unsafe abortion as a major public health concern and to reduce the recourse to abortion through expanded and improved family-planning services. Human rights principles acknowledge all of the many interests that pertain to the abortion dilemma. The evolution of modern human rights in international law, particularly since the Universal Declaration of Human Rights of 1948, goes beyond the exclusively national focus of the historic “Law of Nations” to place the individual at the centre of international legal concern. The individual enjoys rights to protection through his or her nation state, but also to protection against his or her own nation state when that state engages in assaults against the individual’s bodily integrity, and against the nation’s neglect of provision of services upon which the safety and dignity of the individual depends. The 1948 statement was labeled a “Declaration” because it declared human rights that were already recognized in the national laws of countries, often in their constitutions, which are the highest level of national legislation expressing the most profound principles to which countries commit themselves. To protect their human rights, individuals have primary resort to the laws of their own countries, including laws that express the purposes for which countries claim they were legally constituted, namely the welfare of their residents. However, experience before the middle of the twentieth century, particularly in Nazi-occupied Europe, showed that governments violated the human rights of certain of their residents, depriving them of their livelihoods, property, liberty, and life itself. Accordingly, the 1948 Declaration set in motion the modern 16 REBECCA J. COOK Book ch.02.qxd 11.2.2005 10:36 Page 16 human rights movement which reinforces the claims that individuals have to the protection of their national governments, and the duties that nations owe to protect the human rights of individuals. The synergy between public health and human rights was elaborated in a celebrated essay by the late Jonathan Mann. He observed not only that “human rights thinking and action have become much more closely allied to, and even integrated with, public health work” and that “the skills and expertise needed in public health include epidemiology, biostatistics, policy analysis, economics, sociology, and other behavioral sciences”, but also that “in the modern world, public health officials have… two fundamental responsibilities to the public: to protect and promote public health, and to protect and promote human rights” (2). Individual human rights to freedom of religious conscience and observance are important elements of human autonomy and dignity. Abortion is an important part of many religious convictions and, based on individual human rights, each person should be accorded the freedom of personal conscience regarding abortion. The historical conditioning of many laws was often through religious beliefs and institutions, particularly before laws were created by processes that are considered democratic in the modern sense. The Cairo Programme of Action, reinforced by the Beijing Fourth International Conference on Women in 1995, recognized the definition and approach to reproductive health that was rooted in the principles of individual liberty, though not necessarily in historical laws that satisfied religious, institutional, and national demographic agendas. In proposing that the health impact of unsafe abortion be dealt with “as a major public health concern”, the Cairo Programme of Action did not dwell upon repressive laws that deny women the ability to seek abortion through trained and qualified practitioners in medically hygienic and safe circumstances. The Programme reflected the realization that women’s choice to terminate pregnancies, whether originating from their free acceptance of sexual relations or imposed by rape and similar forces they lacked the power to resist, results from their individual moral reflection on their circumstances and the duties they owe to their families, to their communities, and to their own health and welfare. That is, the Cairo Programme of Action recognized the authenticity of each woman as the central decision-maker in her own life and future, including her reproductive future. It called for an individual right of access to sound family planning services to prevent unplanned pregnancy. The Programme recognized the reality of resort to abortion in every community, including those where, because of legal barriers or lack of services, women’s only practical access is through unqualified practitioners and/or unsafe medical environments. 17 ABORTION, HUMAN RIGHTS AND THE ICPD Book ch.02.qxd 11.2.2005 10:36 Page 17 In identifying the issue of “the health impact of unsafe abortion as a major public health concern”, the Cairo Programme of Action transcended public moral debate and urged that the pragmatic strategies of public health protection and promotion be brought to bear. The modern operation of public health services acknowledges that the needs of public health protection of communities in general cannot always be reconciled with tolerance of every person’s individual autonomy, but also acknowledges the claims to individual human rights. Human rights values rather than religious morality provide