|Statement to the International Expert Group Meeting on the theme: Sexual health and reproductive rights|
|15 January 2014|
Statement by the UN Special Rapporteur
International Expert Group Meeting on the theme:
15 – 17 January 2014, New York
I would like to thank the organizers of this International Expert Group Meeting, and the Permanent Forum on Indigenous Issues and its secretariat, for providing me the opportunity to participate in this event and to say some words on the issue of sexual health and reproductive rights. The Permanent Forum is to be commended for convening the expert meeting as part of its work to promote an in-depth examination of this important topic, in relation to articles 21, 22(1), 23 and 24 of the United Nations Declaration on the Rights of Indigenous Peoples.The expert papers that will be presented and the statements that will come during this meeting will together provide a detailed exposition of the issues facing indigenous peoples in regard to sexual health and reproductive rights, as well as provide a close examination of the international standards, analytical approaches and other tools available to address these matters. We will most certainly hear compelling stories from indigenous people, particularly women, regarding the barriers they face in achieving sexual health and realization of their reproductive rights. No doubt we will also be challenged to develop new and practical approaches about how to promote and safeguard sexual health and reproductive rights at a time when many indigenous communities are facing a range of rapid social, cultural and economic transformations. I would like to take this opportunity to add just a few comments to this discussion, without in any way attempting to be comprehensive in addressing particular dimensions of the issue.
Sexual health and reproductive rights as a component of indigenous health
Most or all of us present at this meeting are aware that within the international human rights system there exists today an array of human rights standards relevant to indigenous peoples' right to health, which includes sexual health and reproductive rights. However, we are also aware that in the vast majority of countries indigenous peoples continue to experience significant barriers to social and economic development. In general terms, this means that they earn less, more often live in conditions of poverty, obtain less formal education, and experience greater levels of discrimination when compared to the general population. All of these factors contribute to indigenous peoples struggling to achieve and maintain health as individuals and as communities.
As discussed in the concept note for this meeting, the United Nations Declaration on the Rights of Indigenous Peoples provides in its articles 21, 22(1), 23 and 24 a framework for protecting and promoting indigenous peoples' health. Together, these articles affirm indigenous peoples' equal right to the "highest attainable standard of physical and mental health" (art. 24); their right to improve their economic and social conditions (art. 21); and their right to "determine and develop priorities and strategies for exercising their right to development" (art. 23). In addition, the Declaration emphasizes the responsibility of States to take effective measures to ensure the on-going improvement of indigenous peoples economic and social conditions, including health (arts. 21(2) and 24(2)). In this connection, article 22 calls for special attention to be paid to the "needs of indigenous women, youth, children and persons with disabilities," including through State measures to safeguard women and children against all forms of violence and discrimination.
Common challenges among indigenous peoples regarding their health and the health of their communities
In my work as the United Nations Special Rapporteur on the rights of indigenous peoples I have had the opportunity to regularly interact with indigenous peoples through meetings, conferences, country visits and other activities. This interaction has allowed me to hear directly from indigenous people about the challenges they face, advances they have made and their aspirations for the future in relation to their health, including their sexual and reproductive health, as well as the health of their families and communities.
During my mandate and particularly during country visits, I have learned about reoccurring issues that indigenous peoples face in regard to the realization of their right to health. As an initial matter, disaggregated data on the health situations of indigenous peoples in many countries is simply not available, which makes it difficult to identify specific areas of concern, assess the health situation of indigenous peoples relative to other groups, and to develop appropriate interventions and evaluate their effectiveness.
Indigenous peoples in nearly all of the countries I have visited face problems accessing adequate health services. Most often, health facilities are just not available in the remote communities where indigenous peoples live. Where health facilities do exist, they often have fewer health workers, dilapidated infrastructure, and a dearth of medical equipment and medicines. The situation of poverty in which many indigenous peoples live presents further difficulties. I have heard compelling stories from indigenous people who do not have resources to travel to far-away facilities or have been denied medical care or expelled from hospitals because they were unable to pay for services. During one country visit, indigenous women informed me that mothers who have just given birth are routinely forced out of hospital facilities on the same day they give birth because they cannot afford the hospital fees to stay. Against this background, indigenous women and children are particularly vulnerable, lending to increased rates of infant and maternal mortality, among other issues.
Undoubtedly, stereotypes and discriminatory attitudes toward indigenous peoples figure into the poor health of members of their communities. In this regard, indigenous representatives have informed me that there is an overall of lack health-care professionals who speak or understand local indigenous languages, which can frustrate basic services delivery and can result in improper diagnoses. Health services are not always provided in culturally appropriate ways, including birthing services and pre-natal care; in one country, I was told by State health officials that traditional midwives are not allowed to accompany indigenous women during births in health clinics. At the same time, I have heard indigenous people express a strong desire to access educational opportunities that would prepare them for professional health care positions to help close the health service gap resulting from cultural disconnects.
I have also observed that indigenous peoples' sexual and reproductive health is linked with issues of broader concern. Over the last several years I have carried out a study and reported on extractive industries affecting indigenous peoples. It has become evident through information received within the context of the study that extractive industries many times have different and often disproportionately adverse effects on indigenous peoples, and particularly on the health conditions of women. For example, I have learned that in many cases indigenous women living in communities near oil, gas and mining operations are vulnerable to sexually transmitted diseases, including HIV/AIDS, which are often introduced with a rapid increase of extractive workers in indigenous areas. In addition, indigenous women have reported that the influx of workers into indigenous communities as a result of extractive projects also led to increased incidents of sexual harassment and violence, including rape and assault. In one case in which I intervened indigenous girls walking to school were sexually assaulted by workers operating under a concession granted by the government for the extraction of forest resources in the indigenous peoples' traditional territory.
It also bears mention that contamination of indigenous lands and natural resources resulting from extractive activities has significant implications for reproductive health, having contributed in many cases to birth defects, delayed child development, and disease among community members. The health effects of recent and ongoing extractive operations are often yet to be determined. In this regard, I have listened to fears expressed by indigenous people living in areas contaminated from oil extraction about the unknown intergenerational health effects that the contamination will have on their communities.
All this is not to say that States have not taken any measures to address these concerns. I have heard of many innovative programs to provide sexual and reproductive health services to indigenous peoples in ways that are effective and culturally appropriate. But in general, as we are all aware and as we will be discussing at this seminar, there is still a long way to go to adequately address these problems where they arise around the globe.
In closing, the sexual health and reproductive rights of indigenous peoples require focused attention within the broader topic of indigenous health, and within the broader context of efforts to advance the rights of indigenous peoples more generally. The Declaration on the Rights of Indigenous Peoples, which are designed to remedy the continuing legacies of marginalization of indigenous peoples, provides the principle framework for addressing these areas of concern. In particular, in my view key to promoting indigenous peoples' health are concurrent efforts to enhance indigenous self-determination and control over lands and resources.
This meeting serves as an important step toward drawing greater attention to issues concerning the sexual health and reproductive rights of indigenous people I look forward to hearing further discussions and ideas about these issues at this seminar, and I wish everybody the best for a successful meeting.
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