A/HRC/32/44 not available. Characterizing women’s menstrual pain as “neurotic” tends to make women reluctant to seek help, which can delay diagnosis of, for example, the severely disabling disease of endometriosis, in which tissue that normally grows inside the uterus grows in an abnormal anatomical location. 71. Prejudices surrounding menopause may affect women’s confidence in professional and public life, owing to age-based discrimination in the workplace. In some societies, this question is poorly addressed and understood, if at all. Medicalization through hormone replacement therapy, and pressure on active women to use it, even where there are health contraindications, can have a detrimental effect on women’s mental health. 72. Similarly, instrumentalization and stigmatization are at work regarding breastfeeding in public spaces and at workplaces. Aside from the fact that breastfeeding is often promoted or discouraged for economic reasons, it may be viewed as inappropriate even in countries where the practice is legally protected, exposing women to unnecessary stress and pressure from intimidation and harassment. According to the United Nations Children’s Fund (UNICEF), the majority of the approximately 830 million women workers worldwide do not enjoy workplace policies that support nursing mothers. 4. Pathologization and overmedicalization of women 73. Viewing women’s behaviour and biological physiology, in particular their reproductive functions and sexuality, as symptomatic of medical problems reflects a history of gendered pathologization. Historically, pathologization, unnecessary medicalization and institutionalization in mental care facilities have functioned as forms of social control exercised by patriarchal establishments to preserve the gender roles of women. Pathologization of women’s behaviour has been evidenced in psychiatric diagnoses, which often directly target perceived immoral activity such as unconventional sexual activity or intellectual independence as a source of mental illness or disorder. 74. The Working Group is concerned that many national laws and policies provide for overmedicalization of certain services that women need to preserve their health without a justified medical reason. These include requirements that only doctors can perform certain services, such as pharmaceutical termination of pregnancy or obstetric care. In many countries, women are not given a free choice between different ways of giving birth. Caesarian sections, when medically justified, can be crucial in preventing maternal and perinatal mortality and morbidity. However, studies conducted by WHO demonstrated that performing caesarian sections on more than 10 per cent of women does not lead to improvement in mortality rates. Caesarean section rates of 30 per cent in some countries demonstrate overmedicalization of childbirth, with the risks of obstetrical complications and health problems. 75. Overmedicalization may result in reduced access to or affordability of services needed by women and a barrier to developing adequate alternative services which can be competently provided by nurses, midwives or auxiliary nurses, either at clinics or at home. Such “task shifting”, particularly in places where there are few qualified doctors, would make services more accessible. Similarly, restricting authorization for the use of contraceptives to a medical practitioner is a barrier to access. Allowing pharmacists to provide contraceptives, including emergency contraceptives, over the counter is essential for effective availability, especially for economically disadvantaged women or adolescent girls. 5. Discriminatory use of the criminal law 76. The discriminatory use of criminal law, punitive sanctions and legal restrictions to regulate women’s control over their own bodies is a severe and unjustified form of State 14

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