Sexual health human rights and the law

18 | Sexual health, human rights and the law
regional human rights standards have affirmed
the requirement for full information in relation to
interventions, including for sexual health (28, 56, 92).
3.3.3 Skilled health-care personnel
Health-care providers who are inadequately trained
are not able to provide appropriate health services.
In the field of sexual health, specific training is
needed, especially in the area of counselling
related to sexuality, and more generally for dealing
with many different kinds of clients with a nonjudgemental
and respectful attitude, with sensitivity
to gender and human rights dimensions (1, 65). For
example, health personnel who have to assist with
childbirth for a woman who has been infibulated
(a form of genital mutilation whereby the inner and/
or outer lips of the vulva are cut and then stitched
together, narrowing the vaginal orifice) require
specific training, not only to help in the delivery of
the baby and ensuring the woman’s health, but also
in counselling and follow-up with the woman in a
way that is both culturally appropriate and aligned
with medical ethics and human rights (95–97).
Untrained health-care providers may be unable
or unwilling to provide appropriate health care
for transgender people (98). Health workers may
wrongly assume that people with disabilities are
asexual, or that people with intellectual disabilities
cannot become parents. All such inappropriate
training or gaps in training are likely to be associated
with poor health outcomes (99).
In line with human rights standards, states must
ensure that the training of doctors and other
health and medical personnel meets appropriate
standards of education, skill and ethical codes of
conduct (29). These assurances are often made
through laws and regulations at the national level.
WHO guidance on core competencies for sexual and
reproductive health emphasizes that all workers at
the primary health care level dealing with sexual and
reproductive health must be adequately trained,
prepared and supported in their work, and this must
be accompanied by a supportive infrastructure
and supervision system to ensure that these health
workers maintain an adequate level of competence
(65). This is especially important in remote and rural
areas where the knowledge, skills and attitudes of
health workers may be life-saving, while a lack of
competence could be life-threatening (65).
3.3.4 Quality of supplies and equipment
Due in part to the high cost of many medicines
needed for sexual health care (see section 3.2.1),
the widespread availability of cheaper but substandard
medicines poses a serious health risk
to many people (100). Ranging from inactive or
ineffective preparations to mixtures of harmful toxic
substances, sub-standard products have been found
among, for example, contraceptive pills (101) and
antibiotics in different parts of the world (102).
Outmoded or old equipment may also pose a health
risk, when safer and more effective equipment exists
at competitive prices. For example, in a number of
countries physicians still use dilatation and curettage
(D&C) to perform abortion even though vacuum
aspiration (either manual or electric) has been
shown to be effective, less painful, and easier to
perform, requiring fewer accompanying procedures
(e.g. general anaesthesia) and less hospital
equipment (e.g. operating theatres) (59).
3.4 Elimination of discrimination in access
to health services – addressing the specific
needs of particular populations
Inequity and inequalities in access to health care
around the world are well documented (103). Very
often, such inequities are related to socioeconomic
factors, including income and place of residence
(rural or urban), but they may also be related to
characteristics such as living with a disability. The
provision of services related to sexuality and sexual
health presents additional difficulties related to
societal perceptions (also held by health-care
providers) of acceptable sexual behaviour, which are
often heightened by the fact that laws, policies and
practices may exclude certain categories of people
from health services.
Laws which preclude anyone’s access to needed
health services, including those for all dimensions
of sexual health, violate human rights and are likely
to be associated with ill health which might have