Comments from the Center for Reproductive Rights on the Committee on the Rights of
Persons with Disabilities Draft General Comment on Article 6: Women with Disabilities
July 24, 2015
The Center for Reproductive Rights (“the Center”), an international non-governmental legal
advocacy organization dedicated to advancing reproductive freedom as a fundamental human right,
welcomes the opportunity to provide comments on the Committee on the Rights of Persons with
Disabilities’ draft general comment on Article 6: Women with disabilities. The Center appreciates
the draft general comment’s strong recognition of the role that gender plays in reinforcing and
perpetuating the inequalities and discrimination faced by people with disabilities across the globe.
The exercise of reproductive rights, including the right to decide freely on the number and spacing
of one’s children, is essential to ensuring that women can achieve equality and overcome
discrimination by exercising their autonomy and self-determination. Too often, however, women
face restrictions, in law and/or in practice, on the exercise of their reproductive rights, which is
exacerbated by states’ failure to take positive measures to ensure access to reproductive health
services and to prevent and punish violations of women’s reproductive rights. While the draft
general comment recognizes that women and girls with disabilities’ reproductive health and rights
are essential to the realization of a broad range of their human rights, there are specific areas where
states’ obligations in regards to the reproductive rights of women and girls’ with disabilities, could
be further strengthened. In addition to this submission, the Center fully endorses and supports
Women Enabled International’s submission focusing on violence against women and girls with
disabilities.
I.
Ensuring the standards set forth in the general comment apply to both women and girls with
disabilities
At times, the general comment refers to “women with disabilities,” while in other places, it refers to
“women and girls with disabilities.”1 Because gender inequalities and forms of discrimination that
all women face, including women with disabilities, generally begin in childhood and are
perpetuated throughout adolescence and into their adult lives, it is critical that this general comment
speaks to the entire life course and does not only focus on adulthood. In order to prevent confusion
about whether certain aspects of the general comment apply to adolescents and girls, it might be
useful to include an introductory sentence indicating that for the purposes of this general comment,
“women” refers to adults, girls and adolescents. This would follow the model used by the
Committee on the Elimination of Discrimination against Women in its General Recommendation
No. 24, on women and health.2
II.
Further elaboration on the relationship between discrimination against women and girls with
disabilities and the provisions of the CRPD
Section IV (“Interrelation between the provisions addressing women and girls with disabilities and
their link to other CRPD provisions”) provides concrete guidance to states on the measures they
must take to realize a range of rights for women and girls with disabilities, reflecting how
intersectional discrimination exacerbates the barriers women and girls face in exercising the full
range of their human rights. Although this section is very strong, there are several areas where it
could be further strengthened.
A. The Right to Health (Article 25)
The addition of a subsection in Section IV that explicitly elaborates on the intersection between
women and girls with disabilities and the right to health under Article 25 would provide essential
guidance to states on the measures they must take to realize women and girls’ with disabilities
sexual and reproductive health and rights. Article 25’s recognition that states must “provide persons
with disabilities with the same range, quality and standard of free or affordable health care and
programmes as provided to other persons, including in the area of sexual and reproductive health”3
constitutes one of the strongest explicit protections for sexual and reproductive health in the text of
an international human rights convention. This article is particularly relevant to women and girls
generally due to their greater reproductive health needs stemming from their childbearing
capacities. Furthermore, discriminatory stereotypes about women and girls with disabilities, such as
the belief that they are not or should not be sexually active or bear children, exacerbate the barriers
they face in accessing comprehensive sexual and reproductive health services. Where restrictive
laws on sexual and reproductive health and rights are in place – such as those denying women with
disabilities the right make decisions about their reproductive capacities, restricting access to
abortion, limiting contraceptive coverage under national or public health insurance plans– they
further undermine all women’s ability to exercise their reproductive rights and must be modified to
comply with states’ treaty obligations.
The strong standards set forth in the draft general comment on preventing forced sterilization and
forced abortion highlight the essential nature of reproductive autonomy in guaranteeing women and
girls with disabilities the rights to substantive equality and nondiscrimination. Where states and
third parties seek to control the fertility of women and girls with disabilities, they perpetuate
misconceptions and discriminatory attitudes about their childrearing and decision-making abilities.
States must ensure that women and girls with disabilities have the legal right to make decisions
about their health, as enshrined under the right to health and Article 12 of the CRPD, which
includes the right to full exercise of legal capacity on an equal basis with others.4 The CRPD
Committee has consistently interpreted Article 12 to mean that persons with disabilities should not
be deprived of legal capacity and that states should replace current regimes of substituted decisionmaking, such as guardianship, with systems to support persons with disabilities in making
decisions.5 The Committee has explicitly stated that “a substitute decision-making model that
overrides the wishes of the persons concerned … runs counter to article 12 of the Convention.”6 The
inclusion of a subsection on health would further provide the Committee an opportunity to further
elaborate on states’ obligations to ensure that women and girls with disabilities are able to exercise
reproductive autonomy, including by ensuring that health goods and services are accessible,
acceptable, available and of good quality.7
In accordance with international human rights norms, states must guarantee women’s right to the
full range of services in connection with pregnancy and the postnatal period and the ability to access
these services free from discrimination, coercion, and violence.8 States must ensure that maternal
health services are delivered in a way that respects the dignity of women and girls, is sensitive to the
needs and perspectives of all groups of women and girls, and recognizes that negative attitudes of
health workers can deter women from seeking health services.9 By clearly setting forth states’
obligations to fulfill these obligations for women and girls with disabilities seeking maternal health
care, the human rights standards would be greatly strengthened.
2
Studies have demonstrated that the prevalence of stereotypes and lack of provider training make
healthcare providers significantly less likely to ask women with disabilities about their use of or
need for contraceptives.10 Under international human rights norms, states must provide all women
access to a comprehensive range of short- and long-term contraceptive options, free from
discrimination and on the basis of full and informed consent.11 Further – as the draft general
comment recognizes – forced or coerced sterilizations of women and girls with disabilities
constitutes clear human rights violations which states must work to eradicate. In addition to
sterilization, there is evidence of women with disabilities being administered long-acting reversible
contraceptives without their consent as a means to regulate their fertility and suppress
menstruation,12 which the Committee may consider addressing in this general comment.
Women and girls with disabilities also frequently face pressure from doctors, guardians, social
service workers, parents and society to terminate their pregnancies.13 This pressure stems from
misconceptions and discriminatory beliefs about their ability to raise a family and the inheritability
of certain disabilities. The European Disability Forum has noted that “[i]n some countries where
therapeutic sterilization of women with disabilities has become illegal, the practice of coerced
abortion of women with intellectual or psychosocial disabilities or women and girls with intensive
support needs has become even more common...”14 This general comment provides the Committee
with a critical opportunity to highlight the measures states must take to eliminate forced and coerced
abortion and guarantee women with disabilities the right to freely decide on the number and spacing
of their children. Such measures may include explicit laws protecting the rights of women and girls
to make decisions about pregnancy and childbirth, training for providers on the rights of women and
girls with disabilities and preventing pressure and coercion in this context, and know-your-rights
training for women and girls with disabilities to empower them to assert their rights and report
violations.
In addition to ensuring that women and girls with disabilities are not forced or coerced into
abortion, true reproductive autonomy also requires ensuring that where they face an unwanted
pregnancy, abortion is an available option, if they so choose and they are provided with the
sufficient information and support to make this decision for themselves. This is in line with the
standards from other treaty monitoring bodies, which have recognized that restrictive abortion laws
cause women to seek out unsafe and clandestine abortions, and repeatedly called on states to
liberalize restrictive abortion laws and guarantee all women access to safe abortion services. 15
While all women, including women with disabilities, have difficulty navigating restrictive
environments to fully exercise their reproductive rights,16 women with disabilities are placed at a
particular disadvantage because of the additional barriers they may face in accessing reproductive
health services. Procedural barriers to abortion services, such as mandatory waiting periods and
third-party authorization requirements, generally increase the financial burden associated with
accessing abortion services and exacerbate barriers women and girls with disabilities may face in
relation to accessible transportation.
In countries with restrictive abortion laws, women are often unable to access abortion services in
the limited circumstances they are permitted due to a variety of factors including lack of training for
health care workers, lack of information about legal abortion services, and stigma around abortion.17
Coupled with the barriers already experienced by women with disabilities in accessing reproductive
health services, including barriers to physical access, the absence of alternative formats of
information and communication, lack of disability-related support services,18 abortion services may
be virtually inaccessible for women with disabilities in practice. As a result, they may be compelled
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to carry to term pregnancies and enter motherhood against their will, which in turn affects all facets
of their lives, including their ability to continue their education, pursue career opportunities, and
participate in public life.
Guaranteeing women and girls with disabilities quality maternal health care, comprehensive
contraceptive options, and safe abortion services is essential to realizing their reproductive rights
and enabling them to exercise reproductive autonomy and self-determination. The elaboration of
states’ obligations under the CRPD in this regard will greatly strengthen the human rights
protections for women and girls with disabilities.
B. Education (Article 24, paragraphs 49-50)
The draft general comment’s recognition of the barriers that woman and girls with disabilities face
with regard to access to education and the significant impact this as on their lives and futures is a
critical step forward in overcoming these substantial inequalities. Comprehensive and inclusive
sexuality education is an essential component to realizing women and girls’ right to gender equality
within the context of education. Sexuality education is an important vehicle for empowerment, as it
provides women and girls with the necessary information to protect themselves from sexual abuse;
negotiate contraceptive use in order to prevent unwanted pregnancies and STIs, including
HIV/AIDS; and access sexual and reproductive health services on the basis of free and informed
consent. However, persons with disabilities are more likely than others to be excluded from
comprehensive sexuality education programs,19 and when they are provided with education on
sexual and reproductive health, the content of that information may be different and provided
separately from others.20
Physical obstacles and the lack of disability-related clinical services present barriers to persons with
disabilities accessing information about sexual and reproductive health, including comprehensive
sexuality education.21 Furthermore, educational materials are seldom made available in formats
such as Braille, large print, simple language, pictures, sign language,22 or digital fully accessible
formats, among others appropriate, making it difficult for persons with disabilities to access healthrelated information, including sexuality education.23 Additionally, sexuality education rarely
addresses distinct sexual and reproductive health needs and issues faced by women and girls with
disabilities or the historical discrimination they face in accessing these services, including as a result
of being subjected to forced or coerced sterilization, contraception, or abortion.24
By calling on states parties to provide comprehensive, inclusive, accurate, unbiased and nondiscriminatory sexuality education, women and girls with disabilities’ right to information about
their sexual and reproductive health and rights would be greatly strengthened. Sexuality education
should further include the active involvement of persons with disabilities, in both curriculum
development and teaching, and educational materials and information must be provided in a manner
that is accessible to all persons with disabilities.
C. Accessibility (Article 9, paragraphs 38-40)
The subsection on Article 9 (accessibility) could be enriched by additional content on states’
obligations with regard to accessibility of information. While the draft general comment speaks to
the physical and transportation-related barriers women with disabilities often face, they also must
contend with communication barriers, lack of reproductive health information in accessible formats
and biases within the content of the information that they receive.25 Particularly in the context of
sexual and reproductive health, the information that is provided to women and girls often reflects
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prejudicial gender stereotypes and the health services that should be available to women and girls.26
Access to accurate and timely information is essential to exercising autonomy and making an
informed choice to undergo or forego medical procedures. The failure to guarantee accurate and
evidence-based information, free from biases and prejudices, can be used to manipulate or compel
women and girls to make decisions surrounding their sexual and reproductive health that are in line
with discriminatory stereotypes about people with disabilities, such as the belief that they should not
be sexually active or become parents. By including states’ obligations to ensure that the full range
of information about sexual and reproductive health and rights is available and accessible, free from
biases, prejudices and discrimination, the general comment would afford better protections for
women and girls with disabilities.
III. Substantive Equality (paragraph 29)
Where the draft general comment discusses the measures that states must take to achieve
substantive equality, it would be useful for the Committee to mention that states must recognize
differences between groups that are the result of or may result in discrimination and inequalities.
For women and girls with disabilities, this includes recognition of their biological differences, their
differing health needs, and how gender norms and stereotypes can reinforce inequalities. Further,
substantive equality requires states to not only ensure equality of opportunity – as recognized in the
draft general comment – but also to ensure equality of results, which means ensuring that women
with disabilities have positive reproductive health outcomes and are ensured quality reproductive
health services in line with states’ human rights obligations.
IV. Respect, protect, and fulfill framework (paragraphs 31-33)
The draft general comment’s elaboration on states’ obligations to respect, protect and fulfill the
rights of women and girls with disabilities would benefit from the use of examples that are
particularly relevant to women and girls with disabilities, as opposed to those that are generally
applicable to all persons with disabilities. While such broader examples are indeed useful in
elaborating upon state responsibility under the CRPD, this general comment provides a unique
opportunity for the Committee to explore in particular states’ obligations to respect, protect and
fulfill the human rights of women and girls with disabilities in light of intersectional discrimination,
gender-based stereotypes and socialized gender roles. For example, a relevant example of states’
duty to protect the rights of women and girls with disabilities would be to ensure that health care
providers in private facilities do not commit forced or coerced sterilizations and to hold these
providers accountable for such acts. Further, to fulfill women and girls’ rights, states should take
positive measures, including legal and policy reform, allocation of resources and ensuring
healthcare workers are properly trained in human rights and working with people with disabilities,
to guarantee all women and girls with disabilities access to the full range of quality, comprehensive
reproductive health services, on the basis of free and informed consent. By providing examples that
are particularly applicable for women and girls with disabilities, the respect, protect and fulfill
framework will provide state parties with greater guidance on achieving gender equality.
We greatly appreciate the opportunity to provide substantive feedback on the CRPD’s draft general
comment on women with disabilities. Should the Committee have any questions or require
additional information, please reach out to Rebecca Brown, Director of Global Advocacy, at
Rbrown@reprorights.org or +1 917-637-3606.
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1
See, e.g., CRPD Committee, Draft General Comment Article 6, paras. 6, 8, 24, 25, & 27, among others.
Committee on the Elimination of Discrimination against Women (CEDAW Committee), General Recommendation
No. 24: Women and Health, para. 8 (“States parties are encouraged to address the issue of women's health throughout
the woman's lifespan. For the purposes of the present general recommendation, therefore, "women" includes girls and
adolescents.”).
3
Convention on the Rights of Persons with Disabilities, Article 25(A).
4
Id., Art. 12.
5
Committee on the Rights of Persons with Disabilities (CRPD Committee), Concluding Observations: Tunisia, paras.
22-23, U.N. Doc. CRPD/C/TUN/CO/1 (2011); Spain, paras. 33-34, U.N. Doc. CRPD/C/ESP/CO/1 (2011); Peru, paras.
24-25, U.N. Doc. CRPD/C/PER/CO/1 (2012); Argentina, paras. 19-20, U.N. Doc. CRPD/C/ARG/CO/1 (2012); China,
para. 21-22, U.N. Doc. CRPD/C/CHN/CO/1 (2012); Hungary, paras. 25-26, CRPD/C/HUN/CO/1 (2012).
6
CRPD Committee, Concluding Observations: Argentina, para. 19, U.N. Doc. CRPD/C/ARG/CO/1 (2012).
7
See Committee on Economic, Social and Cultural Rights, General Comment 14, para. 12; Committee on the
Elimination of Discrimination against Women (CEDAW Committee), General Recommendation No. 24: Women and
Health.
8
Convention on the Elimination of Discrimination against Women, Art. 12(2); CEDAW Committee, Gen.
Recommendation No. 24, para. 26.
9
CEDAW Committee, Gen. Recommendation No. 24, para. 22; CEDAW Committee, Concluding Observations: Kenya,
para. 37-38, U.N. Doc. CEDAW/C/KEN/CO/6 (2007).
10
Baylor College of Medicine, Center for Research on Women with Disabilities (CROWD), HEALTH CARE--ACCESS TO
REPRODUCTIVE HEALTH CARE 56.
11
ESCR Committee, Gen. Comment No. 14, para. 12(a); Committee on the Rights of the Child, Gen. Comment No. 15,
para. 30; CEDAW Committee, Concluding Observations: Cyprus, para. 30(b), U.N. Doc. CEDAW/C/ CYP/CO/6-7
(2013); Hungary, para. 30, U.N. Doc. CEDAW/C/HUN/CO/7-8 (2013); India, paras. 30-31, U.N. Doc.
CEDAW/C/IND/CO/4-5 (2014); Sierra Leone, paras. 32-33, U.N. Doc. CEDAW/C/SLE/CO/6 (2014).
12
See, e.g., Disability Rights International and Colectivo Chuhcan, ABUSE AND DENIAL OF SEXUAL AND REPRODUCTIVE
RIGHTS OF WOMEN WITH PSYCHOSOCIAL DISABILITIES IN MEXICO 25-26;
13
Anne Finger, Forbidden Fruit, 233 THE NEW INTERNATIONALIST (July 1992), available at
http://www.newint.org/issue233/fruit.htm; see also Carolyn Frohmader, MOVING FORWARD AND GAINING GROUND:
THE STERILISATION OF WOMEN AND GIRLS WITH DISABILITIES IN AUSTRALIA 6-7 (2012), available at
http://wwda.org.au/wp-content/uploads/2013/12/Moving_Forward_Gaining_Ground.pdf; See generally Law Students
for Reproductive Justice, Women with Disabilities, at 3 (2008), available at http://lsrj.org/documents/factsheets/0809_Women_with_Disabilities.pdf
14
EUROPEAN DISABILITY FORUM, EDF INPUT TO THE GENERAL DISCUSSION OF THE CESCR ON SEXUAL AND
REPRODUCTIVE RIGHTS 6 (2010).
15
See, e.g., L.C. v. Peru, CEDAW Committee, Commc’n No. 22/2009, para. 12(b), U.N. Doc.
CEDAW/C/50/D/22/2009 (2011); K.L. v. Peru, Human Rights Committee, Commc’n No. 1153/2003, U.N. Doc.
CCPR/C/85/D/1153/2003 (2005); L.M.R. v. Argentina, Human Rights Committee, Commc’n No. 1608/2007, U.N.
Doc. CCPR/C/101/D/1608/2007 (2011); Human Rights Committee, Concluding Observations: Ireland, para. 9, U.N.
Doc. CCPR/C/ IRL/CO/4 (2014); CEDAW Committee, Concluding Observations: Paraguay, para. 31(a), U.N. Doc.
CEDAW/C/PRY/CO/6 (2011).
16
HUMAN RIGHTS WATCH, ILLUSIONS OF CARE: LACK OF ACCOUNTABILITY FOR REPRODUCTIVE RIGHTS IN ARGENTINA
35 (2010).
17
Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental
health, Interim rep. of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable
standard of physical and mental health, transmitted by Note of the Secretary-General, U.N. Doc. A/66/254 (Aug. 3,
2011) (by Anand Grover); CENTER FOR REPRODUCTIVE RIGHTS, IN HARM’S WAY: THE IMPACT OF KENYA’S
RESTRICTIVE ABORTION LAW (2010); CENTER FOR REPRODUCTIVE RIGHTS, FORSAKEN LIVES: THE HARMFUL IMPACT OF
THE PHILIPPINE CRIMINAL ABORTION BAN (2010).
18
World Health Organization (WHO) and UNFPA, PROMOTING SEXUAL AND REPRODUCTIVE HEALTH FOR PERSONS
WITH DISABILITIES 6-7 (2009).
19
WHO & THE WORLD BANK, WORLD REPORT ON DISABILITY 61 (2011).
20
For instance, a recent research in Mexico, that included questionnaires to women with psychosocial disabilities,
highlighted their lack of awareness on sexual and reproductive health issues due to lack of effective policies, as well as
a high proportion of victims of abuse and forced sterilizations’ in health services. Disability Rights International and
2
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Colectivo Chucán, Abuso y Negación de Derechos Sexuales y Reproductivos a Mujeres con Discapacidad Psicosocial
en México, 25 February 2015.
21
WORLD HEALTH ORGANIZATION (WHO)/UNITED NATIONS POPULATION FUND (UNFPA), PROMOTING SEXUAL AND
REPRODUCTIVE HEALTH FOR PERSONS WITH DISABILITIES 7 (2009).
22
See, as an example of barriers to health services in the USA, including HIV prevention for deaf persons, Center for
AIDS Prevention, University of California, San Francisco, What Are Deaf Persons’ HIV Prevention Needs?, available
at http://caps.ucsf.edu/archives/factsheets/deaf-persons.
23
WORLD HEALTH ORGANIZATION (WHO)/UNITED NATIONS POPULATION FUND (UNFPA), PROMOTING SEXUAL AND
REPRODUCTIVE HEALTH FOR PERSONS WITH DISABILITIES 7 (2009).
24
Human Rights Watch, “AS IF WE WEREN’T HUMAN”: DISCRIMINATION AND VIOLENCE AGAINST WOMEN WITH
DISABILITIES IN NORTHERN UGANDA 46-47 (2010). See Desjardin M., The sexualized body of the child, parents and the
politics of ‘voluntary’ sterilization of people labelled intellectually disabled in SEX AND DISABILITY (R McRuer and A
Mollow) (2012).
25
WHO & THE WORLD BANK, WORLD REPORT ON DISABILITY 77-79 (2011).
26
See Mandatory Delays and Biased Counseling for Women Seeking Abortions, CENTER FOR REPRODUCTIVE RIGHTS
(Sept. 30, 2010), http://reproductiverights.org/en/project/mandatory-delays-and-biased-counseling-for-women-seekingabortions.
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