the core around which pragmatically determined public health sciences and services are centred. Identification of unsafe abortion as a public health concern requires that the same human rights considerations that apply to other facets of public health be applied to abortion. That is, that individuals be empowered to a maximum extent to achieve safely what they have been doing unsafely, that members of the public be engaged voluntarily in public health strategies, and that legal restraints and punishments be employed only as a means of last resort, after good faith attempts at lesser alternatives have been exhausted. In the context of abortion, this means that avoidance of unplanned pregnancy be minimized by, as the Cairo Programme envisaged, “improved family-planning services”, and that women and health care providers be facilitated to collaborate voluntarily in abortion choices. This may be done, for instance, by reform or liberal interpretation of restrictive laws, and by using legal restraints only against untrained abortion providers when safe legal services are adequately accessible. The spirit of the 1994 Cairo Programme of Action was accurately captured when Guyana enacted its Medical Termination of Pregnancy Act 1995. In its full title, the legislation was described as: An Act to reform the law relating to medical terminations of pregnancies, to enhance the dignity and sanctity of life by reducing the incidence of induced abortion, to enhance the attainment of safe motherhood by eliminating deaths and complications due to unsafe abortion, [ and ] to prescribe those circumstances in which any woman who voluntarily and in good faith wishes to terminate her pregnancy may lawfully do so… The application of human rights to reduce the causes and consequences of unsafe abortion Human rights are being increasingly used to require governments to address the causes and consequences of unsafe abortion. This section will explain how human 18 REBECCA J. COOK Book ch.02.qxd 11.2.2005 10:36 Page 18 rights have been applied, particularly in the developing countries, to the advantage of women’s health in the context of abortion. It addresses how these rights have been applied both by national courts and by international human rights treaty bodies. Human rights treaty committees have been vigilant in their monitoring of country reports on what countries have done to bring their laws, policies and practices into compliance with their respective treaty obligations with respect to unsafe abortion. The Concluding Observations of these human rights monitoring committees are beginning to apply human rights in creative ways to governmental laws and policies that exacerbate the problem of unsafe abortion. Further research into how these laws have been applied by different courts is needed to determine how other national courts and human rights monitoring committees have applied human rights to the many different dimensions of abortion laws and policies. Key human rights that will be addressed are: ● The right to equal protection of the law. ● The right to liberty and security of the person. ● The right to be free from inhuman and degrading treatment. ● The right to health. ● The right to nondiscrimination, on grounds including sex and race. The right to equal protection of the law In failing to put into effective operation the legal indications for providing health services that only women need, a government might well be in violation of the right of women to equal protection of the law. Failure of a government to provide abortion services for the indications for which it is legally permitted is unfair to those who are entitled to the benefit of the law, and thus a denial of the right to equal protection. For instance, in the Mexican states where abortion is permitted in cases of rape, the governments of those states have generally not provided services to the approximately one in five victims of rape who become pregnant as a consequence (3). Despite many criticisms of the lack of access to lawful abortion in such cases, Mexico has not established procedures to enable pregnant rape victims to obtain safe abortions for this legal indication, leaving women at risk of involuntary pregnancy and motherhood of rapists’ children, or to preserve their personal integrity by resorting to unqualified and often unskilled services (4). 19 ABORTION, HUMAN RIGHTS AND THE ICPD Book ch.02.qxd 11.2.2005 10:36 Page 19 In contrast to Mexico, important work has been done in Brazil to operationalize the legal indication for abortion in cases of rape, such as the work in some public hospitals in Rio de Janeiro (5). Women’s health advocates there recognized that women were not able to have access to legally permitted abortion in cases of rape. Health systems research led to better understanding of how women’s health groups, the police, hospitals and health care providers could be better informed about the law, and could work together to ensure women’s access to legal services. They also recognized that norms and standards had to be clarified to bind those responsible for implementation of these legal services. This led to successful collaboration of women’s health advocacy groups and the Brazilian Federation of Gynecologists and Obstetricians with the Ministry of Health, which resulted in the development of a Protocol of the