A/HRC/32/44 individual in her own right, the sole beneficiary of the service provided by the health-care practitioner and fully competent to make decisions concerning her own health. This is a matter of, among other things, a woman’s right to equality before the law. 2. Affordable health care 87. Even where significant resources are being put in place to provide universal health care, women continue to have unequal access to good-quality health-care services in many countries. This is often because the health services that only women need are excluded from insurance coverage and are not affordable. 88. Economically disadvantaged women who do not have the means to access private health care and services are disparately affected by barriers created by unaffordability. It is therefore important for States to ensure that all health care is affordable and to remove legal restrictions that in effect discriminate against women who are economically disadvantaged. 89. Health care is often unaffordable owing to discriminatory health insurance coverage. Some health insurance policies and programmes exclude various aspects of reproductive health care, including modern forms of contraception, termination of pregnancy and maternal care. Alternatively, some private health insurance schemes insure women’s reproductive health needs but add a surcharge to the premiums paid by women. Good practice includes measures that discourage insurance companies from charging women more for health insurance than men because of perceived higher costs associated with women’s reproductive health needs. 90. Public funding is necessary to subsidize primary health-care services, including medications, contraceptives, legal termination of pregnancy and treatment of sexually transmitted infections. Such services should be affordable and, in the case of economically disadvantaged women, provided free of charge. User or “informal” fees for health-care services increase the risk that these women will either forgo services or resort to substandard services, perhaps from unqualified providers. 91. Good practices include listing as essential medicines all those recommended as necessary for women’s health in the WHO Model List of Essential Medicines, public subsidization of the cost of women’s health-related services for everyone and subsidies to women of a given age or income. 92. Unaffordability of medicines is also closely linked to intellectual property laws, many of which provide exclusive patents for new medicines for long periods. However, intellectual property laws that fail to address the medical needs of women obstruct access to medicines by pushing up the price and by impeding the production and distribution of lowcost generic drugs. The right to health requires States to ensure that the pharmaceutical companies that hold a patent on essential medicines and medical devices make use of all the arrangements at their disposal to render the medicines accessible to all. 3. Effective access Conscientious objection to providing health services 93. Inadequately regulated conscientious objection may constitute a barrier for women when exercising their right to have access to reproductive and sexual health services. The jurisprudence of human rights treaty bodies states that where conscientious objection is permitted, States still have an obligation to ensure that women’s access to reproductive health services is not limited and that conscientious objection is a personal, not an institutional, practice. 17