United Nations A/76/172 General Assembly Distr.: General 16 July 2021 Original: English Seventy-sixth session Item 75 (b) of the provisional agenda* Promotion and protection of human rights: human rights questions, including alternative approaches for improving the effective enjoyment of human rights and fundamental freedoms Right of everyone to the enjoyment of the highest attainable standard of physical and mental health Note by the Secretary-General The Secretary-General has the honour to transmit to the General Assembly the report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Tlaleng Mofokeng, submitted in accordance with Human Rights Council resolutions 6/29 and 42/16. * A/76/150. 21-09954 (E) 180821 *2109954* A/76/172 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Tlaleng Mofokeng Sexual and reproductive health rights: challenges and opportunities during the COVID-19 pandemic Summary In her first report to the General Assembly, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Tlaleng Mofokeng, focuses on sexual and reproductive health rights and the opportunities and challenges arising during the COVID-19 pandemic. Adopting the standpoint that patriarchal oppression is universal and at the origin of control of women’s bodies and sexuality, she examines the multifaceted historical impact of colonialism on these rights. She reflects on the importance of the underlying and social determinants of health and substantive equality for the realization of sexual and reproductive health rights and clarifies the nature of the legal framework that recognizes sexual and reproductive rights, with a focus on the right to sexual and reproductive health as an integral part of the right to health. The Special Rapporteur demonstrates how the COVID-19 pandemic has further thwarted the realization of the sexual and reproductive health rights of women, adolescents, girls and all persons capable of getting pregnant. Within an intersectionality framework, she examines the impact of legislation and policy, services and funding in maternal, new-born and child health services, family planning and contraception, adolescent sexual and reproductive health, comprehensive support for sexual and gender–based violence survivors, HIV/AIDS and reproductive cancers. She identifies the important positive opportunities that are offered by digital health if the digital global and gender divide is breached. The Special Rapporteur reaffirms the key principles of non-discrimination, equality and privacy. 2/25 21-09954 A/76/172 Contents Page I. Introduction: sexual and reproductive health rights through the lens of colonialism and its living legacy ................................................................. 4 II. Underlying social determinants of health and substantive equality ...................... 6 III. Methodology ................................................................. 8 IV. Legal framework .............................................................. 8 V. Right to sexual and reproductive health: challenges and opportunities during the COVID-19 pandemic .................................................................... 11 A. Maternal, newborn and child health services .................................... 11 B. Family planning, contraception, including emergency contraception, and abortion ..... 14 C. Adolescent sexual and reproductive health ..................................... 17 D. Comprehensive support for survivors of sexual and gender-based violence of all genders: prevention and response 18 E. HIV/AIDS ............................................................... 19 F. Neglected diseases: reproductive cancers ...................................... 20 G. Digital innovation and intervention: opportunities and risks ....................... 21 H. Health funding, global support and philanthropy for sexual and reproductive health rights ................................................................... 22 VI. Conclusions and recommendations ............................................... 24 21-09954 3/25 A/76/172 I. Introduction: sexual and reproductive health rights through the lens of colonialism and its living legacy 1. Controlling sexuality and, in particular, women’s sexuality has its origins in patriarchy. Patriarchal oppression is not specific to any country or region: it is universal. It has permeated all societies across the globe and its impact has been devastating. Colonialism has perpetuated the patriarchal control and oppression of societies and the control of sexuality.1 Bodies of women, girls and gender-diverse people have long been subjected to discrimination, violence and oppression where human rights violations have occurred unabated. As indicated in the first thematic report, outlining strategic priorities, of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Tlaleng Mofokeng, the right to sexual and reproductive health is an integral part of the right to health. 2 Many obstacles stand between individuals and their enjoyment of sexual and reproductive health rights. These obstacles are interrelated and entrenched, operating at different levels: in clinical care, at the level of health systems and in the context of the underlying determinants of health. The key principles that shape human rights, especially non-discrimination, equality and privacy, as well as the integrity, autonomy, dignity and well-being of individuals, especially in relation to sexual and reproductive health rights, are integral to the realization of the right to health. 2. The historical impacts of colonialism on sexual and reproductive health rights are multifaceted. Broadly, colonial regimes have seen reproduction primarily in instrumentalist terms, promoting it when it was deemed valuable for economic or political objectives and discouraging it when it was deemed undesirable. Maternal health programmes created by European colonial powers in Africa and the Caribbean in the early twentieth century, for example, were driven largely by a perceived shortage of labour needed to work on plantations and in export industries. 3 Colonial and postcolonial regimes, as well as many international organizations, then shifted to discouraging reproduction and promoting family planning in the mid-twentieth century, when smaller families were deemed more conducive to national economic development and global security.4 The connections among fertility, family size and broader social and economic development continued to be debated, strengthened by the resurgence of the rhetoric of population control in the context of climate change. 5 In the era of climate change, it must be noted that these resurgent discourses make their way into social and policy discussions and attribute environmental destruction __________________ 1 A/HRC/29/40, paras. 13–14. 2 A/HRC/47/28, para. 65. 3 Lynn M. Thomas, Politics of the Womb: Women, Reproduction, and the State in Kenya (Berkeley, California, University of California Press, 2003); Juanita De Barros, Reproducing the British Caribbean: Sex, Gender, and Population Politics After Slavery (Chapel Hill, North Carolina, University of North Carolina Press, 2014). 4 Rickie Solinger and Mie Nakachi, eds., Reproductive States: Global Perspectives on the Invention and Implementation of Population Policy (Oxford, Oxford University Press, 2016); Betsy Hartmann, Reproductive Rights and Wrongs: The Global Politics of Population Control (Boston, Massachusetts, South End Press, 1995); Matthew Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge, Massachusetts, Belknap Press of Harvard University Press, 2008); Laura Briggs, Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico (Berkeley, California, University of California Press, 2003); Susanne Klausen, Race, Maternity, and the Politics of Birth Control in South Africa, 1910–39 (Basingstoke, United Kingdom, Palgrave Macmillan, 2004); Sanjam Ahluwalia, Reproductive Restraints: Birth Control in India, 1877–1947 (Urbana, Illinois, University of Illinois Press, 2008); and Nicole Bourbonnais, Birth Control in the Decolonizing Caribbean: Reproductive Politics and Practices on Four Islands, 1930–1970 (New York, Cambridge University Press, 2016). 5 See themed section: Populationism, in Gender, Place and Culture, vol. 27, No. 3 (March 2020). 4/25 21-09954 A/76/172 to the reproduction of poor, indigenous people and people of African descent. A de-colonial approach would refuse the instrumentalist terms of this debate altogether, calling for full access to reproductive and sexual health-based services as a fundamental human right in and of itself, rather than as a means to an end determined by State priorities. 3. Colonialism and its effect on laws and policies also point to the importance of the brutal history of fertility control based on the application of the concept of eugenics through which poor Black women and women of marginalized ethnicities in the global South and indigenous people in the global North6 were targeted in the name of containing “over-population”. The motivations driving this concept, which is still invoked today, are rooted in racism and classism, as illuminated by the concept of “stratified