Equal Access to Health Care

Definition

Countries are obligated by international law to prevent discrimination and to ensure equality of access in the provision of methods, techniques and services that contribute to reproductive health and well-being. Countries must make available to all family-planning counseling, information, and services; prenatal care, safe delivery, and post-natal care; prevention and appropriate treatment of infertility; abortion where permitted by law and post abortion care; treatment of sexually transmitted diseases, including HIV/AIDS; and information and education on human sexuality, reproductive health, responsible parenthood, and harmful traditional practices.[1]

Links to Reproductive Health

Adequate access to health care services can significantly influence patient use of the health care system and, ultimately, improve health. For example, most maternal deaths are preventable through timely provision of emergency obstetric care. Conversely, heightened reproductive risk results from inadequate health care access, as the AIDS pandemic tragically illustrates: partly due to their lack of access to HIV education, information, and prevention methods, the incidence of HIV is greater in young women than in men.

Human Rights Implicated

Impeding equal access to health services and information violates the right to health by restricting individuals' abilities to make personal healthcare decisions and to attain the best possible health status for themselves and their families. Other human rights, including the following, are also implicated by disparate access to health care:

• Right to non-discrimination ? Without careful tailoring, health policies may impact differentially on and increase the marginalization of the poor and uneducated. In particular, close scrutiny must be given to required user fees for health services, privatization of primary healthcare, and "target-oriented" population control programs. Policymakers must ensure that such policies do not bar those in need from essential health care and that coercion or misinformation is not used to achieve programmatic goals.
• Right to equal protection of the law - Individuals are impermissibly excluded from heath care systems through laws that prevent or discourage participation or through inappropriate health resource allocation.
• Right to life - High rates of maternal mortality, preventable through adequate access to obstetric health care, indicate that a country is failing to fulfill women's rights and to prioritize women's lives.

Relevant Human Rights Documents

The International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on Elimination of All Forms of Discrimination Against Women (CEDAW), both treaties binding on ratifying countries, recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. In particular, CEDAW, Article 12, requires countries to take all necessary measures to eliminate discrimination against women in health care and to ensure that women and men have equal access to health services. This Article further requires that countries provide free and accessible health services in relation to pregnancy and post-natal care.

Additionally, the non-binding but highly persuasive consensus statements from the International Conference on Population and Development (ICPD or Cairo) and the Fourth World Conference on Women (Beijing) highlight the importance of ensuring women access to acceptable reproductive health services throughout the life cycle and of implementing gender-sensitive standards for health care delivery. The CEDAW Committee, the body that oversees compliance with CEDAW, refers to the ICPD guidelines to determine country compliance with CEDAW Art 12. In their reports to the CEDAW Committee, countries therefore should detail their implementation of the lCPD Programme of Action.

Key Human Rights Arguments You Could Use

As another the ICESCR Committee notes in its General Comment on the Right to Health, access to health care is determined by the availability of specific services; the accessibility of services to the public; the acceptability of the services to different cultures, sexes, and age groups; and the quality of the services.[2]

• Availability.  Functioning health care facilities, services, and programs, must be available in sufficient quantity within the country. These include safe and potable drinking water, adequate sanitation facilities, health-related buildings, trained medical and professional personnel receiving domestically competitive salaries, and essential drugs.
• Accessibility.  Accessibility has four overlapping dimensions:
• Non-discrimination: health facilities, goods, and services must be accessible to all, especially the most vulnerable or marginalized sections of the population, in law and in fact.  For example, investments should not disproportionately favor expensive curative health services, which are often accessible only to a small, privileged fraction of the population, rather than primary and preventive health care benefiting a far larger part of the population.
• Physical accessibility: health facilities, goods and services must be within safe physical reach for all sections of the population, especially vulnerable or marginalized groups, such as women.  Medical services, safe and potable water, and adequate sanitation facilities must also be within safe physical reach in rural areas and for persons with disabilities.
• Economic accessibility: health facilities, goods, and services must be affordable for all.  Equity demands that poorer households should not be disproportionately burdened with health expenses as compared to richer households.
• Information accessibility: everyone has the right to seek, receive and impart information and ideas concerning health issues.
• Acceptability. All health facilities, goods and services must be respectful of medical ethics and sensitive to gender and life-cycle requirements, as well as designed to respect confidentiality and improve the health status of those concerned.
• Quality. Health facilities, goods and services must also be scientifically and medically appropriate and of good quality. This requires skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment, safe and potable water, and adequate sanitation.

To ensure health services are acceptable, accessible, affordable, and appropriate to the needs of women, countries should integrate a gender perspective in their health-related policies, planning, programs and research.  To do this, the ICESCR Committee encourages countries to develop and implement a comprehensive national strategy for promoting women's right to health.  A major goal should be reducing women's health risks, particularly lowering rates of maternal mortality and protecting women from domestic violence. The realization of women's right to health further requires the removal of all barriers to sexual and reproductive health services, education, and information.  In particular, countries should recognize and address harmful traditional cultural practices and norms that negatively impact women?s health and bar women from health care.[3]

Legal Remedies You Could Try

Subjecting a country to international scrutiny is an effective way of pressing a country to modify laws and policies that permit human rights abuse.  The international legal system offers women several ways to challenge barriers to their equal access to health care. 

• A country?s health advocates can submit complaints and reports about health care access to the committee that monitors compliance with CEDAW.  The CEDAW Committee uses the ICPD Programme of Action to set standards for country compliance with the right to health.[4]  This means that countries party to CEDAW must follow the measures listed in the ICPD to eliminate discrimination against women in health care and to guarantee equal access to health services.
• If it finds a country in violation of the right to health, the CEDAW Committee recommends to that country how to properly promote and protect women?s access to quality health care.  Policymakers may be convinced to improve women?s access to quality health care by being made aware of these recommendations.




A note on legal remedies: These topics highlight legal strategies health advocates can take to remedy situations abusive of reproductive health and human rights. Legal remedies, such as submitting a complaint to an international treaty body or revising laws to comply with international human rights standards, promote enabling policy environments critical to promoting reproductive health and gender equity. At the same time, the social change needed to ensure human rights requires a range of advocacy strategies including, but not limited to, the legal system. For instance, advocates may need to focus on how laws are actually implemented. Or advocacy efforts may need to focus on the cultural beliefs that contradict basic rights or on educating men and women about their rights. Advocates should assess which approaches are most promising for promoting human rights within a given context. When possible, advocates should include legal remedies so to create the legal change necessary for reproductive health policy change.







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[1] International Conference on Population and Development (ICPD) Programme of Action, para. 7.6.

[2]The Right to the Highest Attainable Standard of Health, CESCR General Comment 14, E/C.12/2000/4 (2000), available HERE.

[3] Id.

[4] Report of the Committee on the Elimination of Discrimination Against Women, 14th Sess., U.N Doc. A/50/38 (1995).

This Topic was written by Genevieve Grabman, JD, MPH, in collaboration with Anne K. Eckman, PhD and POLICY's Gender and Human Rights Working Groups. Questions and comments should be directed to policyinfo@futuresgroup.com.
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