relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant (14). The monitoring committee under the Convention on the Elimination of All Forms of Discrimination against Women (the Women’s Convention), the Committee on the Elimination of Discrimination against Women (CEDAW), has further identified the critical elements of women’s health in its 1999 General Recommendation 24: Women and Health (15). It requires that states periodically reporting Book ch.02.qxd 11.2.2005 10:36 Page 24 under the Women’s Convention address distinctive features of health and life that differ for women in contrast with men, taking into account biological factors such as differing reproductive functions, socioeconomic factors including unequal power relations, psychosocial factors such as postpartum depression, and health system factors such as the protection of confidentiality, especially for the treatment of stigmatizing conditions such as unwanted pregnancy. The International Covenant on Economic, Social and Cultural Rights (the Economic Covenant) in Article 12 protects the human right to the highest attainable standard of health. In monitoring the Covenant, the Committee on Economic, Social, and Cultural Rights has developed General Comment 14 on the Right to Health, which explains that the right requires the following interrelated features (16): ● Availability (health care services have to be available in sufficient quantity). ● Accessibility (services, including information, have to be physically and economically accessible to everyone without discrimination). ● Acceptability (services have to be culturally appropriate, that is, respectful of the cultures of individuals, minorities and communities, and sensitive to gender and life-cycle requirements). ● Adequate quality (services have to be scientifically appropriate and of adequate quality). Laws and policies that unreasonably restrict safe abortion services would not comply with this performance standard. For instance, a law or policy requiring unnecessarily high qualifications for health service providers will limit the availability of safe abortion services that contribute to women’s health and later safe motherhood. Examples are policies that require excessive qualifications for health service providers to perform abortion. Such policies may be proposed in good faith in order to ensure excellence in health care. However, it is poor public health policy and may be a human rights violation to jeopardize health care. The right to nondiscrimination, on grounds including sex and race The greatest threat to women’s reproductive health is the inability to exercise women’s rights to sexual nondiscrimination. The transcending human rights violation that explains the unduly high prevalence of abortion mortality and morbidity is that women do not enjoy the same status and significance in their communities as men. As a result, there is lack of attention to risk factors for unsafe abortion such as lack of availability of contraceptives to reduce unplanned pregnancy, sexual 25 ABORTION, HUMAN RIGHTS AND THE ICPD Book ch.02.qxd 11.2.2005 10:36 Page 25 26 REBECCA J. COOK abuse that denies women control over their sexual relations with men, and, in many communities, lack of safe abortion services. Often, sex discrimination is aggravated by discrimination on grounds of women’s race, and age, usually leaving young women of a minority racial group and of lower socioeconomic status the most vulnerable to the risk of maternal death, from both unsafe pregnancy and unsafe abortion. The South African example illustrates the relationship between abortion and racial discrimination. South Africa changed its restrictive Abortion and Sterilization Act, 1975, to the Choice of Termination of Pregnancy Act, 1996, because of its disproportionately harmful impact on the morbidity and mortality of black South African women. Excessive certification procedures for women seeking abortion for specific indications under the 1975 Act confined access to only socioeconomically advantaged, meaning white, women. A study conducted by the Medical Research Council explained that an average of 800 to 1 200 women per year qualified for abortion under the old law. Of these, 66% were white and from urban middle-class backgrounds, at a time when whites constituted only 16% of the general population. According to official estimates: Annually, upwards of 44 000 mainly black women had recourse to backstreet abortion, with the consequent toll on health and mortality. About 33 000 such women would require surgery to treat the residue of septic abortion. Abortion-related deaths amounted to over 400 a year (17). Other