A/HRC/47/38 socioeconomic disadvantage and profound inequalities. 144 The disparities are starkly visible in the poor sexual and reproductive health status of, and the range of human rights violations perpetrated against, women and girls of African descent, including the mistreatment of pregnant women in health-care settings and significantly higher rates of maternal mortality.145 Racial stereotyping by health-care providers against women of African descent that leads to negligent and deliberate delays in care is one of the factors underlying the high incidence of preventable maternal deaths.146 67. Racism within the health system can be intensified by widespread State policing and surveillance and mandatory reporting requirements in relation to suspicions of drug use and child abuse or neglect, which often deters pregnant women from seeking reproductive health care and undermines their trust in health service providers.147 Such norms and practices exist against the backdrop of a harmful narrative about “Black maternal unfitness”,148 which has been used to legitimize State-sanctioned violence against Black women in the form of coerced sterilization149 and the separation of mothers from their children.150 68. As a promising practice, drawing on human rights and, more specifically, in response to their experiences, some Black activist women have developed their own advocacy framework, known as the “reproductive and birth justice framework”, which recognizes three interconnected components of reproductive justice, namely, the right to have a child, the right to not have a child and the right to parent children in a safe and healthy environment.151 (c) Roma women and girls 69. Historically, Roma women and girls across Europe have been subjected to antiGypsyism and have faced egregious violations of their sexual and reproductive health rights. The forced sterilization of Roma women was widespread in some European countries until the 1990s,152 creating a legacy of institutionalized abusive practices and mistrust in the health system. The ethnic segregation of Roma women in maternal health facilities in which basic standards of hygiene and safety are not ensured is a discriminatory practice. Health professionals may refuse their services entirely, due to the perceived inability of Roma to pay,153 or avoid treating them based on harmful stereotypes,154 leading to low quality of care and deliberate delays in the provision of services.155 70. There are disproportionately high teenage pregnancy rates among Roma girls, in part due to high rates of early or child marriage. 156 They have a higher unmet need for contraceptive information and services and face an increased risk of sexually transmitted infections, including HIV, 157 and period poverty. Discriminatory assumptions about their 144 145 146 147 148 149 150 151 152 153 154 155 156 157 18 See Durban Declaration and Programme of Action; Committee on the Elimination of Racial Discrimination, general recommendation No. 34 (2011); Arachu Castro and others, “Assessing equitable care for Indigenous and Afrodescendant women in Latin America”, Rev Panam Salud Publica, vol. 38, No. 2; Cynthia Prather and others, “Racism, African American Women and their sexual and reproductive health: a review of historical and contemporary evidence and implications for health equity”, Health Equity, vol. 2, No. 1. See submission from Birth Justice. See Da Silva Pimentel v. Brazil. See submission from Birth Justice. Ibid. See submission Her Rights Initiative South Africa. See submission from Birth Justice. Ibid. See www.euro.who.int/__data/assets/pdf_file/0015/330090/4-Advancing-womens-sexualreproductive-rights-in-Europe.pdf?ua=1. Ibid. Nadia Rusi, “Discrimination of Roma women regarding their access to reproductive health services in Albania”, European Journal of Multidisciplinary Studies, vol. 2, No. 1. Ibid. See https://eeca.unfpa.org/en/publications/inequities-roma-womens-health?page=4%2C0%2C4. Ibid.