A/HRC/47/38 providing contraceptive services to rural and marginalized communities, by deeming them non-essential, and further rollbacks of existing laws and policies have been attempted. 107 D. Women and girls facing compounded barriers and threats 54. Certain groups of women and girls are at increased risk of violations of their sexual and reproductive health rights, and their situation is worsened in times of crisis, due to multiple and intersecting forms of discrimination. The impact of a crisis is exacerbated by the pre-existing inequalities and discrimination in their socioeconomic status combined with gaps in legal and policy frameworks and crisis responses. 108 Some groups have been historically subjected to a “persistent state of crisis” on racial and ethnic grounds. The Working Group takes note of a selected few cases below. 1. Girls and adolescent girls 55. Girls and adolescent girls are at increased risk of sexual violence, early and unplanned pregnancy, coerced sex and harmful practices in general and in particular in situations of crisis. 109 Those risks are driven by lack of access to information, goods and services, 110 combined with pervasive stereotyping and taboos. School closures and lockdown measures during the COVID-19 crisis have led to a crucial loss of access to sexual and reproductive health information and missed opportunities to detect and report cases of violence. 111 56. During the Ebola virus disease outbreak, adolescent girls in crisis-stricken communities became pregnant at twice the rate of those in communities that were less affected. 112 During a crisis, arranged and forced marriages increase, driven by harmful traditional practices in the context of aggravated poverty.113 Married-off girls face a higher risk of pregnancy-related mortality and obstetric fistula, a preventable and devastating pregnancy-related injury which causes incontinence and can lead to stigma, abandonment and social exclusion. 114 Nevertheless, child marriage and adolescent girls’ sexual and reproductive health needs remain largely unaddressed in humanitarian settings. 115 2. Rural women and girls 57. Rural areas are generally underserved, leaving rural women and girls even more exposed to violations of their sexual and reproductive health rights when crises arise. Contraceptive access is low, 116 and maternal mortality and morbidities, such as obstetric fistula and uterine prolapse, are high among rural women and girls. 117 There is a higher incidence of stillbirths.118 Barriers commonly faced by rural women and girls include long 107 108 109 110 111 112 113 114 115 116 117 118 Colleen Marcoux, “Sexual and reproductive health during the COVID-19 crisis”, International Women’s Health Coalition, 2020; Center for Reproductive Rights, “Sexual and reproductive rights during COVID-19 response and beyond: standards from the United Nations”, 2020; submission by Marie Stopes International; and www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?News ID=26290&LangID=E. See submissions by Mexico, ASEAN Disability Forum, Women Enabled International, Global Interfaith Network, Latsi Nu Women Agency and Choice for Youth and Sexuality. UNFPA, “Adolescent girls in disaster and conflict”, 2016; UNHCR, “Handbook”; and Plan International, “Adolescent girls in crisis: voices from the Sahel”, 2020. See submission by Choice for Youth and Sexuality. See submissions by Kenya and Finland; and Colleen Marcoux, “Sexual and reproductive health”. World Bank, “Empowering adolescent girls in a crisis context: lessons from Sierra Leone in the time of Ebola”, policy brief No. 34, 2019. See CRC/C/SYR/CO/5; 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); and submissions by the Feminist Alliance for Rights and Mali. See www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula. See submission by Plan international. See www.choiceforyouth.org/assets/Docs/198f89dc19/PositionPaper_CSW_DEF.pdf. Committee on the Elimination of Discrimination against Women, general recommendation No. 34 (2016). See https://data.unicef.org/resources/a-neglected-tragedy-stillbirth-estimates-report/. 15