A/HRC/47/38 62. Relief programmes often do not take into account the specific needs of women and girls, including routine menstrual hygiene and pain management, 134 which has physical and emotional consequences for women, who have pointed out that the “[United Nations] provides good health services for pre- and post-natal care, but, after that, there is nothing”.135 5. Women and girls in a “persistent state of crisis” 63. There are communities of women and girls whose lives have been shaped by histories of oppression, enslavement, exclusion, racial discrimination, forced assimilation and apartheid, linked to conquest and colonization, as well as systematic violence and disregard for their culture, spirituality and traditions, and, as a result, have been subjected to a “persistent state of crisis”. Many have been systematically subjected to reproductive violence, including forced pregnancy and sterilization, while others have been separated from their children. Certain groups are highlighted below, although there are women belonging to other ethnic and minority groups in a state of deep crisis, including Dalit, Rohingya, Yazidi and Uighur women.136 (a) Indigenous women and girls 64. Indigenous women and girls are a diverse community, bound by their histories of being subjected to conquest, colonization, forced assimilation and the continuing dispossession of their peoples’ lands, and many have also been subjected to acomplex spectrum of human rights abuses 137 involving discriminatory and coercive practices, such as eugenically imposed birth control, forced sterilization and systemic sexual abuse and rape.138 Pregnancy-related morbidity and mortality rates are relatively higher among indigenous women and girls.139 The absence of health services that specifically incorporate indigenous knowledge, their worldview and an intercultural approach contributes to language and cultural barriers, cost barriers and poorer reproductive health outcomes. 140 65. In urban areas, indigenous women and girls may have greater access to facilities than their rural counterparts, but they often “suffer from invisibility and discrimination” based on their indigenous identity.141 In many cases, the criminalization of indigenous midwifery and the denial of the opportunity to give birth on the land of their ancestors, which in many traditions breaks the spiritual connection of the newborn with the community, also contributes to the overall feeling of insecurity and the distress of pregnant women during childbirth.142 For indigenous women, the connection to ancestral lands and the environment is fundamental to their health status.143 (b) Women and girls of African descent 66. The legacies of slavery, systemic racism, structural discrimination and coercive practices against women of African descent are reflected in contemporary situations of 134 135 136 137 138 139 140 141 142 143 See https://plan-international.org/because-i-am-a-girl/menstrual-hygiene-matters-refugee-girls. See submission by the Feminist Alliance for Rights. See A/HRC/32/18; https://spcommreports.ohchr.org/TMResultsBase/DownLoadPublic CommunicationFile?gId=19319; https://spcommreports.ohchr.org/TMResultsBase/DownLoadPublic CommunicationFile?gId=22468; and https://spcommreports.ohchr.org/TMResultsBase/DownLoad PublicCommunicationFile?gId=25780. A/HRC/30/41, para. 5. See submission by the Castan Centre. See E/2019/43; www.un.org/esa/socdev/unpfii/documents/2014/press/shrr.pdf; www.paho.org/hq/dmdocuments/2011/gdr-gender-equity-and-indigenous-women-healthamericas.pdf; and submissions by the Castan Centre and Native Women’s Association of Canada. See www.unfpa.org/sites/default/files/pub-pdf/UNFPA_PUB_2018_EN_human_rights_report.pdf. Ibid. See submissions by the Castan Centre and Native Women’s Association of Canada. See www.paho.org/hq/dmdocuments/2011/gdr-gender-equity-and-indigenous-women-healthamericas.pdf. 17