Acceso A La Informacin En Materia Reproductiva Desde Una Perspectiva De Derechos Humanos OEA Womenaccessinformationreproductivehealth

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INTER‐AMERICANCOMMISSIONONHUMANRIGHTS

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OEA/Ser.L/V/II.

Doc.61

22November2011

Original:Spanish

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ACCESSTOINFORMATIONONREPRODUCTIVEHEALTH

FROMAHUMANRIGHTSPERSPECTIVE

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2011

Internet:http://www.cidh.org

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OASCataloging‐in‐PublicationData

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Inter‐AmericanCommissiononHumanRights.

Accesoalainformaciónenmateriareproductivadesdeunaperspectiva

dederechoshumanos=Accesstoinformationonreproductivehealthfrom

ahumanrightsperspective.

p.;cm.(OEAdocumentosoficiales;OEASer.L/V/II.Doc.61)

(OASofficialrecords;OEASer.L/V/II.Doc.61)

ISBN978‐0‐8270‐5710‐4

1.Reproductivehealth‐‐America. 2.Freedomofinformation‐‐America.3.

Communicationinreproductivehealth‐‐America.4.Women’shealthservices‐‐

America.5.Medicalrecords‐‐Accesscontrol‐‐America.I.Title.II.Title:Accessto

informationonreproductivehealthfromahumanrightsperspective.III.Series.IV.

Series.OASofficialrecords;OEA/Ser.L/V/II.Doc.61

OEASer.L/V/II.Doc.61

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DocumentpublishedthankstothefinancialsupportofSpainandFinland.

PositionshereinexpressedarethoseoftheInter‐AmericanCommission

onHumanRightsanddonotreflecttheviewsofSpainorFinland.

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ApprovedbytheInter‐AmericanCommissiononHumanRightsonNovember22,2011

INTER‐AMERICANCOMMISSIONONHUMANRIGHTS

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MEMBERS

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DinahShelton

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JosédeJesúsOrozcoHenríquez

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RodrigoEscobarGil

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PauloSérgioPinheiro

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FelipeGonzález

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LuzPatriciaMejíaGuerrero

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MaríaSilviaGuillén

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ExecutiveSecretary:SantiagoA.Canton

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AssistantExecutiveSecretary:ElizabethAbi‐Mershed

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ACCESSTOINFORMATIONONREPRODUCTIVEHEALTH

FROMAHUMANRIGHTSPERSPECTIVE

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TABLEOFCONTENTS

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I.INTRODUCTION..........................................................................................................1

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II.STANDARDSONACCESSTOINFORMATIONASAHUMANRIGHT...........................3

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III.STANDARDSONTHERIGHTTOACCESSTOINFORMATIONONREPRODUCTIVE

HEALTH.......................................................................................................................8

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A.Accesstoinformationandinformedconsent............................................13

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1.Informingpatientsaboutthenatureoftheprocedure,treatment

options,andreasonablealternatives,includingthepotential

benefitsandrisksofproposedprocedures .................................13

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2.Providingappropriateinformation,takingintoaccountthe

person'sneedsandensuringthatthepersonunderstands

theinformationprovided ............................................................16

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3.Ensuringthatanyconsentprovidedisfreeandvoluntary..........18

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B.Accesstoinformationandtheprotectionofconfidentiality.....................22

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C.Accesstoinformationandtheobligationtoprovideinformation

thatistimely,complete,accessible,reliable,andproactive .....................25

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1. Accesstoinformationandconscientiousobjection ....................27

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D.Accesstoinformationandaccesstomedicalrecords ...............................29

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E.Accesstoinformationandtheobligationtoproducereliablestatistics ...31

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IV.RECOMMENDATIONS ..............................................................................................33

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ACCESSTOINFORMATIONONREPRODUCTIVEHEALTH

FROMAHUMANRIGHTSPERSPECTIVE

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I.INTRODUCTION

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1. TheInter‐AmericanCommissiononHumanRights(hereinafter“theInter‐

AmericanCommission”,“theCommission”,orthe“IACHR”)hasconsistently,throughits

variousmechanisms,receivedinformationonthevariousbarrierswomenintheAmericas

faceingainingaccesstoinformationonhealth,particularlyintheareaofsexualand

reproductivehealth.Womenwhohavehistoricallybeenmarginalizedbasedontheirrace,

ethnicity,economicstatus,oragearethosewhofacethemostbarriersinaccessto

informationonhealth,andthesebarriersbecomeevengreaterwhentheinformationhas

todowithmattersrelatedtosexualandreproductivehealth.Accesstoinformationis

closelylinkedtotheattainmentofotherhumanrights;thus,afailuretorespectand

guaranteethisrightforwomencanleadtoaninfringementofotherrights,suchastheir

righttopersonalintegrity,therighttoprivacy,rightsofthefamily,andtherighttobefree

fromviolenceanddiscrimination.Thisreportidentifiesandanalyzes,fromahumanrights

perspective,internationalandregionalstandardsonaccesstoinformationonreproductive

health,withaviewthattheStatesmighteliminatebarriersandeffectivelyguaranteeand

protectthisrightofwomenwithoutdiscrimination.

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2. Accesstoinformationisabasictoolforbuildingcitizenshipina

democraticsystem. 1TheAmericanConventiononHumanRights(hereinafter¨the

Convention¨)expresslyenshrinestheconceptofaccesstoinformationinitsArticle13,and

theInter‐AmericanCourtofHumanRights(hereinafterthe“Inter‐AmericanCourt”)has

interpreteditasahumanright.TheCourtindicatedthatbyexpresslystipulating,inArticle

13,therightto"seek"and"receive"information,theConventionprotectseveryone'sright

toaccessinformation.

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3. Therighttoaccesstoinformationisespeciallyrelevantintheareaof

health,andspecificallyintheareaofsexualityandreproduction,sinceithelpstoensure

thateveryoneispreparedtomakefreeandinformeddecisionswithregardtointimate

aspectsoftheirlife.Intheinter‐Americansystem,accesstoinformationonsexualand

reproductivehealthinvolvesaseriesofrightssuchastherighttofreedomofexpression,to

personalintegrity,totheprotectionofthefamily,toprivacy,andtobefreefromviolence

anddiscrimination.

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4. Inthisregard,theIACHRnotesthatinrecentdecades,accessto

informationonsexualandreproductivemattershasgainedconsiderablerelevanceatthe

regionalandinternationallevel.Infact,theIACHRhasestablishedthatitisnotpossiblefor

womentoattainthefullenjoymentofhumanrightswithouttimelyaccessto

comprehensivehealthcareservices,aswellastoinformationandeducationinthisarea,so

thattheycanmakefree,informed,andresponsibledecisionsregardingreproduction,

1IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation.Officeof

theSpecialRapporteurforFreedomofExpression,December30,2009.

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includingfamilyplanning.2TheCommissionhasalsosaidthatinformationandeducation

enableswomentomakedecisionsatalllevelsandinallareasoftheirlives,especiallyin

thesphereofhealth,sexuality,andreproduction.

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5. Attheinternationallevel,theprovisionscontainedintheConventionon

theEliminationofAllFormsofDiscriminationagainstWomen(hereinafter“CEDAW”)

establishtheobligationoftheStatesPartiestoensure,onabasisofequalityofmenand

women,thesamerightstodecidefreelyandresponsiblyonthenumberandspacingof

theirchildrenandtohaveaccesstotheinformation,education,andmeanstoenablethem

toexercisetheserights.Specifically,theCommitteeontheEliminationofDiscrimination

againstWomen(hereinafterthe“CEDAWCommittee”)hasemphasizedthattheStates'

dutytoensure,onabasisofequality,accesstohealthcareservices,information,and

education"impliesanobligationtorespect,protectandfulfilwomen'srightstohealth

care."3Foritspart,theCommitteeonEconomic,SocialandCulturalRights(hereinafterthe

“ESCRCommittee”)hasinterpretedtherighttohealthasaninclusiverightextendingnot

onlytotimelyandappropriatehealthcarebutalsototheunderlyingdeterminantsof

health,suchas"accesstohealth‐relatededucationandinformation,includingonsexual

andreproductivehealth".4

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6. Nevertheless,theInter‐AmericanCommissionhasconsistently,through

itsvariousmechanisms,receivedinformationregardingvariousbarrierswomeninthe

Americasfaceintheiraccesstoinformationonsexualandreproductivehealth.For

example,thelimitedaccesstoinformationonfamily‐planningservicesdespiteahigh

unmetneedforsuchservices.5Inaddition,theCommissionhasreceivedinformation

aboutproblemsinaccesstobasicinformationandadequatemedicalandsocialservices

relatedtoreproductivehealth,6aswellasaboutdistortionsintheinformationon

reproductivemattersprovidedbypublicservantsforthepurposeofdissuasion.7The

Commissionhasalsoreceivedinformationandprocessedindividualpetitionsregardingthe

practiceofsterilizingwomenwithouttheirconsentinsomeOASMemberStates,apractice

thatinsomecaseshasledtotheirdeaths.8

2IACHR,ReportNo.21/07,Petition161/02,FriendlySettlement,PaulinadelCarmenRamírezJacinto

(Mexico),March9,2007.

3UnitedNations,CEDAWCommittee,GeneralRecommendation24,Womenandhealth,para.13.

4UnitedNationsCommitteeonEconomic,SocialandCulturalRights.Therighttothehighestattainable

standardofhealth(article12oftheInternationalCovenantonEconomic,SocialandCulturalRights),General

Comment14,August11,2000,para.11.

5IACHR,FifthReportontheSituationofHumanRightsinGuatemala,OEA/Ser.L/V/II.111,doc.21,April

6,2001,seeChapterXIII,TheRightsofWomen;IACHR,ThirdReportontheSituationofHumanRightsin

Paraguay,OEA/Ser./L/VII.110doc.52,March9,2001,seeChapterVIII,Women'sRights.Availableat:

http://www.cidh.oas.org/countryrep/Paraguay01eng/chap8.htm.

6IACHR,FifthReportontheSituationofHumanRightsinGuatemala,seeChapterXIII,TheRightsof

Women.

7IACHR,ReportNo.21/07,Petition161/02,FriendlySettlement,PaulinadelCarmenRamírezJacinto

(Mexico),March9,2007.

8IACHR,ReportNo.71/03,Petition12.191,FriendlySettlement,MaríaMaméritaMestanzaChávez

(Peru),October3,2003.

3

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7. Inparticular,womenwhoarepoor,indigenous,and/orofAfrican

descent,womenwholiveinruralareasandmigrantwomen,aretheoneswhofacegreater

obstaclesintheiraccesstoinformationonsexualandreproductivehealth.Insomecases,

thebarriersareofsuchamagnitudethattheymayconstituteviolationsofwomen'srights

topersonalintegrity,privacy,andfamilylife,andtherighttobefreefromviolenceand

discriminationincontraventionoftheobligationstheStatesoftheAmericashaveassumed

intheareaofhumanrights.9Oneexampleofthissituationisthesterilizationofwomen

withouttheirconsent.

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8. Consequently,theInter‐AmericanCommissiononHumanRightsdecided

topreparethisreport,thankstothesupportoftheGovernmentsofSpainandFinland,in

ordertoidentifyandanalyzeregionalandinternationalhumanrightsstandardsonaccess

toinformationonreproductivehealth,withaviewthattheStatesmighteliminatebarriers

andeffectivelyguaranteeandprotectthisrightofwomenwithoutdiscrimination.



9. Thisreportisdividedintothreesections.Thefirstsectiondescribes

standardsontherighttoaccesstoinformationandthesecondsectiondetailsstandardson

therighttoaccesstoinformationonreproductivehealth.Inthatsection,theIACHR

addressesseveraldimensionsofaccesstoinformationthatshouldbetakenintoaccountto

guaranteethisright.ThethirdsectionaddressessomerecommendationstotheStatesin

thisarea.



II.STANDARDSONACCESSTOINFORMATIONASAHUMANRIGHT



10. Article13oftheAmericanConventionestablishesthefollowing:



1.Everyonehastherighttofreedomofthoughtandexpression.

Thisrightincludesfreedomtoseek,receive,andimpartinformationand

ideasofallkinds,regardlessoffrontiers,eitherorally,inwriting,inprint,

intheformofart,orthroughanyothermediumofone'schoice.



2.Theexerciseoftherightprovidedforintheforegoingparagraph

shallnotbesubjecttopriorcensorshipbutshallbesubjecttosubsequent

impositionofliability,whichshallbeexpresslyestablishedbylawtothe

extentnecessarytoensure:



a.respectfortherightsorreputationsofothers;or



b.theprotectionofnationalsecurity,publicorder,orpublichealth

ormorals.



9TheIACHRhasnotedthattheprotectionofwomen'srighttointegrityunderconditionsofequalityis

achievedintheareaofmaternalhealththroughtheprovisionofinformationandeducationonthesubjectsothat

womenwilladoptfree,well‐founded,andresponsibledecisionsregardingreproduction,includingonfamily

planning.

4



3.Therightofexpressionmaynotberestrictedbyindirect

methodsormeans,suchastheabuseofgovernmentorprivatecontrols

overnewsprint,radiobroadcastingfrequencies,orequipmentusedinthe

disseminationofinformation,orbyanyothermeanstendingtoimpede

thecommunicationandcirculationofideasandopinions.....



11. TheAmericanDeclarationoftheRightsandDutiesofMan(hereinafter

the“AmericanDeclaration”),inArticleIV,enshrines"therighttofreedomofinvestigation,

ofopinion,andoftheexpressionanddisseminationofideas,byanymediumwhatsoever,"

asarightinherenttoeveryhumanbeing.Inaddition,ArticleXXIVoftheDeclaration

establishesthateveryone"hastherighttosubmitrespectfulpetitionstoanycompetent

authority,forreasonsofeithergeneralorprivateinterest,andtherighttoobtainaprompt

decisionthereon."



12. Moreover,theIACHRDeclarationofPrinciplesonFreedomofExpression

establishes,inPrinciple2,that"Everypersonhastherighttoseek,receiveandimpart

informationandopinionsfreelyundertermssetforthinArticle13oftheAmerican

ConventiononHumanRights,"andthat"Allpeopleshouldbeaffordedequalopportunities

toreceive,seekandimpartinformation...."



13. InitsAdvisoryOpinionOC‐5/85,theInter‐AmericanCourtstatedthat"a

democraticsocietyrequirestheguaranteeofthewidestpossiblecirculationofnews,ideas

andopinionsaswellasthewidestaccesstoinformationbysocietyasawhole...."Italso

foundthatitis"inherentintheAmericanConventionthattherightofeachindividualto

expresshimselffreelyandthatofsocietyasawholetoreceiveinformationbescrupulously

respected."



14. AccordingtotheInter‐AmericanCourt,undertheprotectiongrantedby

theAmericanConvention,therighttofreedomofthoughtandexpressionincludes“not

onlytherightandfreedomtoexpressone’sownthoughts,butalsotherightandfreedom

toseek,receiveandimpartinformationandideasofallkinds.”10LiketheAmerican

Convention,otherinternationalhumanrightsinstruments,suchastheUniversal

DeclarationofHumanRightsandtheInternationalCovenantonCivilandPoliticalRights,

establishapositiverighttoseekandreceiveinformation.11 Ashasbeenexplainedincase

law,freedomofinformationisarightinandofitselfandnotjustamanifestationofthe

rightoffreedomofexpressionofwhichitisapart.12 



10I/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.Judgmentof

September19,2006.SeriesCNo.151,para.76.LópezÁlvarezv.HondurasCase.JudgmentofFebruary1,2006.

SeriesCNo.141,para.163;RicardoCanesev.ParaguayCase.JudgmentofAugust31,2004.SeriesCNo.111,

para.77;andHerreraUlloav.CostaRicaCase.JudgmentofJuly2,2004.SeriesCNo.107,para.108.

11I/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.Judgmentof

September19,2006.SeriesCNo.151,para.76.

12IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.141.

5



15. Sothen,therightofaccesstoinformationfallswithinthegeneral

frameworkoffreedomofexpression.13AstheInter‐AmericanCommissionhasinterpreted

it,Article13oftheAmericanConventionincludesapositiveobligationonthepartofthe

Statetoprovidecitizenswithaccesstoinformationinitspower,andarelatedrightof

individualstoaccessinformationheldbytheState.Alongtheselines,theIACHR

DeclarationofPrinciplesontheRighttofreedomofExpressionestablishesthefollowing,in

Principle3:"Everypersonhastherighttoaccess...informationabouthimselforherselfor

his/herassetsexpeditiouslyandnotonerously,whetheritbecontainedindatabasesor

publicorprivateregistries,andifnecessarytoupdateit,correctitand/oramendit."In

Principle4,itestablishes:"Accesstoinformationheldbythestateisafundamentalrightof

everyindividual.Stateshavetheobligationtoguaranteethefullexerciseofthisright."



16. TheIACHRhasestablishedthattoguaranteethefullandeffective

exerciseoftherightofaccesstoinformation,thepublicadministrationmustfollowthe

principlesofmaximumdisclosureandgoodfaith.14 Theprincipleofmaximumdisclosure

callsforthedesignofalegalregimeinwhichtransparencyandtherightofaccessto

informationarethegeneralrule,subjectonlytostrictandlimitedexceptions.15 The

principleofgoodfaithimpliesthatthoseboundtoguaranteethisrightactingoodfaith;

thatis,thattheyinterpretthelawinsuchaswaythatitmeetstheaimsoftherightof

accessandthattheyensurethestrictapplicationoftheright,providethenecessary

measuresofassistancetopetitioners,promoteacultureoftransparency,contributeto

makingpublicadministrationmoretransparent,andactwithduediligence,

professionalism,andinstitutionalloyalty.16



17. TheOfficeoftheSpecialRapporteurforFreedomofExpressionhas

maintainedthattherightofaccesstoinformationcreatesobligationsforallpublicpersons

ofallbranchesofgovernmentandautonomousbodiesatalllevelsofgovernment.17This

rightalsoaffectsthosewhocarryoutpublicfunctions,providepublicservices,ormanage

publicfundsonbehalfoftheState.Reiteratingexistingcaselaw,theResolutionofthe

Inter‐AmericanJuridicalCommitteeon"PrinciplesontheRightofAccesstoInformation"

statesthefollowinginPrinciple2:“Therightofaccesstoinformationappliestoallpublic

bodies,includingtheexecutive,legislativeandjudicialbranchesatalllevelsofgovernment,

constitutionalandstatutorybodies,bodieswhichareownedorcontrolledbygovernment,

andorganizationswhichoperatewithpublicfundsorwhichperformpublicfunctions.”18

13Ibid.,para.142.

14IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation,para.8.

15TheIACHRhasmaintainedthatthefollowingconsequencesarederivedfromthisprinciple:(1)the

rightofaccessmustbesubjecttoalimitedregimeofexceptions,andtheseexceptionsmustbeinterpreted

restrictively;(2)denialsofinformationmustbereasoned,andinthissensetheburdenofprovingthatthe

requestedinformationcannotbereleasedfallstotheState;and(3)therightofaccesstoinformationshouldtake

precedenceintheeventofdoubtsorlegalvacuums.IACHR,TheInter‐AmericanLegalFrameworkregardingthe

RighttoAccesstoInformation,para.10.

16IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation,para.15.

17Ibid.,para.20.

18Ibid.

6



18. Inaddition,theexerciseoftherighttoinformationpertainstodifferent

typesofinformationthatis,orshouldbe,inthepossessionoftheauthoritiesorprivate

citizens.19 Thetypesofinformationthatthisrightcoversincludethefollowingin

particular:informationintheState'scustody,management,orpossession;informationthe

Stateproduces,orinformationitisobligedtoproduce;informationinthepossessionof

thosewhomanagepublicservicesorpublicfunds;informationtheStatereceives,oris

requiredtocollectinthecourseofperformingitsduties;andinformationconcerningone’s

ownpersonaldata(habeasdata)orpropertyheldbythosewhoadministerprivate

databasesorregistriesandarelegallyrequiredtoprovideit.20



19. TheInter‐AmericanCourtofHumanRights,inahistoricjudgment,

interpretedthatArticle13oftheAmericanConventionestablishesaccesstoinformationas

ahumanright.21TheCourtstated:



[T]heCourtfindsthat,byexpresslystipulatingtherightto“seek”and

“receive”“information,”Article13oftheConventionprotectstherightof

allindividualstorequestaccesstoState‐heldinformation,withthe

exceptionspermittedbytherestrictionsestablishedintheConvention.

Consequently,thisarticleprotectstherightoftheindividualtoreceive

suchinformationandthepositiveobligationoftheStatetoprovideit,so

thattheindividualmayhaveaccesstosuchinformationorreceivean

answerthatincludesajustificationwhen,foranyreasonpermittedby

theConvention,theStateisallowedtorestrictaccesstotheinformation

inaspecificcase.22



20. TheCourtmoreoverindicatedthattheinformation"shouldbeprovided

withouttheneedtoprovedirectinterestorpersonalinvolvementinordertoobtainit,

exceptincasesinwhichalegitimaterestrictionisapplied.Thedeliveryofinformationtoan

individualcan,inturn,permitittocirculateinsociety,sothatthelattercanbecome

acquaintedwithit,haveaccesstoit,andassessit.Inthisway,therighttofreedomof

thoughtandexpressionincludestheprotectionoftherightofaccesstoState‐held

information,whichalsoclearlyincludesthetwodimensions,individualandsocial,ofthe

righttofreedomofthoughtandexpressionthatmustbeguaranteedsimultaneouslybythe

State."23

19IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.154.

20IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.155.See

IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation,para.21.

21I/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.Judgmentof

September19,2006.SeriesCNo.151.

22.I/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.Judgmentof

September19,2006.SeriesCNo.151,para.77.

23I/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.Judgmentof

September19,2006.SeriesCNo.151,para.77;I/ACourtH.R.,LópezÁlvarezv.HondurasCase.Judgmentof

February1,2006.SeriesCNo.141,para.163;RicardoCanesev.ParaguayCase.JudgmentofAugust31,2004.

SeriesCNo.111,para.80;andHerreraUlloav.CostaRicaCase.JudgmentofJuly2,2004.SeriesCNo.107,

paras.108‐111.

7



21. Inaresolutiononrecommendationsregardingaccesstoinformation,the

PermanentCounciloftheOrganizationofAmericanStatessummedupthefollowing

guidelinesonArticle13establishedbytheInter‐AmericanCourtinitsdecision:24



• Thatbyexpresslystipulatingtherights“toseekandreceiveinformation,”

Article13oftheConventionprotectstherightofallpersonstohave

accesstoinformationheldbythestate,withthesafeguardspermitted

undertheConvention’ssystemofrestrictions.



• Thatthestatemustfollowtheprinciplesofthepublicnatureof

information,transparency,andmaximumdisclosure—thelatterofwhich

establishesthepresumptionthatallinformationisaccessible,subject

onlytoanarrowsystemofexceptions.



• Thatsilencecannotbearesponsetoarequestforinformation.



• Thatthisrighthasthecounterpartofspecificobligationsbythestate.



• Thatthestatemusteliminatenormsandpracticesthatresultinthe

violationoftherightsprotectedbytheConvention,andenactlawsand

developpracticesleadingtotheeffectiverespectfortheseguarantees.



• Thatthestatemustguaranteetheefficacyofanappropriate

administrativeprocedureforprocessingandrespondingtorequestsfor

information,withdeadlinesforresponseanddeliveryoftheinformation,

handledbydulytrainedofficials.



• Thatthestatemustguaranteetherighttobeheardandprovidearapid

andsimpleremedyforexercisingthisright.



• Thatthestatemusttrainagencies,officials,andpublicagentsinaccessto

information.



22. TheIACHRhasestablishedthefollowingStateobligationsgeneratedby

therightofaccesstoinformation:theobligationtorespondtorequestsinatimely,

complete,andaccessiblemanner;toofferalegalrecoursethatsatisfiestherightofaccess

toinformation;toprovideanadequateandeffectivelegalremedyforreviewingdenialsof

requestsforinformation;toprovidethemaximumquantityofinformationproactively(also

calledtheobligationofactivetransparency);toproduceorgatherinformation;tocreatea

cultureoftransparency;toadequatelyimplementaccesslaws;andtoadjustdomestic

legislationtothedemandsoftherightofaccesstoinformation.25



24PermanentCounciloftheOrganizationofAmericanStates,CommitteeonJuridicalandPolitical

Affairs.RecommendationsonAccesstoInformation.CP/CAJP‐2599/08,April21,2008.

25IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation,pp.6‐12.

8



23. Moreover,asthisisoneoftheprotectedformsoftherighttofreedomof

expression,limitationstotherightofaccesstoinformationmustbeprescribedbylaw

expresslyandinadvance,andtheirestablishmentmustbesufficientlyclearandspecificso

astonotgrantanexcessivedegreeofdiscretiontothepublicofficialswhodecidewhether

ornottodisclosetheinformation.26Thus,theAmericanConventionestablishesthatany

lawsestablishingrestrictionstotherightofaccesstoinformationmustbeexpressly

establishedtotheextentnecessarytoensurerespectfortherightsorreputationsofothers

orprotectnationalsecurity,publicorder,orpublichealthormorals.27Moreover,any

limitationsimposedontherightofaccesstoinformationmustbenecessaryina

democraticsocietytosatisfyacompellingpublicinterest.Amongseveraloptionsfor

accomplishingthisobjective,theoneleastrestrictivetotherightmustbechosen,andthe

restrictionmustbeconducivetotheattainmentoftheobjective,beproportionatetothe

interestthatjustifiesit,andinterferetotheleastextentpossiblewiththeeffectiveexercise

oftheright.28



24. ThereisaregionalconsensusamongtheStatesthatmakeupthe

OrganizationofAmericanStatesregardingtheimportanceofaccesstopublicinformation

andtheneedtoprotectit.Thisrighthasbeenthesubjectofspecificresolutionsissuedby

theOASGeneralAssembly.29Forexample,inaresolutiondatedJune4,2009,theOAS

GeneralAssemblyresolvedto"urgememberstatestorespectandpromoterespectfor

everyone’saccesstopublicinformationandtopromotetheadoptionofanynecessary

legislativeorothertypesofprovisionstoensureitsrecognitionandeffective

application."30



III.STANDARDSONTHERIGHTTOACCESSTOINFORMATIONON

REPRODUCTIVEHEALTH



25. TheIACHRbelievesthattheobligationtoprovideinformationproactively

(alsocalledtheobligationofactivetransparency)laysthegroundworkfortheStates'

obligationtoprovidepublicinformationthatisessentialforpeopletobeabletoexercise

theirfundamentalrightsorsatisfytheirbasicneedsinthisarea.Thisisparticularly

relevantwhentheinformationhastodowithissuesrelatedtosexualityandreproduction,

sincesuchinformationhelpspeoplebepreparedtomakefreeandinformeddecisions

concerningtheseaspectsthataresointimatetotheirlives.



26IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation,para.49.

27Article13(2)oftheAmericanConvention.

28IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation,para.53.

29SeejudgmentofI/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.

JudgmentofSeptember19,2006.SeriesCNo.151,para.78.ResolutionAG/RES.1932(XXXIII‐O/03)ofJune10,

2003,on"AccesstoPublicInformation:StrengtheningDemocracy";ResolutionAG/RES.2057(XXXIV‐O/04)of

June8,2004,on"AccesstoPublicInformation:StrengtheningDemocracy";ResolutionAG/RES.2121(XXXV‐O/05)

ofJune7,2005,on"AccesstoPublicInformation:StrengtheningDemocracy";andAG/RES.2252(XXXVI‐O/06)of

June6,2006,on"AccesstoPublicInformation:StrengtheningDemocracy."

30 ResolutionAG/RES.2514(XXXIX‐O/09)ofJune4,2009,on"AccesstoPublicInformation:

StrengtheningDemocracy,"resolutionpoint2.

9



26. Inthisregard,women'srightofaccesstoinformationonreproductive

healthgivesrisetoaproactiveobligationbytheState,duetotherecognitionofthe

limitationsthattendtoaffectwomen—particularlythosewhoarepoor,indigenous,and/or

ofAfricandescent,orwholiveinruralareas—intermsofaccessingreliable,complete,

timely,andaccessibleinformationthatallowsthemtoexercisetheirrightsormeettheir

needs.Inthesecases,aswillbesetforthbelow,therightofaccesstoinformationtakeson

aninstrumentalnaturethatisusually,thoughnotnecessarily,associatedwiththe

satisfactionofotherhumanrightsenshrinedintheAmericanConvention.



27. TheIACHRbegantoaddresstheissueofaccesstoinformationon

reproductivematterssometimeago.Inits1998regionalreportonthestatusofwomenin

theAmericas,theCommissionestablished,basedonresponsessentinbytheStateson

healthandreproductivehealth,theexistenceintheregionofseriousproblemsofaccessto

basicinformationandadequatemedicalcareandsocialservices.TheIACHRrecommended

thattheStatesadoptmeasurestokeepproperstatisticaldataandtohavethenecessary

resourcesinordertoensureplansandprogramsthatallowwomentofullyexercisethe

righttohealth.



28. Initscountryvisits,theIACHRhasexpresseditsconcernoverthelimited

accesstotheseservicesdespiteahighlevelofunmetneeds.31Onthispoint,theIACHR

hasindicatedthatongoinglimitationsonfamily‐planninginformationandservicesare

relatedtobarriersinaccesstopublichealthcareandeducation.32



29. Moreover,theIACHRhasestablishedthatinformationandeducation

enablewomentomakedecisionsatalllevels,inallaspectsoftheirlives,especiallyinthe

areaofhealth,sexuality,andreproduction.Specificallyintheareaofmaternalhealth,the

IACHRhasemphasizedthatprotectingwomen'srighttointegrityunderconditionsof

equalityisachievedbyprovidinginformationandeducationonthesubjectsothatwomen

willmakefree,well‐founded,andresponsibledecisionsregardingreproduction,including

familyplanning.Moreover,toaddressthehighratesofmaternalmortality,theIACHRhas

recommendedimplementingmeasuresandpublicitycampaigns,targetedtothegeneral

public,onthedutytorespectwomen'scivil,political,economic,social,cultural,sexual,and

reproductiverights.33



30. TheCommissionhasalsomaintainedthatitisimportantthatwomenand

theirfamiliesandcommunitiesbeawareofhealthservicesandthattheyalsobeableto

identifywarningsignsthatrequiremedicalattention.34Thus,ithasstatedthatthelackof

informationonreproductivehealthactsasabarriertoobtainingaccesstomaternalhealth

31IACHR,FifthReportontheSituationofHumanRightsinGuatemala,ChapterXIII,TheRightsof

Women.

32IACHR,FifthReportontheSituationofHumanRightsinGuatemala,ChapterXIII,TheRightsof

Women;IACHR,ThirdReportontheSituationofHumanRightsinParaguay,ChapterVIII,Women'sRights.

33IACHR,AccesstoJusticeandSocialInclusion:TheRoadtowardsStrengtheningDemocracyinBolivia,

June28,2007,seeChapterV,Women'sRights.

34IACHR,AccesstoMaternalHealthServicesfromaHumanRightsPerspective,June7,2010,para.33.

10



servicesbecauseitpreventswomenfrommakingfreeandinformeddecisionsabouttheir

health,resultinginalackofappropriatepreventionandhealthpromotionbehaviorsto

protecttheirownhealthandthatoftheirchildren.35



31. Foritspart,theOfficeoftheRapporteurforFreedomofExpressionhas

statedthat"therightofaccesstoinformationisakeyinstrumentfortheexerciseofother

humanrights,particularlybythemostvulnerableindividuals."36 Withrespecttoaccessto

informationonreproductivematters,ithasindicatedthatwomenthroughouttheregion

areentitledtohavetheStatefullyguaranteetothemtherightofaccesstoinformationon

theirsexualandreproductiverightsthroughitsmassandtargetedcampaigns,forexample,

atallcentersprovidingbasichealthcare.37



32. Specificallywithrespecttoadolescentgirls'accesstoinformationon

reproductivehealth,theCommitteeontheRightsoftheChildhasestablishedStates'

obligationtoprovidethemwithaccesstoinformationonthepotentialharmthatcanbe

causedbyearlypregnancy.Ithasalsoestablishedthatadolescentgirlswhobecome

pregnantshouldhaveaccesstohealthservicesthataresensitivetotheirrightsand

particularneeds.38



33. TheIACHRdrawsattentiontothecomprehensivetreatmentofthisissue

bytheCommitteeonEconomic,SocialandCulturalRights(hereinafter,"theESCR

Committee").TheESCRCommitteehasexpoundedontheimportanceofaccessto

informationinthefieldofhealth,includingreproductivehealth.Itinterpretedtherightto

healthasaninclusiverightthatextendsnotonlytotimelyandappropriatehealthcarebut

alsototheunderlyingdeterminantsofhealth,suchasaccesstohealth‐relatededucation

andinformation,includingonsexualandreproductivehealth.39



34. AccordingtotheESCRCommittee,therighttohealthiscloselyrelatedto

anddependentupontherealizationofotherhumanrights,includingthatofaccessto

information.40 Moreover,inlayingoutthedimensionsoftherighttohealth,theESCR

Committeeestablishedthataccesstoinformationincludestherighttoseek,receive,and

impartinformationandideasconcerninghealthissues.41SpecificallytheESCRCommittee

establishedthattherealizationofwomen'srighttohealthasregardsreproduction

35IACHR,AccesstoMaternalHealthServicesfromaHumanRightsPerspective,June7,2010,para.33.

36IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.147.

37Ibid.,para.91.Seealso,IACHR,FifthReportontheSituationofHumanRightsinGuatemala,6April,

2001,CahpterXIII,TheRightsofWomen,para.36.

38UnitedNations,CommitteeontheRightsoftheChild,GeneralCommentNo.4.

39UnitedNations,CommitteeonEconomic,SocialandCulturalRights.Therighttothehighest

attainablestandardofhealth,GeneralCommentNo.14,para.11.

40Ibid.,para.3.

41Ibid.,para.12.

11



"requirestheremovalofallbarriersinterferingwithaccesstohealthservices,education

andinformation,includingintheareaofsexualandreproductivehealth."42



35. IntermsofStates'obligationstorespect,protect,andfulfilltherightto

healthinrelationtoaccesstoinformationonreproductivematters,theESCRCommittee

indicatedthattheStatesmusthavearoleinensuringthatthirdpartiesdonotrestrict

people'saccesstoinformationandhealth‐relatedservices.Italsostatedthatother

obligationsincludethepromotionofmedicalresearchandhealtheducation,aswellas

informationcampaigns,inparticularwithrespecttoHIV/AIDS,sexualandreproductive

health,traditionalpractices,anddomesticviolence.



36. Meanwhile,theprovisionscontainedintheCEDAWunderscorethe

importanceofguaranteeingaccesstoinformation,particularlyasregardshealth.Article

10,paragraph(h),establishesStates'obligationtoadoptallappropriatemeasuresto

eliminatediscriminationagainstwomen,inordertoensuretothemequalrightswithmen

inthefieldofeducationandinparticulartoensure,onabasisofequalityofmenand

women,"accesstospecificeducationalinformationtohelpensurethehealthandwell‐

beingoffamilies."43



37. Moreover,Article16,paragraph1,subparagraph(e),ofCEDAW

establishestheobligationofStatesPartiestoensure,onabasisofequalityofmenand

women,thesamerightstodecidefreelyandresponsiblyonthenumberandspacingof

theirchildren,andtohaveaccesstotheinformation,education,andmeanstoenablethem

toexercisetheserights.Alongtheselines,theCEDAWCommitteehasstatedthefollowing:



ThedutyofStatespartiestoensure,onabasisofequalitybetweenmen

andwomen,accesstohealthcareservices,informationandeducation

impliesanobligationtorespect,protectandfulfilwomen'srightsto

healthcare.Statespartieshavetheresponsibilitytoensurethat

legislationandexecutiveactionandpolicycomplywiththesethree

obligations.44



38. Meanwhile,theCEDAWCommitteehasemphasizedthatadultwomen

andadolescentgirlsinmanycountrieslacksufficientaccesstonecessaryinformationand

servicestoensuresexualhealth.Thisisparticularlyrelevantinthecaseofwomenand

adolescentswhoareinasituationofexclusion.Thusithasmaintainedthat"Statesparties

shouldensure,withoutprejudiceanddiscrimination,therighttosexualhealthinformation,

educationandservicesforallwomenandgirls."45Inparticular,theCEDAWCommitteehas

notedStates'obligationtoensurethenecessaryinformationandservicestoaddressissues

42Ibid.,para.21.

43UnitedNations,ConventionontheEliminationofAllFormsofDiscriminationagainstWomen,

Article10(h).

44 UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,General

RecommendationNo.24,Womenandhealth,para.13.

45Ibid.,para.28.

12



relatedtoHIV/AIDSandothersexuallytransmitteddiseases,includinginformationand

counselingonallmethodsoffamilyplanning.46 



39. TheIACHRnotesthattheInter‐AmericanCourt,initsjudgmentinClaude‐

Reyesetal.v.Chile,reiteratedthat"thegeneralobligationcontainedinArticle2ofthe

Conventioninvolvestheeliminationofnormsandpracticesofanytypethatresultin

violationsoftheguaranteesestablishedintheConvention,aswellastheenactmentof

lawsandthedevelopmentofpracticesconducivetotheeffectiveobservanceofthese

guarantees."47Thisreasoning,appliedinthesphereofaccesstoinformationintheareaof

reproduction,impliesthatStateshavetheobligationtoadoptthenecessarymeasuresto

ensureprotectionoftherightofaccesstoinformation.Thisshouldincludeguaranteeing

theeffectivenessofanappropriateadministrativeprocedureforprocessinganddeciding

onrequestsforinformation,onewhichsetsdeadlinesformakingadeterminationand

providingtheinformation,andwhichfallsundertheresponsibilityofproperlytrained

officials.



40. TheIACHRbelievesthatArticle2oftheAmericanConvention,with

regardtoaccesstoinformationonreproductivematters,presupposestheprovisionof

effective,accessible,andtransparentaccountabilitymechanismsintheeventthatStates

failtofulfilltheirinternationalobligationsinthisarea.



41. TheCourt,intheCaseofClaude‐Reyes,wentastepfurtherandordered

theStatetoprovidetrainingtothepublicentities,authorities,andagentsresponsiblefor

respondingtorequestsforaccesstoState‐heldinformationonthelawsandregulations

governingthisright.Basedonthispremise,theStateshavetheobligationtotraintheir

professionalstoinformwomenregardingtheirhealth,includinginformationonaspects

relatedtoreproductivehealth.Alongtheselines,theIACHRconsidersthataccessto

informationonsexualandreproductivemattersrequiresaStateresponseacrosssectors.

Whilethisreportisbasedprimarilyonaspectsofaccesstohealth‐relatedinformation,the

rightofaccesstoinformationonsexualandreproductivemattersrequiresvarioussectors

tobeinvolvedinordertoaddressthissubjectcomprehensively.



42. TheIACHRwillnowanalyzecertainspecificstandardsonaccessto

informationonsexualandreproductivematters,whichtheStatesshouldobserveinorder

toguaranteethisright:(a)accesstoinformationandinformedconsent;(b)accessto

informationandtheprotectionofconfidentiality;(c)accesstoinformationandthe

obligationtoprovideinformationthatistimely,complete,accessible,reliable,and

proactive;(d)accesstoinformationandaccesstomedicalrecords;ande)accessto

informationandtheobligationtoproducereliablestatistics.



46 UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,General

RecommendationNo.24,Womenandhealth.

47I/ACourtH.R.,Claude‐Reyesetal.v.ChileCase.Merits,ReparationsandCosts.Judgmentof

September19,2006.SeriesCNo.151,para.163.

13



A.Accesstoinformationandinformedconsent



43. TheIACHRrecognizesthataccesstoinformationisanessentialfactorto

beabletoreceivemedicalcare.Consentconstitutesanethicalprincipleofrespectfor

individualautonomy,onethatrequiresthatpeopleunderstandthedifferenttreatment

optionsamongwhichtheycanchoose.48 Informedconsent,meanwhile,impliesthe

existenceofahorizontalrelationshipbetweendoctorandpatient.Whilehealth

professionalsaretheoneswhobestunderstandthephysicalconditionsofthepatients'

disordersandthemostappropriatemeansforpreventionandtreatment,itisthepatients

whobetterunderstandtheirdispositionandtemperament,includingtheirpriorexperience

withearliertreatments,preferences,andfears.49



44. Aswillbelaidoutbelow,theissueofinformedconsentinreproductive

healthhasbeensubjecttodiscussionanddevelopmentbythevariousinternational,

regional,andnationalbodiesfortheprotectionofhumanrights.TheIACHRnotessome

factorsthatareanintegralpartofaprocessofinformedconsent:(i)informingpatients

aboutthenatureoftheprocedure,treatmentoptions,andreasonablealternatives,

includingthepotentialbenefitsandrisksofproposedprocedures;(ii)takingintoaccount

theperson'sneedsandensuringthatthepersonunderstandstheinformationprovided;

and(iii)ensuringthatanyconsentprovidedisfreeandvoluntary.



1.Informingpatientsaboutthenatureoftheprocedure,treatment

options,andreasonablealternatives,includingthepotentialbenefits

andrisksofproposedprocedures



45. Accesstoinformationonreproductivemattersrequiresthatwomenhave

sufficientinformationtomakedecisionsabouttheirhealth.Toattainthisobjective,the

informationprovidedmustbetimely,complete,accessible,reliable,andproactive.Itmust

alsobeunderstandable,usinglanguagethatisaccessible,andmustbecurrent.According

toRebeccaCook,informationthathealthprofessionalsshouldofferincludes,inprinciple:50



• Thepatient'scurrentreproductivehealthconditionintermsoftherisks

ofanunplannedpregnancy,sexuallytransmittedinfections,the

conceptionandbirthofachildaffectedbyareasonablypreventable

disability,andinfertility.



• Reasonableaccesstothemedical,social,andothermeansthatrespond

tothepatient'sconditionsandreproductiveintentions,including

48B.M.DickensandR.JCook,Dimensionsofinformedconsenttotreatment,Ethicalandlegalissuesin

reproductivehealth.InternationalJournalofGynecology&Obstetrics85(2004),pp.309‐314.

49Thephrase"informedconsent"isthemostcommonlyusedterm.However,somewouldarguethat

thetermcouldbemisinterpretedandthatitshouldbereplacedbytheterm"informedchoice."Thisisduetothe

factthatthechoicenottoconsentisessentialtotheoverallconceptofvoluntariness,orconsentgranted

voluntarily.SeeB.M.DickensandR.JCook,Dimensionsofinformedconsenttotreatment.

50RebeccaJ.Cook,BernardM.Dickens,andMahmoudF.Fathalla,ReproductiveHealthandHuman

Rights:IntegratingMedicine,Ethics,andLaw,p.104.

14



expectedratesofsuccess,sideeffects,andtherisksinvolvedwitheach

option.



• Theimplicationsforthepatient'ssexualandreproductivehealth,aswell

asforhergeneralhealthandlifestyle,ofdeclininganyoftheoptions.



• Theprovider'srecommendationsandthereasonsbehindthem.



46. Throughitsvariousmechanisms,theCEDAWCommitteehasaddressed

therelevanceofaccesstoinformationonreproductivemattersandhasmaintainedthat

women"havetherighttobefullyinformed,byproperlytrainedpersonnel,oftheiroptions

inagreeingtotreatmentorresearch,includinglikelybenefitsandpotentialadverseeffects

ofproposedproceduresandavailablealternatives."51 



47. Indeed,accesstoinformationhelpswomenmakeinformeddecisions

regardingthemostintimaterealmoftheirlife,decidingtohavechildren.Onthispoint,the

IACHRhasestablishedthatacouple'sdecisiontohavechildrenfallswithinthemost

intimatesphereoftheirprivateandfamilylife.52Italsostatedthatthewayinwhich

couplesarriveatthatdecisionispartofaperson’sautonomyandidentity,bothasan

individualandasapartner,andisthereforeprotectedunderArticle11oftheAmerican

Convention.TheEuropeanCourtofHumanRightsestablishedthattheconceptofprivatelife,

inadditiontocoveringthephysicalandpsychologicalintegrityofaperson,53canembrace

aspectsofanindividual'sphysicalandsocialidentity,includingtherighttopersonal

autonomy,personaldevelopment,andtherighttoestablishanddeveloprelationshipswith

otherhumanbeingsandtheoutsideworld.54Italsoheldthattheprotectionofprivatelife

incorporatestherighttorespectdecisionsregardingwhetherornottobecomeaparent.55 

Moreover,theEuropeanCourtrecentlydeterminedthattherighttotimelyaccessto

informationwithregardtoaprenatalgenetictestfallswithintheambitofprivatelifeand

includesarighttoobtainavailableinformationonone’scondition.56



48. TheIACHRconsidersthatfortheOASMemberStatestoensurewomen's

righttoaccesstoinformationonreproductivematters,theyshouldprovideallavailable

informationwithrespecttofamily‐planningmethodsaswellastootherlawfullyprovided

sexualandreproductivehealthservices.Withrespecttofamily‐planningservices,thisat

theleastincludesmakingavailableallinformationregardingthefamily‐planningservices

51UnitedNations,CEDAWCommittee,GeneralRecommendation24,para.20.

52 ApplicationtotheInter‐AmericanCourtofHumanRights,GretelArtaviaMurillo(InVitro

Fertilization).

53EuropeanCourtofHumanRights,Prettyv.TheUnitedKingdom,Application2346/02,April29,2002,

para.61.

54EuropeanCourtofHumanRights,Tysiacv.Poland,para.107;EuropeanCourtofHumanRights,

Prettyv.TheUnitedKingdom,para.61.

55EuropeanCourtofHumanRights,Prettyv.TheUnitedKingdom,para.61;EuropeanCourtofHuman

Rights,Evansv.TheUnitedKingdom,Application6339/05,April10,2007,para.71.

56EuropeanCourtofHumanRights,R.R.v.Poland,Application27617/04,May26,2011,para.197.

15



allowedbylawandthescope,risks,benefits,andsideeffectsofeachofthem.With

respecttosexualandreproductivehealthservices,thisincludesinformationonthe

preventionofsexuallytransmittedinfections,includingHIV/AIDS,aswellasadiscussionof

thenatureofanymedicalproceduresthatmayberequired,reasonablealternativestothe

proposedintervention,andinformationontherelevantrisksandbenefits.Inboth

situations,aswillbeexplainedbelow,healthprofessionalsshouldassessthepatient'slevel

ofunderstandingsothatshecanmakeadecisionregardingtheinterventionortreatment.

Thatinvolvestakingintoaccountthespecificinformationneedsthatsomegroupsof

womenmayhaveduecontextsofexclusion,marginalizationordiscrimination,including

indigenousandAfro‐descendantwomen,adolescentgirls,womenwholiveinruralareas

andmigrantwomen57 .



49. ItisimportanttonotethatinsomeStatesoftheAmericas,caselawhas

developedtheconceptofaccesstoinformationinthesphereofhealthasaguarantee

obligationoftheStates.Bywayofillustration,theSupremeCourtofCanada,inits

judgmentinMcIrneyv.MacDonald,establishedthepositiveobligationofhealthcare

professionalstoprovideinformationtopatientsregardingtheirdiagnosisandtreatment.58

Foritspart,theUnitedStatesCourtofAppealsfortheDistrictofColumbia,inCanterburyv.

Spence,rejectedthepropositionthatapatientmustrequestinformationbeforethedoctor

isrequiredtoinformhimorher.TheCourtindicatedthatthedoctorhastheobligationto

provideinformation,evenifithasnotbeenrequested,sothatthepatientcanmakean

informeddecision.59



50. Alongthesesamelines,theEuropeanCourtofHumanRightssanctioned

oneofitsMemberStatesforfailingtoprovideinformationonthehealthservices

permittedbylaw.TheCourtfoundthatthefailuretoprovidetheinformationconstituted

aviolationoftherighttoreceiveandimpartinformation.60TheCourtinparticular

underscoredthepossibleprejudicialeffectsofthelackofinformationinsomecasesin

whichaninjunctionimposedtopreventinformationfrombeingprovidedmayhavehad

moreadverseeffectsonwomenwhowerenotsufficientlyresourcefulordidnothavethe

necessarylevelofeducationtohaveaccesstoalternativesourcesofinformation.61



51. Inanotherdecision,theCourtestablishedthatduringpregnancy,the

conditionandhealthofthefetusconstituteanelementofthepregnantwoman'shealth.

Asaresult,theeffectiveexerciseoftherightofaccesstoinformationisoftendecisivefor

thepossibilityofexercisingpersonalautonomybydeciding,onthebasisofsuch

57TheIACHRalsohighlightsthespecificneedsonreproductivehealthinformationthatwomenofage

require.

58SupremeCourtofCanada,McIrneyv.MacDonald[1992]2S.C.R.138.

59CourtofAppealsfortheDistrictofColumbiaCircuit,Canterburyv.Spence464F.2d772(D.C.Cir.

1972).

60EuropeanCourtofHumanRights,OpenDoorCounselingandDublinWellWomenv.Ireland(1992).

JudgmentofOctober29,1992.

61Ibid.,para.77.

16



information,onthefuturecourseofeventsrelevantfortheindividual'squalityoflife.62

TheCourtindicatedthattimelyaccesstoinformationconcerningaparticularhealth

condition"applieswithparticularforcetosituationswhererapiddevelopmentsinthe

individual'sconditionoccurandhisorhercapacitytotakerelevantdecisionsisthereby

reduced."Itaddedthatinthecontextofpregnancy,theeffectiveaccesstorelevant

informationonthehealthofthemotherandthefetusisdirectlyrelevantfortheexercise

ofpersonalautonomy,specificallywheredomesticlegislationallowsforabortionincertain

situations.63



52. Similarly,aswillbelaidoutbelow,inA.S.v.HungarytheCEDAW

CommitteeaffirmedthatArticle10ofCEDAWincludesarighttoreceivespecific

informationonfamily‐planningmethods,inordertopreventproceduresfrombeing

performedonwomenwithouttheirbeingabletomakefullyinformeddecisions.



2.Providingappropriateinformation,takingintoaccounttheperson's

needsandensuringthatthepersonunderstandstheinformation

provided



53. TheIACHRobservesthathealthcareprofessionalsareunderthe

obligationtoguaranteethatanydecisionsthatwomenmakeregardingsexualand

reproductivemattersaremadefreely,forexamplewhenitcomestochoosingapreferred

contraceptivemethod.TheIACHRhasstatedthatwhenwomen'sdecision‐making

freedomiscompromisedbycircumstancessuchaspoverty,orthefactthattheybelongto

aparticularraceorsocialorigin,theirhumanrightsareatrisk.Thisisespeciallypertinent

whenitcomestocertaingroupsofwomenwhoareparticularlyvulnerable,suchas

indigenouswomen,womenofAfricandescent,migrantwomen,womenlivinginrural

areas,andwomenlivinginpoverty,whobecauseoftheirparticularcircumstancesface

greaterdifficultiesinaccessinginformationonreproductivehealth.64



54. AccordingtotheInter‐AmericanCourt,"anypersonwhoisina

vulnerableconditionisentitledtospecialprotection,whichmustbeprovidedbytheStates

iftheyaretocomplywiththeirgeneraldutiestorespectandguaranteehumanrights."65

Thisrequirestheeliminationofprovisionsorpracticesthatdiscriminateagainstwomen,

suchasforexamplerequiringthattheirpartnersbepresenttoreceiveinformationabout

theirhealth.



55. TheformerUnitedNationsSpecialRapporteurontherightofeveryoneto

theenjoymentofthehighestattainablestandardofphysicalandmentalhealthhas

indicatedthatStateshaveadutytoensurethathealthinformationandservicesaremade

availabletovulnerablegroups,inthecontextoftheirobligationstocombatdiscrimination.

Asanexample,henotesthatStates"musttakestepstoempowerwomentomake

62EuropeanCourtofHumanRights,R.R.v.Poland,para.197.

63Ibid.

64IACHR,AccesstoMaternalHealthServicesfromaHumanRightsPerspective.

65I/ACourtH.R.,XimenesLopesv.BrazilCase.JudgmentofJuly4,2006.SeriesCNo.149,para.103.

17



decisionsinrelationtotheirsexualandreproductivehealth,freeofcoercion,violenceand

discrimination."66 Inthisregard,theCEDAWCommitteehasmaintainedthatacceptable

healthcareservicesarethosethataredeliveredinawaythatensuresthatawomengives

herfullyinformedconsent,respectsherdignity,guaranteesherconfidentiality,andis

sensitivetoherneedsandperspectives.67



56. CEDAWGeneralRecommendationNo.21statesthatinordertomakean

informeddecisionaboutsafeandreliablecontraceptivemeasures,womenmusthave

informationaboutcontraceptivemeasuresandtheiruse,andguaranteedaccesstosex

educationandfamily‐planningservices,asprovidedinArticle10(h)ofCEDAW.68



57. Forthatpurpose,theinformationshouldbecomplete,understandable,

anduptodate.69TheIACHRunderscorestheimportancethattheinformationprovidedbe

adaptedtothelanguageofthepersonwhorequestsorneedsit.TheOfficeoftheSpecial

RapporteurforFreedomofExpressionhasheldthatethnicandculturalgroupshavethe

righttohavetheStatedesignpoliciesaimedatadaptingtherightofaccesstotheircultural

needs,suchastheirlanguage.70Thus,toguaranteeeffectiveaccesstoinformationon

sexualandreproductivematters,theStatesmustensurethatwomenreceiveinformation

andeducationintheirownlanguagesandinsuchawaythatrespectstheircultures.Along

theselines,theESCRCommitteehasheldthatinformationaboutpublicservices,for

example,shouldbeavailable,asfaraspossible,inlanguagesspokenbyminorities.71



58. TheHumanRightsCouncilrecentlyindicatedthatStatesshouldensure

theavailabilityofawiderangeofpreventionprogramsthattakeintoaccountlocal

circumstances,ethics,andculturalvalues,includinginformation,education,and

communicationinlanguagesmostunderstoodbycommunitiesandrespectfuloftheir

cultures,aimedatreducingrisk‐takingbehaviorsandencouragingresponsiblesexual

behavior.72



66UnitedNations,ReportoftheSpecialRapporteur,PaulHunt.Therightofeveryonetotheenjoyment

ofthehighestattainablestandardofphysicalandmentalhealth,E/CN.4/2004/49,February16,2004,para.39.

67 UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,General

Recommendation24,para.22.

68 UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,General

Recommendation21,para.22;UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,

A.S.v.Hungary,CommunicationNo.4/2004,CEDAW/C/36/D/4/2004.

69IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation.Officeof

theSpecialRapporteurforFreedomofExpression,December30,2009,para.32.

70IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression.

71GeneralCommentNo.20,Non‐discriminationineconomic,socialandculturalrights(art.2,para.2,

oftheInternationalCovenantonEconomic,SocialandCulturalRights),July2,2009.

72UnitedNations,ResolutionoftheHumanRightsCouncil,Theprotectionofhumanrightsinthe

contextofhumanimmunodeficiencyvirus(HIV)andacquiredimmunodeficiencysyndrome(AIDS),

A/HRC/RES/12/27),October22,2009,para.6.

18



59. Inaddition,theIACHRnotesthatanothergrouprequiringaccessto

timely,complete,accessible,reliable,andproactiveinformationareadolescents.Inits

reportonAccesstoMaternalHealthServicesfromaHumanRightsPerspective,theIACHR

addressedtheproblemofhighratesofmaternalmortalityamongadolescentgirlsandthe

needtoprovidethemwithinformationandeducationonthesubject.73



60. Onthispoint,theESCRCommitteehasestablishedthat"therealization

oftherighttohealthofadolescentsisdependentonthedevelopmentofyouth‐friendly

healthcare,whichrespectsconfidentialityandprivacyandincludesappropriatesexualand

reproductivehealthservices."74Alongthesesamelines,theformerUnitedNationsSpecial

Rapporteurontherightofeveryonetotheenjoymentofthehighestattainablestandardof

physicalandmentalhealthmaintainedthat"Statesshouldensurethatadolescentsareable

toreceiveinformation,includingonfamilyplanningandcontraceptives,thedangersof

earlypregnancyandthepreventionofsexuallytransmittedinfectionsincludingHIV/AIDS,

aswellasappropriateservicesforsexualandreproductivehealth."75



3.Ensuringthatanyconsentprovidedisfreeandvoluntary



61. Thevarioussystemsfortheprotectionofhumanrightshaveemphasized

theneedforStatestoensurethatthedecisionswomenmakeabouttheirreproductive

healtharefreeofanyformofcoercion.Thataccountsfortheimportanceofguaranteeing

women'sconsentintheprovisionofmedicaltreatmentorsurgicalintervention.TheIACHR

hasdeemedthatthepracticeofasurgicalinterventionwithouttherequiredconsentmay

constituteaviolationofthepatient'shumanrights.76Specifically,itmayconstitutea

violationoftheperson'srighttopersonalintegrityprotectedbyArticle5oftheAmerican

Convention.Thiscloserelationshipbetweenaccesstoinformationandwomen'srightto

integritywasaddressedbytheEuropeanCourtinarecentjudgment,inwhichtheCourt

establishedthatcompliancewiththeState'spositiveobligationtosecuretoitscitizens

theirrighttoeffectiverespectfortheirphysicalandpsychologicalintegritymaynecessitate

theadoptionofregulationsconcerningaccesstoinformationaboutanindividual's

health.77



62. Indeed,alackofvoluntarinessofmedicalproceduresmayconstitutea

violationoftherightstointegrity,life,andequalprotectionbeforethelaw,pursuanttothe

AmericanConvention,aswellasformsofviolenceanddiscriminationagainstwomen,

73Formoreinformation,seeIACHR,AccesstoMaternalHealthServicesfromaHumanRights

Perspective.

74UnitedNationsCommitteeonEconomic,SocialandCulturalRights.Therighttothehighest

attainablestandardofhealth,GeneralCommentNo.14,para.23.

75UnitedNations,ReportoftheSpecialRapporteur,PaulHunt.Therightofeveryonetotheenjoyment

ofthehighestattainablestandardofphysicalandmentalhealth,para.39.

76AccordingtotheWorldHealthOrganization,"Maleandfemalesterilizationshouldberegardedas

permanentmethodsandallindividualsandcouplesconsideringthesemethodsshouldbecounselledaccordingly.

Noothermethodsresultinpermanentinfertility."Medicaleligibilitycriteriaforcontraceptiveuse(3rd

Edition)(2005),p.8.

77EuropeanCourtofHumanRights,R.R.v.Poland,para.188.

19





pursuanttoprovisionsoftheInter‐AmericanConventiononthePrevention,Punishment

andEradicationofViolenceagainstWomen(hereinafter“ConventionofBelémdoPará”).

TheIACHRhasexpresseditsconcernovercasesofsterilizationperformedinPeruwithout

women'sconsent,relatedtotheimplementationoffamily‐planningpolicyandthe

VoluntaryContraceptiveSurgeryprogram.78TheIACHRheldthatwhenafamily‐planning

programceasestobevoluntaryandturnswomenintomereobjectsofcontrolsoasto

makeadjustmentstopopulationgrowth,itposesadangerofviolenceanddirect

discriminationagainstwomen.79 TheCommissionfoundthat"acampaigntodisseminate

familyplanningmethodsisapositiveaction,solongasitisvoluntaryfamilyplanning."



63. Throughitscasesystem,theIACHRreceivedapetitionthatreferredtoa

forcedsterilizationperformedatapublichealthcenterinPeru,whichresultedinthedeath

ofthevictim,MaríaMaméritaMestanza.Inthiscase,thevictimwasnotinformedabout

theprocedurethemedicalauthoritiesweregoingtoperformonherandthuswasdeprived

ofthepossibilityofacceptingorrejectingthemedicalintervention,whichledtoan

infringementofvarioushumanrights.Thecasewasresolvedwithafriendlysettlement

agreementbetweenthepartiessignedin2001,bywhichtheStateofPerurecognizedits

responsibilityforviolatingthevictim'srighttolife,tophysicalandpsychologicalintegrity

andhumanetreatment,andtoequalitybeforethelaw,andtherighttobefreefrom

violence.80Amongitscommitments,theStatepledgedtoimplementmeasurestoensure

thatwomencanprovideinformedconsentwithina72‐hourperiodpriortosterilization.

TheIACHRismonitoringcompliancewiththeagreement.



64. OnJuly23,2008,theIACHRadmittedapetitioninwhichtheStateof

Boliviaisallegedtohaveinternationalliabilityovertheallegedforcedsterilizationofa

womaninapublichospital.Thepetitionermaintainsthatintheyear2000,Mrs.I.V.was

submittedtoatuballigationsurgicalprocedurewithoutherinformedconsent,andthat

thiswasthereforeaninvoluntarysterilization,inwhichshepermanentlylosther

reproductivecapacity.TheState,foritspart,indicatesthatwhiletheallegedvictimwas

undergoingacaesareansection,shepresentedwithmultipleadhesionsandasaresultwas

toldthatanyfuturepregnancycouldputherlifeatrisk.Becauseofthis,theState

indicates,itwassuggestedtoherthataligationofherfallopiantubesbeperformed,to

whichshegaveherverbalconsent.81Itisimportanttonotethatforthefirsttime,the

CommissiondeemedthatthefactsshouldbeanalyzedunderArticle13oftheAmerican

ConventioninrelationtotheobligationsenshrinedinArticle1(1)ofthesameinstrument,

insofarasitwasarguedthatthealledgedvictimhadnot"beenadequatelyinformedofthe

effects,risksandconsequencesofthesurgicaloperationshewassubmittedto,and/or

78IACHR,SecondReportontheSituationofHumanRightsinPeru,June2,2000,seeChapterVII,

Women'sRights.

79Ibid.

80IACHR,ReportNo.71/03,Petition12.191,FriendlySettlement,MaríaMaméritaMestanzaChávez

(Peru),October3,2003.

81IACHR,ReportNo.40/08,Admissibility,I.V.(Bolivia),July23,2008.

20



alternativemethodsasdemandedbyBolivianlawandtheinternationalstandardsof

humanrightsinthisarea."82Thiscaseisnowinthemeritsstage.



65. InitsreportonAccesstoMaternalHealthServicesfromaHumanRights

Perspective,theIACHRstatedthattheConventionofBelémdoPará"recognizesthecrucial

linkagebetweentherighttolivefreeofdiscriminationandtherecognitionofother

fundamentalrights,particularlytherighttobefreeofviolencebasedongender."83The

ConventionofBelémdoPará,inArticle6,establishesthattherightofeverywomantobe

freefromviolenceincludes,amongothers:



− Therightofwomentobefreefromallformsofdiscrimination;and

− Therightofwomentobevaluedandeducatedfreeofstereotyped

patternsofbehaviorandsocialandculturalpracticesbasedonconceptsof

inferiorityorsubordination.



66. InaccordancewiththeparametersestablishedintheConventionofBelém

doPará,thelackofinformationwithrespecttoasterilizationperformedwithouta

woman'sconsent,aswellasthephysicalandpsychologicalconsequencesofsuchan

intervention,areexamplesofformsofviolenceagainstwomen.Likewise,failingtoinform

womenvictimsofsexualviolenceabouttheservicesthatareavailabletotheminthese

circumstancesmayalsoamounttoaformofviolence.



67. TheIACHRhasstatedthatsubparagraph(e)ofArticle7oftheConvention

ofBelémdoParáimposesonStatestheobligationtotakeallappropriatemeasures,

includinglegislativemeasures,toamendorrepealexistinglawsandregulationsortomodify

lawfulorcustomarypracticesthatsustainthepersistenceandtoleranceofviolenceagainst

women.Giventheclearrelationshipthatexistsbetweendiscriminationandviolence,this

preceptshouldbeinterpretedinthesenseofimposingonStatestheobligationtoreview

publicregulations,practices,andpoliciesthatarediscriminatoryorcouldleadto

discriminatoryeffectsagainstwomen(forexample,legalnormsthatdonotguarantee

womenaprocessforfreeandvoluntaryconsentforamedicalintervention).



68. Foritspart,theCEDAWCommitteehasmaintainedthefollowing:



Statespartiesshouldnotpermitformsofcoercion,suchasnon‐

consensualsterilization,mandatorytestingforsexuallytransmitted

diseasesormandatorypregnancytestingasaconditionofemployment

thatviolatewomen'srightstoinformedconsentanddignity.84

82Ibid.,para.81.

83IACHR,AccesstoMaternalHealthServicesfromaHumanRightsPerspective.

84 UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,General

RecommendationNo.24,para.22.ItisimportanttonotethatArticle14(2)(b)oftheConventiononthe

EliminationofAllFormsofDiscriminationagainstWomenestablishesthat"StatesPartiesshalltakeall

appropriatemeasurestoeliminatediscriminationagainstwomeninruralareasinordertoensure,onabasisof

equalityofmenandwomen,thattheyparticipateinandbenefitfromruraldevelopmentand,inparticular,shall

ensuretosuchwomentheright...tohaveaccesstoadequatehealthcarefacilities,includinginformation,

counsellingandservicesinfamilyplanning."

21





69. IntheA.S.v.Hungarycase,thepetitionerarguedtotheCEDAW

CommitteethatHungaryhadviolatedseveralprovisionsofCEDAWasaresultofherhaving

beensubjectedtosterilization,duringasurgicalinterventiontoextractafetus,without

havingreceivedspecificorunderstandableinformationonthesterilizationorontheeffects

itwouldhaveonherabilitytoreproduce.Shealsoarguedthatshewasunabletogive

informedconsentonaccountoftheincompleteinformationprovidedtoher,which

constitutedaviolationoftherighttoappropriatehealthcareservices.Shealsoindicated

thatthesurgicalinterventiontowhichshewassubjectedlimitedhercapacityto

reproduce.



70. AnopinionissuedonAugust29,2006,pursuanttoparagraph3ofArticle

7oftheOptionalProtocolofCEDAW,expandedontheinterpretationofArticle10of

CEDAW.TheCommitteereasonedthatthepetitionerhadarightprotectedbyArticle10(h)

oftheConventiontospecificinformationonsterilizationandalternativeproceduresfor

familyplanninginordertoguardagainstsuchaninterventionbeingcarriedoutwithout

herhavingmadeafullyinformedchoice.85Giventhecircumstancesoftheparticularcase,

theCEDAWCommitteeevaluatedthepetitioner'sstateofhealthonarrivalatthehospital

anddeterminedthatanycounselingshereceivedmusthavebeengiven"understressful

andmostinappropriateconditions."86



71. Asaresult,theCEDAWCommitteefound"afailureoftheStateparty,

throughthehospitalpersonnel,toprovideappropriateinformationandadviceonfamily

planning,"whichconstitutesaviolationofthevictim'srightunderArticle10(h)ofthe

ConventionandArticle16,paragraph1(e)ofthesameinstrument[CEDAW].87



72. TheCEDAWCommittee'sdecisionemphasizesthat,inorderforconsent

nottobeflawed,itmustnotbeobtainedundercoercionorinfluenceofanykind.Onthis

point,theCommissionemphasizesthatwhileconsentmaybegrantedverballyorin

writing,inpractice,forgreaterlegalprotectionandintheeventofpossiblefuturedisputes,

consentshouldbegrantedinwriting.TheCommissionunderstandsthatthegreaterthe

consequencesofadecisiontobemade,themorerigorousthecontrolsshouldbetoensure

thatconsentwastrulygiven.Thesituationandconditionsunderwhichconsentisgiven

shouldbestrictlyanalyzedonacase‐by‐casebasis.Inaddition,theCommissionrecognizes

thatthemerestatementorrecordofconsentdoesnotconstitutefullproofofconsent.

Thestatementofconsentisusedasevidencewithrespecttothecontentsofthe

conversationbetweenthehealthcareproviderandthepatient.88



85UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,A.S.v.Hungary,

CommunicationNo.4/2004,CEDAW/C/36/D/4/2004.

86Ibid.

87Ibid.

88JocelynDownie,TimothyCaulfield,ColleenFlood,CanadianHealthLawandPolicy,SecondEdition,

2000,p.112.

22



73. TheUnitedNationsInternationalConferenceonPopulationand

Development,heldinCairoin1994,emphasizedtheimportanceofpeoplebeingwell‐

informedsotheycanmakedecisionsresponsibly,basedontheirneeds.



Thesuccessofpopulationeducationandfamily‐planningprogrammesin

avarietyofsettingsdemonstratesthatinformedindividualseverywhere

canandwillactresponsiblyinthelightoftheirownneedsandthoseof

theirfamiliesandcommunities.Theprincipleofinformedfreechoiceis

essentialtothelong‐termsuccessoffamily‐planningprogrammes.Any

formofcoercionhasnoparttoplay.89



74. TheCommissionrecognizesthatexceptionalcircumstancesexistinwhich

consentdoesnotapply.Suchexceptionsarerelatedtoemergencysituations,forexample

whenitisnecessarytotreatapersonmedicallytosavehisorherlifeorhealthbutneither

thepersonnoraclosefamilymembercanprovideconsent.Othercasesinwhichconsent

maynotapplyinvolvetheexistenceoflegalmandatestiedtoissuesofmentalhealthand

publichealth.Inthisregard,theIACHRconsidersitimportantthatinthosecasesinwhich

publichealthisinvokedtonotapplyconsent,theStatesensurethatsituationsdonotexist

inwhichtheobligatorynatureofsomeevidencerunscontrarytowomen'srighttobefree

fromallformsofdiscrimination.



B.Accesstoinformationandtheprotectionofconfidentiality



75. TheIACHRdeemsthatoneimportantaspecttoconsiderintermsof

accesstoinformationonsexualandreproductivemattersiscloselytiedtotheprofessional

relationshipbetweenhealthcareprofessionalsandwomenwhousehealthservices.The

WorldHealthOrganization(WHO)definesconfidentialityasthedutyofproviders"to

protectpatients’informationagainstunauthorizeddisclosures."90 



76. Confidentialityisadutyofhealthcareprofessionalswhoreceiveprivate

informationinamedicalenvironment,andmaintainingtheconfidentialityorprivacyof

informationtheyobtainfromtheirpatientsisofcriticalinterestinsexualandreproductive

health.91ProfessionalconfidentialityandsecrecywereaddressedbytheInter‐American

CourtofHumanRightsinitsjudgmentinDeLaCruz‐Floresv.Peru.ThiscaseinvolvesMaría

TeresaDeLaCruz,amedicalprofessionalwhowasprosecuted,convicted,andsentenced

forterrorism,basedontheargumentthatshewasprovidinghealthtreatmenttoalleged

terrorists.Initsdecision,theInter‐AmericanCourtestablishedthat"themedicalactis

acknowledgedinnumerousnormativeanddeclarativedocumentsrelatingtothemedical

profession."Forinformationalpurposes,theCourtmadereferencetoArticle18oftheFirst

GenevaConventionof1949,whichstatesthat“[n]oonemayeverbemolestedor

89UnitedNations,InternationalConferenceonPopulationandDevelopment,Cairo,1994,Programme

ofAction,para.7.12.

90WorldHealthOrganization.SafeAbortion:TechnicalandPolicyGuidanceforHealthSystems.

Geneva:WHO,2003,p.68.

91RebeccaJ.Cook,BernardM.Dickens,andMahmoudF.Fathalla,p.115.

23



convictedforhavingnursedthewoundedorsick.”ItalsoreferredtoArticle16ofProtocolI

andArticle10ofProtocolII,bothProtocolstothe1949GenevaConventions,which

establishthat“Undernocircumstancesshallanypersonbepunishedforcarryingout

medicalactivitiescompatiblewithmedicalethics,regardlessofthepersonbenefiting

therefrom.”92 



77. TheCourtalsoestablishedthattheinformationaphysicianobtainsinthe

exerciseofhisorherprofessionisprivilegedbyprofessionalconfidentiality.Onthatpoint,

itreferredtoaprovisioninInternationalCodeofMedicalEthicsoftheWorldMedical

Associationestablishingthat“aphysicianmustkeepabsolutelysecreteverythingthathas

beenconfidedinhim,evenafterthedeathofthepatient.”93 TheCourtalsoemphasized

thattheHumanRightsCommitteehasalreadyrecommendedthatdomesticlegislationbe

modifiedtoprotecttheconfidentialityofmedicalinformation.94



78. Initsdecision,theCourtconsideredthatphysicianshavearightandan

obligationtoprotecttheconfidentialityoftheinformationtowhich,asphysicians,they

haveaccess.95 TheInter‐AmericanCourtofHumanRightsdeterminedthattheStateof

PeruhadviolatedtheprincipleoflegalityestablishedinArticle9oftheAmerican

Convention,amongotherreasonsbecauseitpenalizedamedicalactivitywhichisnotonly

anessentiallawfulact,butwhichitisalsothephysician’sobligationtoprovide.96Italso

foundaviolationoftheprincipleoflegalityforimposingonphysicianstheobligationto

reportthepossiblecriminalbehavioroftheirpatients,basedoninformationobtainedin

theexerciseoftheirprofession.97



79. Inhisseparateopinion,JudgeSergioGarcíaRamírezindicatedthatthe

Statemaynotviolatetheprotectionofhealthandlifeforwhichdoctorsareresponsible,

throughnormsorinterpretationsofnormsthatdissuadeadoctorfromcomplyingwithhis

duty,eitherbecausetheythreatenhimwiththeimpositionofapenalty(athreatthatcould

preventhimfromprovidingmedicalservices),orbecausetheyinducehimtomake

distinctionscontrarytotheprinciplesofequalityandnon‐discrimination,orbecausethey

forcehimtodeviatefromhisproperfunctionsandassumeothersthatconflictwiththem,

poseunacceptabledilemmas,orchangethebasisoftherelationshipbetweendoctorand

patient,aswouldhappenifdoctorswereobligedtoinformonthepatientstheytreat.98 



92I/ACourtH.R.,DeLaCruz‐Floresv.PeruCase.JudgmentofNovember18,2004.SeriesCNo.115,

para.95.

93Ibid.,para.97.

94Ibid.,para.100,citingtheFinalobservationsoftheHumanRightsCommittee,Chile,U.N.Doc.

CCPR/C/79/Add.104.(1999).

95I/ACourtH.R.,DeLaCruz‐Floresv.PeruCase.JudgmentofNovember18,2004.SeriesCNo.115,

para.101.

96Ibid.,para.102.

97Ibid.

98Ibid.,para.100,citingtheFinalobservationsoftheHumanRightsCommittee,Chile,U.N.Doc.

CCPR/C/79/Add.104.(1999).

24



Asimilarsituationwouldarise,iflawyerswereforcedtoreportthe

unlawfulactscommittedbytheirclients(whichtheylearnaboutthrough

theirrelationshipofassistanceanddefense),orprieststorevealthe

secretsoftheconfessional.



80. JudgeGarcíaRamírezemphasizedtheneedtoprohibitincriminatingthe

conductofadoctorwhoabstainsfromprovidinginformationtotheauthoritiesabouthis

patient’spunishableconduct,whichheisawareofthroughinformationprovidedtohimby

thepatientinconnectionwiththemedicalprocedure.99



Iconsiderthatitisinadmissible—aconsiderationthatcoincideswiththe

opinionoftheInter‐AmericanCourt,asstatedinthejudgmentinthis

case—tocriminallypenalizetheconductofadoctorwhoprovidescare

designedtoprotectthehealthandlifeofotherindividuals,

notwithstandingtheircharacteristics,activitiesandbeliefs,andtheorigin

oftheirinjuriesorillnesses.



81. TheIACHRnotesthatissuesrelatedtosexualityandreproductionare

extremelysensitive,andthusthefearthatconfidentialitywillnotberespectedcanhave

theeffectofwomennotseekingthemedicalcaretheyneed.Bycontrast,ifapersonfeels

safeandtrusting,shewillprovidealltheinformationneededsothemedicalprofessional

canmoreeffectivelydiagnoseandtreather.



82. Onthatspecificpoint,theCEDAWrecognizestheimportanceof

respectingtheconfidentialityoftheinformationobtainedinthemedicalenvironment,

especiallysothatwomenarenotdeterredfromseekingneededcare.



Whilelackofrespectfortheconfidentialityofpatientswillaffectboth

menandwomen,itmaydeterwomenfromseekingadviceand

treatmentandtherebyadverselyaffecttheirhealthandwell‐being.

Womenwillbelesswilling,forthatreason,toseekmedicalcarefor

diseasesofthegenitaltract,forcontraceptionorforincompleteabortion

andincaseswheretheyhavesufferedsexualorphysicalviolence.100



83. TheformerUnitedNationsSpecialRapporteurontherightofeveryoneto

theenjoymentofthehighestattainablestandardofphysicalandmentalhealthhasalso

expressedhimselfinthisregard,indicatingtheimportanceofconfidentialityinthemedical

context.InthewordsoftheformerRapporteur:



...inthecontextofsexualandreproductivehealth,breachesofmedical

confidentialitymayoccur.Sometimesthesebreaches,when

accompaniedbystigmatization,leadtounlawfuldismissalfrom

99Ibid.,SeparateopinionofJudgeSergioRamírez.

100 UnitedNations,CommitteeontheEliminationofDiscriminationagainstWomen,General

Recommendation24,Womenandhealth,para.12(d).

25



employment,expulsionfromfamiliesandcommunities,physicalassault

andotherabuse.Also,alackofconfidentialitymaydeterindividualsfrom

seekingadviceandtreatment,therebyjeopardizingtheirhealthandwell‐

being.Thus,Statesareobligedtotakeeffectivemeasurestoensure

medicalconfidentialityandprivacy.101



84. Foritspart,theESCRCommitteehasnotedthat"accessibilityof

informationshouldnotimpairtherighttohavepersonalhealthdatatreatedwith

confidentiality."102Consequently,guaranteeingconfidentialityinaccesstoinformation

regardingreproductivemattersiscriticaltoguaranteeingthatwomenseekmedicalcarein

atimelymanner.Thisisparticularlyrelevantinsomecountriesoftheregionwheresome

medicalserviceshavebeencompletelycriminalizedandhealthcareprofessionalsare

requiredtoreportthem.Inthisregard,theCommitteeAgainstTorturehasclassifiedas

torturethepracticeofprovidinglife‐savingmedicalcareforwomensufferingcomplications

fromillegalabortionsonlyonconditionthattheyfirstprovideinformationonwhetherthey

hadhadanabortion.103



C.Accesstoinformationandtheobligationtoprovideinformationthatis

timely,complete,accessible,reliable,andproactive



85. Ashasalreadybeennoted,itisimportantthattheinformationthatis

providedhelpswomenmakeinformeddecisionsabouttheirreproductivehealth.Inthis

framework,theobstructionofaccesstoinformationortheprovisionofinadequateor

erroneousinformationcontravenestherighttoaccesstoinformation.



86. Onthispoint,theIACHRemphasizesthatStateshaveanobligationto

refrainfromcensoring,eitheradministrativelyorjudicially,informationonreproductive

mattersthatfallswithinexistinglawsinthisarea,forexampleontheeffectsand

effectivenessoffamily‐planningmethods.Thismeans,fortheStates,thatthepublic

101UnitedNations,ReportoftheSpecialRapporteur,PaulHunt.Therightofeveryonetothe

enjoymentofthehighestattainablestandardofphysicalandmentalhealth,para.40.

102UnitedNationsCommitteeonEconomic,SocialandCulturalRights.Therighttothehighest

attainablestandardofhealthGeneralComment14,para.12.

103TheCommitteeAgainstTorturehasexpresseditsconcernaboutreports"thatlife‐savingmedical

careforwomensufferingcomplicationsafterillegalabortionsisadministeredonlyonconditionthattheyprovide

informationonthoseperformingsuchabortions.Suchconfessionsarereportedlyusedsubsequentlyinlegal

proceedingsagainstthewomenandagainstthirdparties,incontraventionoftheprovisionsoftheConvention."

ConclusionsandrecommendationsoftheCommitteeagainstTorture,Chile,U.N.Doc.CAT/C/CR/32/5(2004),

para.6(j).

TheCommitteethereforerecommendedthattheStateshould:"Eliminatethepracticeofextracting

confessionsforprosecutionpurposesfromwomenseekingemergencymedicalcareasaresultofillegalabortion;

investigateandreviewconvictionswherestatementsobtainedbycoercioninsuchcaseshavebeenadmittedinto

evidence,andtakeremedialmeasuresincludingnullifyingconvictionswhicharenotinconformitywiththe

Convention.InaccordancewithWorldHealthOrganizationguidelines,theStatepartyshouldensureimmediate

andunconditionaltreatmentofpersonsseekingemergencymedicalcare."Conclusionsandrecommendationsof

theCommitteeagainstTorture,Chile,U.N.Doc.CAT/C/CR/32/5(2004),para.7(m).

26



policiesandprogramsonsexualandreproductivehealthshouldbebasedonscientific

evidencethatprovidescertainty.



87. TheIACHRhasmaintainedthatpriorcensorship“impliesrestrictingor

preventingexpressionbeforeithasbeencirculated,sopreventingnotonlytheindividual

whoseexpressionhasbeencensored,butalsoallofsociety,fromexercisingtheirrightto

theinformation.Inotherwords,priorcensorshipproduces‘aradicalsuspensionof

freedomofexpressionthroughpreventingthefreecirculationofinformation,ideas,

opinions,ornews.’"This"constitutesaradicalviolationnotonlyoftherightofeach

persontoexpresshimself,butalsooftherightofeverypersontobewellinformed,and

thereforeconstitutesoneofthebasicconditionsofademocraticsociety.”104



88. Asthecaselawoftheinter‐Americansystemhasheld,casesofprior

censorship"resultintheradicalviolationofeachperson'srightofexpression,aswellasthe

rightofallpeopletobewell‐informedandtoreceiveandknowtheexpressionsofothers;

assuch,oneofthebasicconditionsofademocraticsocietyisadverselyaffected."105The

DeclarationofPrinciplesonFreedomofExpressionestablishes,"Priorcensorship,director

indirectinterferenceinorpressureexerteduponanyexpression,opinionorinformation

transmittedthroughanymeansoforal,written,artistic,visualorelectroniccommunication

mustbeprohibitedbylaw."106Italsostates,"Restrictionstothefreecirculationofideas

andopinions,aswellasthearbitraryimpositionofinformationandtheimpositionof

obstaclestothefreeflowofinformationviolatetherighttofreedomofexpression."107



89. Intheareaofreproductivehealth,theESCRCommitteenotedthatStates

haveanobligationtorefrainfromcensoring,withholding,orintentionallymisrepresenting

health‐relatedinformationsuchascontraceptivemethods—includingsexualeducationand

relatedinformation—aswellasfrompreventingpeople'sparticipationinhealth‐related

matters.108



90. Foritspart,theCommitteeontheRightsoftheChildaddressedprior

censorshipasregardschildren'saccesstoinformationaboutHIV/AIDS.Itemphasizedthat

effectiveHIV/AIDSpreventionrequiresStatestorefrainfromcensoring,withholding,or

intentionallymisrepresentinghealth‐relatedinformation,includingsexualeducationand

information,andthatconsistentwiththeirobligationstoensurethesurvival,life,and

104IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,citingIACHR.

ReportontheMeritsNo.90/05.CaseNo.12.142.AlejandraMatusAcuña(Chile).October24,2005,para.35.

105IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,citingIACHR.Case

ofPalamara‐Iribarnev.Chile,JudgmentofNovember22,2005,SeriesCNo.135,para.68.I/ACourtH.R.,

CompulsoryMembershipinanAssociationPrescribedbyLawforthePracticeofJournalism(Arts.13and29

AmericanConventiononHumanRights),AdvisoryOpinionOC‐5/85ofNovember13,1985,SeriesANo.5,para.

54.IACHR,ArgumentsbeforetheInter‐AmericanCourtofHumanRightsintheCaseofHerrera‐Ulloav.CostaRica,

citedinthejudgmentofJuly2,2004,SeriesCNo.107,para.101(5).

106DeclarationofPrinciplesonFreedomofExpression,para.5.

107Ibid.

108UnitedNationsCommitteeonEconomic,SocialandCulturalRights.Therighttothehighest

attainablestandardofhealth,GeneralComment14,para.34.

27



developmentofthechild,theymustensurethatchildrenhavetheabilitytoacquirethe

knowledgeandskillstoprotectthemselvesandothersastheybegintoexpresstheir

sexuality.109Forhispart,theformerRapporteurontheRighttoHealth,PaulHunt,has

stated,"Sometraditionalviewsaboutsexualityareobstaclestotheprovisionofsexualand

reproductivehealthservices,includingreliableinformation,andtheseviewshavean

especiallydamagingimpactuponadolescents."110



91. Asanexampleofthissituation,onMarch8,2002,theIACHRreceiveda

petitionallegingtheviolationofthehumanrightsoftheminorchildPaulinaRamírez

Jacinto,whowasavictimofarapethatresultedinpregnancyandwaspreventedbyState

authoritiesfromexercisingherrighttointerruptthepregnancy,inaccordancewith

Mexicanlaw.Amongothermethodsemployedtodissuadeherfromgettingalegal

abortion,sheandhermotherweregivenincompleteanderroneousinformationaboutthe

medicalprocedureanditsconsequences.Thecasewasresolvedthroughafriendly

settlementagreementdatedMarch8,2006.Inthatagreement,theIACHRstatedthat

womencannotfullyenjoytheirhumanrightswithouthavingtimelyaccessto

comprehensivehealthcareservices,andtoinformationandeducationinthissphere.111

TheIACHRismonitoringcompliancewiththeagreement.



92. Consequently,theIACHRconsidersthattoguaranteeaccessto

informationonreproductivematters,theOASMemberStatesmustrefrainfromcensoring,

withholding,ormisrepresentinginformation.Moreover,pursuanttotherespectand

guaranteeobligationsimposedbytheIACHR,andundertheprinciplesofequalityandnon‐

discrimination,theStatesmustguaranteethatwomenhaveaccesstoinformationthatis

timely,complete,accessible,reliable,andproactiveonreproductivematters;thisshould

includeinformationaboutthesexualandreproductivehealthservicesthatarelegally

available.



1.Accesstoinformationandconscientiousobjection



93. TheIACHRrecognizesthathealthprofessionalshavetherighttohave

theirfreedomofconsciencerespected.Article18(1)and(2)oftheUnitedNations

InternationalCovenantonCivilandPoliticalRightsestablishesthefollowing:



1.Everyoneshallhavetherighttofreedomofthought,conscience

andreligion.Thisrightshallincludefreedomtohaveortoadopta

religionorbeliefofhischoice,andfreedom,eitherindividuallyorin

communitywithothersandinpublicorprivate,tomanifesthisreligionor

beliefinworship,observance,practiceandteaching.



109UnitedNations,CommitteeontheRightsoftheChild,GeneralComment3,HIV/AIDSandtherights

ofthechild,March17,2003,para.16.

110UnitedNations,ReportoftheSpecialRapporteur,PaulHunt.Therightofeveryonetothe

enjoymentofthehighestattainablestandardofphysicalandmentalhealth,para.14.

111IACHR,ReportNo.21/07,Petition161/02,FriendlySettlement,PaulinadelCarmenRamírezJacinto

(Mexico),March9,2007.

28





2.Nooneshallbesubjecttocoercionwhichwouldimpairhis

freedomtohaveortoadoptareligionorbeliefofhischoice.



94. Inaddition,Article18(3)establishes:"Freedomtomanifestone'sreligion

orbeliefsmaybesubjectonlytosuchlimitationsasareprescribedbylawandare

necessarytoprotectpublicsafety,order,health,ormoralsorthefundamentalrightsand

freedomsofothers."Thatistosay,whilehealthcareprofessionalsdemandrespectfor

theirrighttoconscience,theymustalsoshowequalrespectfortheirpatients'rightsto

conscience.





95. Conscientiousobjectionisaveryrelevantissuewhenitcomestoaccess

toinformationintheareaofreproductivehealth.Manyhealthprofessionalshavetheir

ownconvictionswithrespecttotheuseoffamily‐planningmethods,emergencyoral

contraception,sterilization,andlegalabortion,andtheyprefernottoprovidethese

services.Aswasindicatedintheprecedingparagraph,thehealthprofessional'srightto

conscientiousobjectionisafreedom.However,thisfreedomcouldcomeintoconflictwith

patients'freedoms.Consequently,thebalancebetweentherightsofhealthcare

professionalsandtherightsofpatientsismaintainedthroughreferrals.Inotherwords,a

healthprofessionalmayrefusetotakecareofapatient,butshouldtransferthepatient

withoutobjectiontoanotherhealthprofessionalwhocanprovidewhatthepatientis

seeking.Forexample,ifawomanneedsfamily‐planninginformationandservicesand/or

otherlawfulreproductivehealthservices,andthehealthprofessionalhashisorherown

convictionswithrespecttotheutilizationofsuchservices,theprofessionalhasthe

obligationtoreferthepatienttoanotherhealthproviderwhocanprovidetheinformation

andservicesinquestion.Thisisinordernottocreatebarriersinaccesstoservices.





96. TheIACHRnotesthattheEuropeanCourtaddressedtheissueof

conscientiousobjectionintheprovisionoffamily‐planningservices.Inthiscase,the

petitionersallegedthattheyrefusedtosellbirth‐controlpillsatapharmacybecausethis

wentagainsttheirreligiousbeliefs.TheEuropeanCourtheldthat"aslongasthesaleof

contraceptivesislegalandoccursonmedicalprescriptionnowhereotherthanina

pharmacy,theapplicantscannotgiveprecedencetotheirreligiousbeliefsandimpose

themonothersasjustificationfortheirrefusaltosellsuchproducts."Thatisbecausethey

areabletomanifesttheirbeliefs"inmanywaysoutsidetheprofessionalsphere."112In

anotherdecisionhandeddownrecently,theEuropeanCourtruledthattheStates"are

obligedtoorganisethehealthservicessysteminsuchawayastoensurethataneffective

exerciseofthefreedomofconscienceofhealthprofessionalsintheprofessionalcontext

doesnotpreventpatientsfromobtainingaccesstoservicestowhichtheyareentitled

undertheapplicablelegislation."113 



112EuropeanCourtofHumanRights,PichonandSajousv.France.App.No.49853/99,2001.

113EuropeanCourtofHumanRights,R.R.v.Poland.

29



97. Inaddition,theIACHRnotesthattheConstitutionalCourtofColombia,in

adecisionhandeddownin2008,determinedsomefactorsthatareworthnotingwith

respecttoobjectionsofconscience.114



‐ Conscientiousobjectionisnotarighttowhichjuridicalpersonsorthe

Stateareentitled;itcanberecognizedonlyfornaturalpersons;

‐ Incasesinwhichaphysicianinvokesaconscientiousobjection,heorshe

mustproceedtoreferthewomantoanotherphysicianwhocanprovide

themedicalservicebeingrequested,withoutprejudicetoalater

determinationastowhethertheconscientiousobjectionwasapplicable

andrelevantthroughthemechanismsestablishedbythemedical

profession.

‐ Conscientiousobjectionisanindividual,notaninstitutionalorcollective,

decision.

‐ Conscientiousobjectionappliesonlytodirectprovidersandnotto

administrativepersonnel.

‐ Conscientiousobjectionapplieswhenittrulyinvolvesareligious

convictionthatisproperlyreasonedandsubmittedinwriting.The

physicianwhoinvokesitmustfollowtheobligationtoimmediatelyrefer

thewomantoaphysicianwhocanprovidethereproductivehealth

servicebeingrequested,thissoastopreventtherefusalfrombecoming

abarrierinaccesstoreproductivehealthservices.



98. Initsdecision,theConstitutionalCourtofColombiaunderscoresthatthe

exerciseoftherighttoconscientiousobjectionmustfallwithinthelaw,andthusmaynot

constituteamechanismfordiscriminationandtheviolationofwomen'sfundamental

rights.



99. Inthisregard,theIACHRconsidersthattheStatesmustguaranteethat

womenarenotpreventedfromaccessinginformationandreproductivehealthservices,

andthatinsituationsinvolvingconscientiousobjectorsinthehealtharena,theStates

shouldestablishreferralprocedures,aswellasappropriatesanctionsforfailuretocomply

withtheirobligation.



D.Accesstoinformationandaccesstomedicalrecords



100. TheIACHRhasindicatedthat,apartfromthegeneralrightofaccessto

State‐heldinformation,"Everypersonhastherighttoaccesstoinformationabouthimself

orherself,whetherthisisinthepossessionofagovernmentorprivateentity."Thisright

"includestherighttomodify,removeorcorrectsuchinformationduetoitssensitive,

erroneous,biasedordiscriminatorynature."115Moreover,theDeclarationofPrincipleson

FreedomofExpressionestablishes:"Everypersonhastherighttoaccesstoinformation

114ConstitutionalCourtofColombia,JudgmentT‐209/08.

115IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.94.IACHR,

ReportonTerrorismandHumanRights.ChapterIII,E):RighttoFreedomofExpression.OEA/Ser.L/V/II.116.

October22,2002.Availableat:http://www.cidh.oas.org/Terrorism/Eng/toc.htm.

30



abouthimselforherselforhis/herassetsexpeditiouslyandnotonerously,whetheritbe

containedindatabasesorpublicorprivateregistries,andifnecessarytoupdateit,correct

itand/oramendit."116 



101. Inaddition,theIACHRhasestablished,"Therighttoaccesstoandcontrol

overpersonalinformationisessentialinmanyareasoflife,sincethelackoflegal

mechanismsforthecorrection,updatingorremovalofinformationcanhaveadirect

impactontherighttoprivacy,honor,personalidentity,property,andaccountabilityin

informationgathering."117 



102. TheIACHRnotesthatthematterofaccesstopersonalinformation

containedinmedicalrecordswasaddressedbytheEuropeanCourtofHumanRights.In

K.H.andOthersv.Slovakia,theapplicantsallegedaviolationoftheirrighttorespectfor

privateandfamilylife,establishedinArticle8oftheEuropeanConventiononHuman

Rights,becausetheydidnothaveaccesstophotocopiesofthemedicalrecordsofthe

allegedvictims,whomtheyconsideredtohavebeenvictimsofsterilizationwithouttheir

consentandwithouthavingbeeninformed.TheEuropeanCourtframedthecaseasone

involving"theexercisebytheapplicantsoftheirrightofeffectiveaccesstoinformation

concerningtheirhealthandreproductivestatus,"anddeterminedaviolationofthevictims'

"righttorespectforprivateandfamilylife."118



103. Initsreasoning,theCourtreiteratedthat"inadditiontotheprimarily

negativeundertakingsinArticle8oftheConvention,theremaybepositiveobligations

inherentineffectiverespectforone’sprivatelife."AccordingtotheEuropeanCourt,the

originalrecords,whichcouldnotbereproducedmanually,containedinformationwhich

theapplicantsconsideredimportantfromthepointofviewoftheirmoralandphysical

integrity,astheysuspectedthattheyhadbeensubjectedtoaninterventionaffectingtheir

reproductivestatus.119



104. TheEuropeanCourtdeterminedthattheobligationsderivedfromthe

exerciseoftherighttorespectforprivateandfamilylifeshouldextend,inparticularin

casesliketheonethatisthesubjectofthecomplaint,whichconcernedpersonaldata.The

Courtindicatedthat"protectionofmedicaldataisoffundamentalimportancetoa

person’senjoymentofhisorherrighttorespectforprivateandfamilylifeasguaranteed

byArticle8oftheConventionandthatrespectingtheconfidentialityofhealthdataisa

vitalprincipleinthelegalsystemsofalltheContractingPartiestotheConvention."The

Courtlikewisedeterminedthatwhileprotectionofmedicaldataisoffundamental

116IACHRDeclarationofPrinciplesonFreedomofExpression.

1172008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.94.IACHR,Reporton

TerrorismandHumanRights.ChapterIII,E):RighttoFreedomofExpression.OEA/Ser.L/V/II.116.October22,

2002.Availableat:http://www.cidh.oas.org/Terrorism/Eng/toc.htm.

118EuropeanCourtofHumanRights,K.H.andOthersv.Slovakia,Judgment32881/04ofApril28,2009.

119Ibid.,para.50.

31



importance,theriskofabusebythirdpersons"couldhavebeenpreventedbymeansother

thandenyingcopiesofthefilestotheapplicants."120 



105. Meanwhile,incomparativecaselaw,theIACHRhasreferredtocaselaw

oftheConstitutionalCourtofColombia,whichhasindicatedthattherighttopetition,and

indirectlytherighttohealth,isbreachedwhenapatientispreventedfromaccessinghisor

herclinicalrecords.121 Inthatregard,inJudgmentT‐275of2005,theConstitutionalCourt

held:"Theclinicalhistoryheldbythepetitionedentityinprinciplecomprisesnotsimplya

privatedocumentsubjecttoconfidentiality,whichmaybeseenonlybythepatientandthe

institution,andinexceptionalcasesbyathirdparty,butinaddition,alltheevaluations,

tests,interventions,anddiagnosesdoneonthepatient,intheonlyfileordatabasewhere

theyarelegitimatelykept.Inthisregard,notallowingthepatientaccesstohisclinical

historyviolatesthepetitioner'srighttopetition,andindirectlyhisrighttohealth...."122



106. TheIACHRconsidersthattherighttoaccesstoinformationisalso

adverselyaffectedwhenaccesstoinformationregardingmedicalhistoryisdenied.

Consequently,theStatesoftheAmericasmustguaranteethatpeoplecanaccessthe

informationcontainedintheirclinicalrecords,orfacepossiblesanction.



E.Accesstoinformationandtheobligationtoproducereliablestatistics



107. Theobligationtoproduceinformationhasbeenthesubjectofvarious

pronouncementsandspecificrecommendationsattheinternationallevel.Informationon

people'shealth,whetherthroughstatisticsorothermeans,isessentialforidentifying

majorproblems,formulatingpublicpolices,andassigningthenecessaryresources.The

IACHRhasindicatedthat"theStatehastheobligationtoproduceorobtaintheinformation

itneedstofulfillitsduties,pursuanttointernational,constitutional,orlegalnorms."123

Thisobligationextendstothesphereofhealth.Infact,inits1998regionalreportonthe

statusofwomenintheAmerica,"theCommissionwasabletoconfirmseriousdeficiencies

instatistics,generallyowingtoalackofresourcesandsuitableinfrastructure."124



108. TheIACHRhasindicatedthatinternationallawsincludeclearandexplicit

obligationsonproductionofinformationtiedtotheexerciseoftherightsofsectorsthat

historicallyhavebeenexcludedordiscriminatedagainst.Indeed,theConventionofBelém

doParáestablishestheStates’obligationsto"ensureresearchandthegatheringof

statisticsandotherrelevantinformationrelatingtothecauses,consequencesand

120EuropeanCourtofHumanRights,K.H.andOthersv.Slovakia.

121ConstitutionalCourtofColombia,JudgmentT‐232/09,Reference:casefileT‐2171774,Injunction

(accióndetutela)filedbyMaríaIsabelIsazaagainstFranciscoJavierVillegasAlzate.

122ConstitutionalCourtofColombia,JudgmentT‐275of2005(MP:AntonioHumbertoSierraPorto),

SeeJudgmentT‐232/09,Reference:casefileT‐2171774,InjunctionfiledbyMaríaIsabelIsazaagainstFrancisco

JavierVillegasAlzate.

123IACHR,2008AnnualReport,OfficeoftheRapporteurforFreedomofExpression,para.162.

124IACHR,ReportoftheInter‐AmericanCommissiononHumanRightsontheStatusofWomeninthe

Americas,October13,1998.

32



frequencyofviolenceagainstwomen,inordertoassesstheeffectivenessofmeasuresto

prevent,punishanderadicateviolenceagainstwomenandtoformulateandimplement

thenecessarychanges."125



109. InitsreportonGuidelinesforPreparationofProgressIndicatorsinthe

AreaofEconomic,SocialandCulturalRights,theIACHRnotedthattheState’sobligationto

takepositivestepstosafeguardtheexerciseofsocialrightsraisesimportantimplications,

forexample,concerningthetypeofstatisticalinformationtheStateshouldproduce.126It

alsostated:



Fromthisperspective,thegenerationofinformationsuitably

disaggregatedtoidentifythesedisadvantagedsectorsorgroupsdeprived

oftheenjoymentofrightsisnotonlyameanstoensuretheeffectiveness

ofapublicpolicy,butacoreobligationthattheStatemustperformin

ordertofulfillitsdutytoprovidespecialandpriorityassistancetothese

sectors.Forexample,thedisaggregationofdatabysex,raceorethnicity

isanessentialtoolforhighlightingproblemsofinequality.127



110. Inthesamedocument,theIACHRrecalledthat“TheCommitteeon

Economic,SocialandCulturalRightshasdrawnattentiontothestateobligationtoproduce

informationbaseswithwhichtovalidateindicatorsand,ingeneral,accesstomanyofthe

guaranteescoveredbyeachsocialright.Accordingly,thisobligationisessentialforthe

enforceabilityoftheserights."128TheIACHRalsonotedthatinternationallawincludes

clearandpreciseobligationsontheproductionofinformationtiedtotheexerciseofrights

bysectorsthathavetraditionallysufferedexclusionanddiscrimination.129 



111. Specificallyintheareaofhealth,inthereportonGuidelinesfor

PreparationofProgressIndicatorsintheAreaofEconomic,SocialandCulturalRights,the

IACHRincludedindicatorsrelatingtoaccesstoinformationandparticipation.These

indicatorsincludethoserelatingspecificallytoinformationonreproductivematters:

statutoryprotectionofpersonalhealthinformation,includingitsscopeandlimits;

governmentdisseminationofinformationonsexualandreproductivehealthpolicy,

includingitsscopeandcoverage;andadvisoryservicesforpregnantwomenonmother‐

childHIV/AIDStransmission.



125Article8(h),ConventionofBelémdoPará.

126IACHR,GuidelinesforPreparationofProgressIndicatorsintheAreaofEconomic,SocialandCultural

Rights,July19,2008,para.58.

127Ibid.

128IACHR,GuidelinesforPreparationofProgressIndicatorsintheAreaofEconomic,SocialandCultural

Rights,para.78.IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation.Office

oftheSpecialRapporteurforFreedomofExpression,December30,2009,para.37.

129IACHR,GuidelinesforPreparationofProgressIndicatorsintheAreaofEconomic,SocialandCultural

Rights,para.81.IACHR,TheInter‐AmericanLegalFrameworkregardingtheRighttoAccesstoInformation.Office

oftheSpecialRapporteurforFreedomofExpression,December30,2009,para.37.

33



112. TheIACHRconsidersthattheStatesshouldcompileinformationonthe

statusofwomen’shumanrightsandreproductivehealth—includingspecificinformation

ongroupsthathavesufferedexclusion,suchasindigenouswomen,womenofAfrican

descent,migrantwomenandwomenwholiveinruralareas—inordertoidentifyand

addressthespecificproblemsofthesepopulationsinthissphere.



113. Foritspart,theCEDAWCommitteehasencouragedStatestoincludein

theirreportsinformationondiseasesorconditionshazardoustohealththataffectwomen

orcertaingroupsofwomendifferentlyfrommen,aswellasinformationonpossible

interventioninthisregard.130 TheCEDAWCommitteehasalsomaintainedthattheStates

shouldreportontheirunderstandingofhowpoliciesandmeasuresonhealthcareaddress

thehealthrightsofwomenfromtheperspectiveofwomen’sneedsandinterests,andhow

healthcareaddressesdistinctivefeaturesandfactorswhichdifferforwomenin

comparisontomen.131



114. Likewise,theCommitteeonEconomic,SocialandCulturalRightshas

statedthatagender‐basedapproachrecognizesthatbiologicalandsocio‐culturalfactors

playasignificantroleininfluencingthehealthofmenandwomen.Thedisaggregationof

healthandsocio‐economicdataaccordingtosexisessentialforidentifyingandremedying

inequalitiesinhealth.132



115. TheIACHRconcludesthattheproductionofreliablestatisticson

reproductivemattersandthedisseminationofthatinformationwillhelptobringgreater

attentiontocountries'publichealthpoliciessotheStatescanmeettheirinternational

obligationsinthisarea.Moreover,beingawareofthetruesituationregardingwomen’s

sexualandreproductivehealthwillraisecollectiveawarenessabouttherealneedsthat

mustbeaddressed.



IV.RECOMMENDATIONS



116. ThisreporthasreviewedtheminimumprinciplestheOASMemberState

shouldobserveinordertoguaranteetheprotection,underequalconditions,oftherightof

accesstoinformationonreproductivehealth.TheCommissiontruststhatits

recommendationswillcontributetotheeffortstheStatesarecarryingoutinthisarea:



1.Adaptdomesticlawsonaccesstoinformationandeducationonsexual

andreproductivehealthsothattheymeettheinternationalstandards

theStateshavepledgedtofollowwithregardtotherightofaccessto

information.Ensurethatpoliciesandprograms,designedwiththe

participationofwomenthemselves,areconsistentwiththegoals

130UnitedNations,CEDAWCommittee,GeneralRecommendation24,Womenandhealth,para.10.

131Ibid.,para.12.

132UnitedNationsCommitteeonEconomic,SocialandCulturalRights.Therighttothehighest

attainablestandardofhealth,GeneralComment14,para.20.

34



establishedbytheStatestoimprovetheflowofinformationrelatedto

reproductivehealth.



2.Analyze—atthelevelofthelegislative,executive,andjudicialbranches,

andwithstrictscrutiny—alllaws,regulations,practices,andpublic

policiesintheareaofhealthsothattheyguaranteetherighttoaccessto

informationonsexualandreproductivehealthandtheobligationofthe

Statetoprovidesuchinformation.Ensure,therefore,thatthe

informationprovidedistimely,complete,accessible,reliable,and

proactive.



3.Incorporatesimple,effective,andappropriateadministrativeprocedures

whichcanbeusedbyanyonetorequestneededinformation.



4.Incorporateeffectivejudicialproceduresforreviewingdecisionsbypublic

officialsthatdenywomentherightofaccesstocertaininformationor

thatsimplyfailtorespondtorequests.



5.Guaranteeconfidentialityinaccesstoinformationonsexualand

reproductivehealth.



6.Ensurehealthprofessionals’obligationtoinformwomenabouttheir

healthsothatwomencanmakefree,informed,andresponsible

decisionsrelatedtosexualityandreproduction.



7.Ensurethattheinformationprovidedisadaptedtotheaudiencethat

needsit,particularlysothatwomenwhospeakotherlanguagescanhave

accesstotheinformationintheirowntongue.



8.Establishprotocolsforeffectiveaccesstoinformationincasesinvolving

conscientiousobjection.



9.Revisecriminal‐lawprovisionsthatforcehealthprofessionalstoviolate

confidentialityandprofessionalsecrecyinaccordancewithinternational

standardsinthisarea.



10.Guaranteethatpatientscanhaveaccesstotheirmedicalrecordswhen

needed,andestablishmechanismsforsanctioningthefailuretocomply

withsuchaprovision.



11.Implementmeasuressothatinformationsystemsadequatelyreflectthe

situationofwomen’shealth,atthenationalandlocallevel,including

figuresonfamily‐planningneeds,maternalmorbidityandmortality,and

neonatalmortality,alongwiththeircauses,sothateffectivedecisions

andactionscanbetaken.



35



12.Establishsystematicpoliciesfortrainingandcapacitatinggovernment

officialsontherightofaccesstoinformationinallspheresoftheState.



13.Promotethewidespreaddisseminationofinformationonthehealthand

therightsofindigenousandAfro‐descendantwomen,andwomenwho

liveinruralareas,toensuretheireffectiveparticipationindecision‐

makingconcerningtheirreproductivehealth.Includeadolescentgirls,

withafocusonpreventingearlymotherhood.



14.Ensurethatnationalbudgetscontemplateproducingreliablestatisticson

sexualandreproductivematters,brokendownattheveryleastbysex,

gender,ethnicity,andage.

