A/HRC/47/38 an enabling environment that facilitates the discharge of those responsibilities and promotes respect for those rights. Health service providers should be subject to regulations to avoid violations of sexual and reproductive health rights, for example, by obstructing access to goods and services, engaging in misinformation48 or refusing care based on conscience or religion. Their conduct must be consistent with human rights standards and their ethical obligations as health-care professionals. 28. The Working Group recognizes as a promising practice the constitutional recognition of sexual and/or reproductive rights by some States and the integration of human rights standards into national legislation and policy. The formal recognition of sexual and reproductive health services as essential is also a promising practice, which, in some countries, has been achieved through national courts49 and, in others, through the explicit inclusion of those services in emergency-related responses. In cases in which sexual and reproductive health services have been declared as essential only after the onset of a crisis, implementation has suffered, in the absence of a coherent and comprehensive response and the institutional mechanisms needed to support the design and implementation of such measures with the participation of women.50 29. WHO has called for the relaxation of certain requirements and the reduction of barriers during COVID-19 in order to avoid delays in acquiring access to certain essential sexual and reproductive health goods and services, including contraceptives and safe abortion and post-abortion care.51 A promising practice by some States has been the expansion of access to self-managed medical abortion, including through telemedicine. 52 The Working Group notes that community-based midwifery can play a crucial role in responding to sexual and reproductive health needs during a crisis, supplementing scarce human resources and ensuring service coverage, in particular in remote areas, while allowing for an intercultural approach to care, which is a crucial component of acceptable and good quality care in certain communities. 3. Lack of investment in sexual and reproductive health-care services and shortcomings in foreign aid 30. States’ failure to adequately prioritize the sexual and reproductive health rights of women and girls is reflected in the lack of gender budgeting and financial investment in that area, including in foreign aid, and it is further exacerbated by austerity and neoliberal measures encompassing the privatization of public services. 53 Government spending on sexual and reproductive health could double, at least in lower middle-income countries, if countries were to increasingly prioritize health within their own budgets.54 Many States have shown a lack of capacity or willingness to commit adequate resources to sexual and reproductive health.55 31. The Working Group is concerned about structural barriers linked to mismanagement and corruption, ranging from bottlenecks that impede the flow of resources within States to 48 49 50 51 52 53 54 55 See Committee on Economic, Social and Cultural Rights, general comment No. 24 (2017); and Committee on the Elimination of Discrimination against Women, general recommendation No. 24 (1999). See www.icj.org/wp-content/uploads/2020/11/Nepal-Right-to-health-Advocacy-analysis-brief-2020ENG.pdf. See submissions by ASEAN Disability Forum and the Defensor del Pueblo of Argentina. WHO, “Maintaining essential health services: operational guidance for the COVID-19 context”, 2020. Submission by Centro de Estudios Legales y Sociales. See also Church et al, “Reproductive health under COVID-19 – challenges of responding in a global crisis”, Sexual and Reproductive Health Matters, vol. 28, No. 1. See submission by AIDS and Rights Alliance for Southern Africa. Partnership for Maternal, Newborn and Child Health and others, “Funding for sexual and reproductive health and rights in low- and middle-income countries: threats, outlook and opportunities”, 2019. See A/HRC/39/26. 9