Committee on the Elimination of Discrimination against Women, general recommendation No. 24 (1999). See A/HRC/32/44. See E/CN.6/2020/3. A/HRC/42/24, para. 53. A/HRC/39/26, para. 47. See Committee on Economic, Social and Cultural Rights, general comment No. 14 (2000) and general comment No. 22 (2016). Submission by the Feminist Alliance for Rights about the experience during the Ebola virus disease crisis. See Office of the United Nations High Commissioner for Refugees (UNHCR), “Handbook for the protection of women and girls”, 2008. See submissions by Danish Institute for Human Rights; Finland; El Salvador; Slovenia; Global Respectful Maternity Care Council; End FGM European Network; Marie Stopes International; and Comunidad de Derechos Humanos. See submissions by Finland and CHOICE for Youth and Sexuality. Committee on Economic, Social and Cultural Rights, general comment No. 12 (1999).