Sexual and Reproductive Health and Rights: Plan International’s Position Statement - 2016 - 1

Plan International believes that all children, adolescents and young people have the right to make their own free andinformed choices and to have control over their sexual and reproductive health and lives, free from coercion, violence,
discrimination and abuse. Girls and young women in particular are denied the ability to exercise these rights. Fulfilling therights of all children, adolescents and young people is fundamental to achieving gender equality.

Traditional, cultural or religious grounds should not
be used to justify these norms. Upholding sexualand reproductive rights in accordance with humanrights standards and international agreements2 is apriority for Plan International.
➢

To bring about change in attitudes, norms andbehaviour, it is crucial to engage and promote intergenerational dialogue on sexual and reproductive
health and rights as well as to challenge
stereotypical attitudes and expectations aroundsexuality and reproduction. Dialogue should include
the participation of children, adolescents, young
people, parents, caregivers, traditional and religious
leaders, health workers and teachers.3➢

We believe that creating positive change inbehaviours requires an approach that engages boys
and men as much as girls and women. Involving
boys and men as beneficiaries, rights holders andas agents of change is key to challenging dominantnorms of masculinity, and to developing equality,
safety, respect and responsibility in relationships,
and thus to realising the sexual and reproductive
health and rights of all children, adolescents andyoung people.

➢

We also recognise the role and responsibility of
governments, including national health andeducation systems, in challenging harmful norms
and gender inequality.

➢

Plan International is committed to working withothers to challenge discriminatory attitudes, norms
and behaviours which drive stigma, discriminationand violence towards children, adolescents andyouth who identify as lesbian, gay, bisexual,
transgender, intersex, questioning.

➢

Plan International believes that all children,
adolescents and young people – without
discrimination – are entitled to comprehensive
sexuality education to gain knowledge, explore
values and attitudes, and develop the skills theyneed to make conscious, healthy and respectful
choices about relationships and sexuality. Parents
and educators should be supported to embrace➢ Plan International believes that States must ratify

and fully implement all ratified conventions oragreements relating to sexual and reproductive
health and rights, including all action points that arelisted in such documents, as well as generalcomments and treaty body recommendations. Thisrequires governments to align all national and local
laws and policies accordingly.

➢

We respect cultural traditions, religious beliefs andsocial norms, but believe that they should notconstitute reasons for countries to makereservations to international conventions andagreements in relation to sexual and reproductive
health and rights.

➢

We believe it is important to collect data
disaggregated by age, sex, ethnicity, religion,
disability, location, wealth, marital status, sexual
orientation and gender identity, and migratory status(with due protections for privacy and human rights).
This must include the age range 10 to 14 years inorder to make younger adolescent girls and theirneeds visible and to track progress against
commitments, policies and programmes on girls andyoung women.

➢ Plan International also supports the call in theConvention on the Elimination of All Forms ofDiscrimination against Women1 for States to take allappropriate measures, including legislation, tomodify or abolish existing laws, regulations,customs and practices which constitutediscrimination against girls and women.

➢

Plan International believes that it is crucial tochallenge gender inequality and social norms whichhinder fulfilment of the sexual and reproductive
health and rights of children, adolescents and young
people, and in particular of girls and young women.

Sexual and Reproductive Health and Rights: Plan International’s Position Statement - 2016 - 2

children’s learning about their bodies, relationships
and sexuality from early childhood to allow children
to explore, clarify and form life-long healthy attitudes
and practices, free from coercion, violence anddiscrimination.
➢➢

Comprehensive sexuality education should beaccessible for all children, adolescents and young
people, in both formal and non-formal educationalsettings. Co-curricular activities which complement
the formal curriculum are also important as areparental and community involvement and links togender-responsive, child- adolescent- and youthfriendly healthcare and other services.4
Comprehensive sexuality education should be
provided in a way that is non-judgemental, nondiscriminatory, scientifically accurate, accessible,
inclusive, rights-based, gender-transformative andadapted to the evolving capacity of the child,adolescent or young person.

Plan International believes that sexual andreproductive health and rights services should be
gender-responsive, rights-based, adolescent- andyouth-friendly and available to all adolescents andyoung people, including during conflicts anddisasters. The services should be available andaccessible to the most vulnerable and excluded
adolescents and young people, including but notlimited to migrants, those from ethnic minorities andindigenous groups, those living with disabilities andthose identifying as lesbian, gay, bisexual,
transgender, intersex, questioning.5➢

Sexual and reproductive health and rights services
should be linked with interventions to end violenceagainst girls and women.

➢

It is important that health services are available andaccessible to everyone, regardless of age or marital
status.6 Services should respect privacy andconfidentiality. They should be free of requirements
for judicial, spousal, parental or guardian consent.

➢

We believe well-trained and supported healthpersonnel are critical to delivering quality, genderresponsive adolescent- and youth-friendly services.
A dedicated health budget for these services isessential so that user fees and expenses can be
reduced or eliminated, making them accessible andaffordable to all adolescents and young people.

➢

In order to ensure that services are fit-for-purposeand meet the needs of adolescents and young
people, there needs to be a greater focus on
ensuring their participation in the planning,
implementation and monitoring of services. 7➢

Plan International believes that the taboo nature of
menstruation and sensitivity around discussing thiswith girls at home, in school and more broadly
within society reinforces and perpetuates genderinequality. All girls and young women should haveaccess to separate and hygienic sanitary facilities inall public spaces, especially in schools, as this is
critical to ensure their attendance. They should also
have access to accurate information about
menstruation and to clean sanitary equipment.

➢

We believe that public and private water, sanitationand hygiene service providers should consult withgirls and young women to ensure facilities meettheir needs, and to enable them to practise goodmenstrual hygiene management.

➢

We will work with others to contribute tostrengthening knowledge on the impact of socialand cultural norms around menstruation and poor
menstrual hygiene management.

➢

Plan International is committed to tacklingadolescent pregnancy, particularly pregnancy inyounger adolescents, and to supporting adolescentmothers. We recognise that adolescent pregnancy
is a major contributor to maternal mortality andmorbidity, which are grave violations of girls’ rights.

➢

We believe that early unintended and unwanted
adolescent pregnancy can and should be
prevented. This requires challenging gender
discriminatory norms and ending sexual violenceagainst girls; strengthening girls’ agency and ability
to make autonomous and informed decisions about
their reproductive health; ensuring the provision ofcomprehensive sexuality education and ensuringthat health systems and services meet the specificneeds of adolescents (in line with the Committee on
the Rights of the Child General Comment No. 15,
paragraph 56).

➢

Education can be a powerful tool for delaying
adolescent pregnancy and early childbirth. We also
recognise that adolescent pregnancy can be adriver for, or a consequence of child, early andforced marriage. This is particularly important for
countries and regions that are projected toexperience rising rates of adolescent pregnancy,such as Latin America.

➢

Plan International believes that all girls and young
women have the right to access quality maternal
health and obstetric care services. Health budgets
must include adequate resourcing for their provision
including emergency obstetric care and treatment offistula.

Sexual and Reproductive Health and Rights: Plan International’s Position Statement- 2016 - 3

➢

➢

➢

Plan International believes that all sexually active
adolescents, including younger adolescents, andyoung people with an unmet need for familyplanning should be able to access modern
contraception. In line with the Committee on
Economic, Social and Cultural Rights General
Comment No. 14, contraceptive services should be
provided free of discrimination, stigma and coercion,and free of spousal, parental, guardian or judicial
consent, and in accordance with the evolving
capacities of the person in question.
Plan International agrees with the Committee on the
Rights of the Child General Comment No. 4 thatadolescents should have access to information andservices regarding contraceptives and familyplanning.

Plan International believes that abortions should berare and that priority should be given to avoiding
unintended pregnancy, through the provision ofcomprehensive sexuality education including
accurate information on contraceptives as well as
access to quality contraceptive services (including
emergency contraception) for all girls and women.

➢

In line with the Convention on the Elimination ofDiscrimination against Women Committee,8 Plan
International recognises reproductive rights toinclude the right of girls and women to makeautonomous decisions about their health. Denying
girls and women access to safe abortion services
prevents them from exercising this right. Plan
International does not provide medical healthservices.

➢

We believe that the provision of services for safe
abortion should be available and accessible to all
girls and women.

➢

Where abortion is legal, the provision of services
should be within the fullest extent of the legal
framework of the country.

➢

In countries where abortion is illegal or restricted werecognise that girls and women will still undergo
unsafe abortions. In such countries, we take thestand that girls and women who seek or obtainabortions should neither be prosecuted nor
penalised.

➢

Plan International acknowledges that unsafe
abortion is a preventable cause of death and illhealth of girls and women across the world andoften a consequence of violations of girls’ andwomen’s fundamental human rights. The right tohealth and gender equality are advanced by accessto safe and legal abortion.

➢

Irrespective of the legal status of abortion, Plan
International believes that quality post-abortion care
as well as psychosocial counselling and support for
all girls and women should be accessible.

➢

In line with Committee of the Rights of the Child
General Comment No. 3 on HIV/AIDS and the rightsof the child,9 Plan International believes that all
children, adolescents and young people, including
girls and young women, should have the ability toacquire the knowledge and skills they need toprotect themselves and others from HIV infection.

➢

Plan International strongly emphasises the need toeliminate stigma and discrimination experienced by
HIV-positive children, adolescents and young
people both on an institutional and community or
individual level. This requires challenging negativesocial norms around adolescents’ and young
people’s sexual activity, as well as the provision ofscientifically accurate information on HIV and AIDS
transmission.

➢

We believe that all children, adolescents and young
people should have equal access to the necessary
health services, treatment and support they need.
All services should have particular regard for theright to privacy and confidentiality.10➢

We also recognise that gender inequality is a driverof the rising number of girls and young women livingwith HIV and AIDS, and that effective approaches
for prevention, treatment and care need to begender-transformative, empowering girls and young
women to have control over their bodies and theirlives.

➢

Plan International strongly condemns female genital
mutilation/cutting under all circumstances. Female
genital mutilation/cutting is a human rights violationand needs to be treated as such.

➢Female genital mutilation/cutting is linked to harmful
norms and gender stereotypes as well as aperceived need to control female sexuality. Plan
International believes that every girl and woman
should have the autonomy and necessary
knowledge to be able to make free and informed
decisions about her body. Local actors need to besupported to challenge social norms and successfulprojects should be scaled up.

➢

Plan International believes that it is important totackle female genital mutilation/cutting both througheffective legislation as well as through awarenessraising about the physical and mental harm andlong-term adverse impacts that can result from thispractice.

Sexual and Reproductive Health and Rights: Plan International’s Position Statement- 2016 - 4

➢➢Engaging families, communities and traditional andreligious leaders in changing attitudes and norms
around this harmful practice is crucial to ensure that
it is no longer perceived to be acceptable, beneficial
or tolerated and is instead condemned as a humanrights violation which needs to be eliminated.
Plan International notes that achieving the target toeliminate female genital mutilation/cutting includedin the 2030 Agenda for Sustainable Development
will require urgent attention, given current
population growth rates11.

➢ Plan International strongly condemns the practice ofchild, early and forced marriage12 and calls for theprohibition of the practice under national andcustomary law, and for the full and effective
enforcement of these laws. In line with theCommittee on the Rights of the Child General
Comment No. 4, Plan International believes that theminimum age for marriage should be 18 and that
this should apply equally to both men and women,
regardless of any provisions concerning parental or
judicial consent.

➢➢

Engaging communities and traditional and religious
leaders, as well as girls and boys themselves, iscritical to changing norms and eliminating thispractice.
We recognise that education is a powerful tool for
preventing child, early and forced marriage. Girls
who benefit from a quality education are less likely
to marry while they are still children. Therefore,
governments must ensure all girls, including married
girls, can access and complete primary andsecondary education in line with their commitments
to the 2030 Agenda.

➢

Plan International believes that all children andyoung people have the fundamental human right tolive free from violence.13➢

We recognise that gender-based violence
disproportionately affects girls and women. The root
causes of gender-based violence are discriminatorysocial norms and unequal power dynamics between
men and women. Changing these deep-rooted
norms and attitudes that normalise and excuse
violence against girls and women is critical toending gender-based violence.

➢

We also recognise the critical role that childprotection services can play in preventing abuse andextending assistance to victims.

➢

Plan International stresses the importance of theprovision of care and support to survivors ofviolence, including the provision of safe houses.
Healthcare providers and support services should
respond to gender-based violence in a way that does
not reinforce harmful attitudes.

➢

Protective measures for victims of violence, including
sexual violence and rape, should include effective
mechanisms to ensure care, support and protection,
including access to healthcare (including emergency
contraception), psychosocial support, access to safe
abortion services and effective means to seek justiceand redress.

➢ Plan International believes that human rights should
be ensured in times of crises and all actors involvedin humanitarian responses should take all possible
measures to ensure that all children, adolescentsand young people, including girls and young women,
are able to realise their sexual and reproductive
health and rights.
➢ Sexual and reproductive health and rights are not
only critical in their own right, but also to achieving
humanitarian objectives in other sectors such as
child survival and education. The sexual andreproductive health and rights of children and young
people should be protected and fulfilled before,
during and after disasters and conflicts.
➢ Disaster risk reduction, resilience building and theplanning and implementation of humanitarian
responses must take full account of the risks facedby children, adolescents and young people, inparticular girls and young women, and protect andfulfil their sexual and reproductive health and rights.
Plan International also firmly believes that all
humanitarian actors should ensure that a gender andage lens is applied to all aspects of humanitarian
response, and that all possible measures are taken
to prevent and respond to sexual and gender-based
violence.

Sexual and Reproductive Health and Rights: Plan International’s Position Statement- 2016 - 5

Introduction
Table of contents
Introduction .................................................................. 6
Voices of young people………………………………….7
Definitions..................................................................... 8
Overview of current global situation .......................... 9
Human rights standards and international
commitments relating to SRHR ................................ 10
Key SRHR issues ....................................................... 12
Social norms and gender inequality ......................... 12
Comprehensive sexuality education ....................... 14
Access to adolescent- and youth-friendly SRHR
services .................................................................... 16
Menstruation ............................................................ 18
Adolescent pregnancy ............................................. 18
Contraception........................................................... 21
Access to safe abortion ............................................ 22
HIV and AIDS........................................................... 24
Harmful practices ..................................................... 25
Female genital mutilation/cutting ......................... 26Child, early and forced marriage ......................... 26
Gender-based violence ............................................ 27
SRHR in humanitarian contexts ............................... 29
Plan International’s existing work on SRHR issues 31
Annex 1: Human rights standards and international
commitments relating to SRHR ............................... 32
References .................................................................. 39

Plan International believes that all children,
adolescents and young people have the right to maketheir own free and informed choices and to have control
over their sexual and reproductive health and lives, freefrom coercion, violence, discrimination and abuse. Girlsand young women in particular are denied the ability to
exercise these rights. Fulfilling the rights of all children,
adolescents and young people is fundamental toachieving gender equality.
However, gender inequality and discriminatory social
norms mean that girls and young women often lack thevoice, agency and autonomy to make their own
decisions in relation to their sexual and reproductive
health and are frequently denied access to quality sexualand reproductive health information and services. Thiscan leave them vulnerable and unable to protect
themselves from unwanted pregnancy and sexuallytransmitted infections (including HIV), as well as fromcomplications related to pregnancy and childbirth. It canalso result in serious psychological harm. Girls andyoung women are frequently subjected to serious humanrights violations, including coerced sex, sexual violenceand harmful practices, such as female genital
mutilation/cutting and child, early and forced marriage.
This is a position statement for Plan International, Inc.
(“PII”). It presents our position on sexual andreproductive health and rights (SRHR), as well as ananalysis of: the current global situation; the legal andpolitical framework; and specific issues related to SRHR,
in particular for girls and young women. This paper
supports the new Global Strategy, in which SRHR is
identified as a priority, and our work in relation to the2030 Agenda and the Sustainable Development Goals –in particular Goals 3 and 5. A number of high-levelrecommendations are included to guide advocacy,
however, a more specific advocacy framework will be
developed.
The analysis and positions are founded on human rights,
global evidence and Plan International’s programmaticwork, as well as a youth consultation with members ofPlan International’s youth advisory panels at the global
level and in four countries; Bangladesh, El Salvador,
Togo and Uganda, as well as young people who havebeen part of Plan International’s programmes in thesecountries.
PII’s country, regional, and liaison offices (including our“field country national organisations” (i.e. India andColombia)) will be expected to put the position statement
into practice using their judgement and analysis of the
key issues in their specific context.

Young man, aged 22, Uganda.
Girl, aged 18, Bangladesh.

Young man, aged 22,
Uganda.

Girl, Uganda.

Young woman, aged 22,
Bangladesh.

Girl, Bangladesh.

Boy, aged 17, Togo.
Young woman, aged 21, Bangladesh.

Young man, aged 19, El Salvador.
Young woman, aged 23, Uganda

Young man, aged 24, Uganda.

Young man, aged 19,
El Salvador.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 7

ABORTION is the termination of a pregnancy before thefoetus has reached viability, i.e. become capable ofindependent extra-uterine life.14
ADOLESCENT: While adolescence is difficult to define, notleast because individual experiences of puberty varyconsiderably, Plan International adopts the UN definition ofan adolescent as a person between the ages of 10 and19.15
CHILD: Plan International adopts the definition of the UN
Convention on the Rights of the Child (CRC), which definesa child as anyone under the age of 18.16
CHILD-, ADOLESCENT- AND YOUTH-FRIENDLYHEALTH SERVICES: These are services targeting children,
adolescents and youth that are sensitive and responsive totheir particular needs, non-judgemental, gender-sensitive
and that ensure confidentiality and privacy. Specificattention should be paid to the Availability, Accessibility,
Acceptability and Quality17 of the services. In addition,
services should be scientifically and medically appropriate
with personnel trained to care for children, adolescents andyouth as well as adequate facilities and scientifically
accepted methods.18
COMPREHENSIVE SEXUALITY EDUCATION: UNESCO
defines comprehensive sexuality education as a culturally
relevant approach to teaching about sex and relationships
by providing scientifically accurate, realistic, nonjudgemental information. Sexuality education provides
opportunities to explore one’s own values and attitudes andto build decision-making, communication and risk reduction
skills about many aspects of sexuality. The term“comprehensive” emphasises an approach to sexuality
education that encompasses the full range of information,
skills and values to enable young people to exercise theirsexual and reproductive rights and to make informed
decisions about their health and sexuality. 19
GENDER-BASED VIOLENCE is defined as “acts ofphysical, mental or social abuse that is attempted or
threatened, with some type of force and is directed against
a person because of his or her gender roles andexpectations in a society or culture. A person facing genderbased violence has no choice to refuse or pursue otheroptions without severe social, physical, or psychologicalconsequences. Forms of gender-based violence include
sexual violence, sexual abuse, sexual harassment, sexual
exploitation, early marriage or forced marriage, gender
discrimination, denial (such as education, food, freedom)and female genital mutilation/cutting.20
LESBIAN, GAY, BISEXUAL, TRANSGENDER,INTERSEX, QUESTIONING (LGBTIQ) CHILDREN,
ADOLESCENTS OR YOUTH: This is a broad category of
those who self-identify as being lesbian, gay, bisexual,
transgender, intersex, questioning. It also includes those
who are questioning their sexual orientation and/or gender
identity. Issues relating to LGBTIQ can emerge at different
ages. For example, some people’s intersex identity is clear
at birth, and some transgender people are aware from earlychildhood that their real gender identity differs from thatassigned at birth. Many realise their sexual orientation
during adolescence. Being LGBTIQ is central to a person’s
identity and their physical and emotional wellbeing. 21
REPRODUCTIVE HEALTH: Defined by the International
Conference on Population and Development as “a state ofcomplete physical, mental and social wellbeing and not
merely the absence of disease or infirmity, in all mattersrelating to the reproductive system and to its functions andprocesses” which “implies that people are able to have asatisfying and safe sex life and they have the capability toreproduce and the freedom to decide if, when and how
often to do so.”22

REPRODUCTIVE RIGHTS: These are defined by theInternational Conference on Population and Development
as embracing “certain human rights that are alreadyrecognized in national laws, international human rights
documents and other consensus documents. These rights
rest on the recognition of the basic right of all couples andindividuals to decide freely and responsibly the number,spacing and timing of their children and to have theinformation and means to do so, and the right to attain thehighest standard of sexual and reproductive health. It also
includes their right to make decisions concerning
reproduction free of discrimination, coercion and violence.” 23
SEXUAL HEALTH: Defined by the World HealthOrganization as “a state of physical, emotional, mental andsocial well-being in relation to sexuality; it is not merely theabsence of disease, dysfunction or infirmity. Sexual healthrequires a positive and respectful approach to sexuality andsexual relationships, as well as the possibility of havingpleasurable and safe sexual experiences, free of coercion,
discrimination and violence. For sexual health to be attained
and maintained, the sexual rights of all persons must be
respected, protected and fulfilled.”24
SEXUAL ORIENTATION refers to each person’s capacity
for profound emotional, affectionate and sexual attraction to,and intimate and sexual relations with, individuals of adifferent gender or the same gender or more than one
gender.25
SEXUAL RIGHTS: According to World Health Organisation,these embrace certain human rights that are alreadyrecognised in international and regional human rights
documents and other consensus documents and in nationallaws. These include the rights: to equality and nondiscrimination; to be free from torture or from cruel,inhumane or degrading treatment or punishment; to privacy;
to the highest attainable standard of health (including sexual
health) and social security; to marry and to found a family
and enter into marriage with the free and full consent of theintending spouses; and to equality in and at the dissolutionof marriage; to decide the number and spacing of children;
to information, as well as education, freedom of opinion andexpression; and the right to an effective remedy for
violations of fundamental rights. Sexual rights protect all
people’s rights to fulfil and express their sexuality and enjoy
sexual health, with due regards for the rights of others andwithin a framework of protection against discrimination. 26
SEXUALITY: According to World Health Organisation “acentral aspect of being human throughout life encompasses
sex, gender identities and roles, sexual orientation,
eroticism, pleasure, intimacy and reproduction. Sexuality isexperienced and expressed in thoughts, fantasies, desires,
beliefs, attitudes, values, behaviours, practices, roles andrelationships. While sexuality can include all of these
dimensions, not all of them are always experienced or
expressed. Sexuality is influenced by the interaction of
biological, psychological, social, economic, political, cultural,
legal, historical, religious and spiritual factors.” 27
UNSAFE ABORTION is defined as a procedure forterminating an unwanted pregnancy either by persons
lacking the necessary skills or in an environment lacking theminimal medical standards, or both.28
VIOLENCE AGAINST WOMEN is defined as “any act ofgender-based violence that results in, or is likely to result in,physical, sexual or psychological harm or suffering to
women, including threats of such acts, coercion or arbitrary
deprivation of liberty, whether occurring in public or in
private life”.29
YOUTH/YOUNG PERSON: Youth is best understood as aperiod of transition from childhood to adulthood. Plan
International adopts the UN Secretariat definition ofyouth/young person to mean a person between the ages of
15 and 24.30

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 8

Overview of current global
situation
Around the world, many children, adolescents and young
people grow up and become sexually active without
access to timely, appropriate, gender-responsive, quality
SRHR information and services.
Harmful social norms, gender stereotypes, power
imbalances between males and females, perceptions ofgirls’ and young women’s sexuality and other inequalities
are significant barriers in restricting children’s,adolescents’ and young people’s access to SRHR.
Despite efforts of advocates from around the world,
Sexual and Reproductive Health and Rights (SRHR) is
not an internationally agreed concept. Governments
have only agreed to recognise Sexual and Reproductive
Health and Reproductive Rights.31 Sexual rights havenot been recognised in international agreements.32
Nevertheless, the term SRHR is commonly usedamongst rights-based groups and organisations.
There have been significant advances over the last 20
years in certain aspects of SRHR – such as maternal
health, HIV prevention, treatment and care, andcontraceptive use. However, other areas, such as
deaths due to complications of pregnancy, childbirth andunsafe abortion33 and sexual violence remain alarmingly
high.
Girls and young women are disproportionately affectedby and vulnerable to SRHR violations due to entrenchedgender inequalities and the lower value attributed to girls
and women in many societies. They are often denied theautonomy or knowledge to make informed decisions tobe able to exercise a healthy, safe and enjoyablesexuality, free from coercion, subjugation, violence anddiscrimination. This is particularly true for girls and young
women who live in poverty, in crisis or emergency
settings or who belong to vulnerable and excluded
groups,34 who often face additional risks to their healthand wellbeing due to the intersection of multiple forms of
discrimination. Restrictions on mobility and freedom of
movement can specifically limit girls’ and young
women’s equal access to sexual and reproductive healthservices.35
Complications due to pregnancy and childbirth is still thesecond leading cause of death for adolescent girls aged
15 to 19 globally, exceeded only by suicide.36 Suicide is
the leading cause of death among adolescent girls aged
15 to 19 globally.37 The highest rates can be found in inSouth-East Asia, where suicide is the cause for one insix deaths among adolescent girls.38
Younger adolescents under the age of 15 face evenhigher risks related to pregnancy and childbirth39 and it isestimated that 2 million births occur among this younger
age group in low-resource countries each year.40 Ninetynine per cent of all maternal deaths occur in developing
countries and a majority of these could be prevented.41
Girls and young women not only face increased risks
related to pregnancy and childbirth – they are also more
seriously affected by complications than older women.42
For example, up to 65 per cent of women with obstetricfistula develop this as adolescents.43 At the same time, alarge proportion of adolescent girls and young women
who want to delay or space pregnancy are not using any
form of modern contraception. In developing countries
23 million girls and young women aged 15 to 19 haveexperienced an unmet need for modern
contraceptives.44 Every year, some 3 million girls aged

15 to 19 undergo unsafe abortions putting themselves atrisk of death.45
Gender inequality, violation of girls’ and young women’s
rights, such as sexual abuse, child, early and forced
marriage and age-disparate sexual relationships, andother social and economic inequalities, put girls at risk ofacquiring HIV. Girls accounted for more than 60 per centof the 220,000 adolescents (aged 15 to 19) who
contracted HIV in 2014.46
Girls and young women continue to experienceextremely high levels of violence, including sexual
abuse. More than a third – 35.6 per cent – of womenaround the world have experienced either non-partner
sexual violence or physical or sexual violence by an
intimate partner, or both.47 In some countries up to 68
per cent of women are reported to have experienced
these forms of intimate-partner violence.48 However,actual figures may be even higher, as sexual violenceand domestic abuse are often underreported. Violenceagainst girls and women results in considerable physicaland psychological consequences, including injuries,
disabilities, increased risk of HIV infection and unwanted
pregnancy from sexual violence.49
Harmful practices such as child, early and forced
marriage and female genital mutilation/cutting also
continue to have devastating effects on girls’ andwomen’s sexual and reproductive health and wellbeing.
Some 200 million girls and women alive today are
estimated to have been subjected to female genital
mutilation/cutting 50 and the current rate of progress on
ending child marriage needs to be accelerated to eighttimes faster than the current rate in order to meet thetarget of eliminating the practice by 2030.51
There are strong links between girls’ and women’s
health and nutritional status and their children’s survival,
growth and development: deaths during the first monthof life constitute 44 per cent of child deaths, and mostresult from inadequate maternal healthcare before birthand during delivery.52
In humanitarian contexts, existing gender inequalities
are exacerbated, placing girls and women at aheightened risk of gender-based violence, exploitation
and abuse.53 Loss of support and protection
mechanisms, financial pressures and the absence of
reliable healthcare and judicial systems render girls andwomen particularly vulnerable and makes it difficult forthem to realise their sexual and reproductive rights.54
During conflict, girls and women may also bedeliberately targeted and subjected to various forms ofviolence and abuse, including arbitrary killings, tortureand mutilation, sexual violence, forced marriage, forced
prostitution, forced impregnation, forced termination ofpregnancy and sterilisation.55 However, sexual violence
is often underreported due to the trauma suffered bysurvivors as well as fear of stigmatisation and retribution
as well as the limited availability of services.56
In addition, disruption to essential health services, which
often occurs during times of crisis, increases thelikelihood of unplanned pregnancy and severe sexualand reproductive health problems and complications.
Approximately three-fifths of all maternal deaths takeplace in humanitarian and fragile contexts.57 Girls andwomen are also at greater risk of contracting sexuallytransmitted infections including HIV and AIDS as a resultof sexual violence, transactional sex and other risks
which are exacerbated during times of crisis.58

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 9

Given that we now have the largest generation ofadolescents the world has ever seen, it is critical toensure their access to sexual and reproductive healthinformation and services, as these are fundamental totheir lifelong health.59 In 2014, the world was home to
1.8 billion 10 to 24 year-olds, of whom most wereadolescents.60

Human rights standards andinternational commitments
relating to SRHR
Sexual and reproductive rights61 are stipulated in a
number of human rights instruments and international
agreements. These include (but are not limited to) theConvention on the Rights of the Child, the Convention
on the Elimination of All Forms of Discrimination Against
Women, the International Covenant on Economic, Social
and Cultural Rights, the Programme of Action of theInternational Conference on Population andDevelopment, the Beijing Declaration and Platform of
Action and the 2030 Agenda for Sustainable
Development. There are also a number of regional
human rights instruments and frameworks that address
SRHR. However, for the purpose of this paper, we will
be focusing on international conventions andagreements.
Annex 1 provides a more detailed analysis of theinternational legal framework and key human rights andinternational consensus documents that guide our workin this area. Below we present a brief overview of themost important documents that guide Plan
International’s work in this area.

Convention on the Rights of theChild
Article 24 of the Convention on the Rights of the Child(CRC) clearly expresses that all children have the rightto enjoy the highest attainable standard of health andthat no child should be deprived of his or her right toaccess such healthcare services.62 The Committee of
the Rights of the Child General Comment No. 4 on
Adolescent Health and Development emphasises thatearly marriage and pregnancy are significant factors inhealth problems related to sexual and reproductive
health, recommending that States reform legislation toprovide for a minimum age of marriage with and withoutparental consent to 18 years for both boys and girls.63 It
also stresses the need for States to provide adolescentswith access to sexual and reproductive information,
including information on family planning andcontraceptives; the dangers of early pregnancy; and theprevention and treatment of sexually transmitted
infections, including HIV, regardless of marital status andparental or guardian consent.64 It places particularemphasis on the need to respect adolescents’ rights to
privacy and confidentiality including with respect toadvice and counselling on health matters.65 Furthermore,States are urged to take effective measures to ensurethat adolescents are protected from all forms of violence,
abuse, neglect and exploitation.66
The Committee on the Rights of the Child General
Comment No. 3 on HIV/AIDS emphasises the obligation
on States to ensure that children have the ability toacquire the knowledge and skills to protect themselves
and others as they begin to express their sexuality. 67 It

also calls on States to guarantee the equal access ofchildren to all relevant services with particular regard forthe child’s right to privacy and confidentiality.68 It alsoemphasises the need for services to be friendly andsupportive, accessible, affordable, non-judgemental andfree from any requirement for parental consent. 69

Convention on the Elimination of All
Forms of Discrimination Against
Women
Article 12 of the Convention on the Elimination of All
Forms of Discrimination Against Women requires States
to take all appropriate measures to eliminate
discrimination against women when it comes tohealthcare and accessing services. Of particular
relevance for SRHR, the convention requires that States
ensure that women have equal access to family planning
services, as well as access to services during pregnancy
and the postnatal period.
General Recommendation No. 2470 provides further
clarification on the scope of Article 12. It clarifies that its
recommendations apply equally to girls and adolescentsas well as women. Of particular note, the General
Recommendation clarifies that where a health worker
refuses to perform certain health services on the
grounds of conscientious objection, the State is required
to introduce measures to ensure that women arereferred to alternative health providers.71 It goes on tonote that States should not restrict women’s access tohealth services on the grounds that they lack theauthorisation of their husbands, partners or healthauthorities or because they are unmarried or women.72
The General Recommendation further recommends that
“States parties should ensure the rights of female andmale adolescents to sexual and reproductive healtheducation by properly trained personnel in speciallydesigned programmes that respect their right to privacy
and confidentiality”.73

2030 Agenda for Sustainable
Development
Gender equality is embedded in the 2030 Agenda for
Sustainable Development (often referred to as Agenda
2030 and the Sustainable Development Goals) as awhole and also addressed in a stand-alone goal. The
2030 Agenda also tackles cross-cutting issues whichhinder the realisation of SRHR, such as child marriage;
poverty; violence; stigma and discrimination. It also
contains two targets specifically addressing SRHR andaccess to health services.
Target 3.7 provides: “By 2030, ensure universal accessto sexual and reproductive health-care services,
including for family planning, information and education,and the integration of reproductive health into national
strategies and programmes”.
Target 5.6 provides: “Ensure universal access to sexualand reproductive health and reproductive rights asagreed in accordance with the Programme of Action of
the International Conference on Population andDevelopment and the Beijing Platform for Action and theoutcome documents of their review conferences”.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 10

Implementation of internationalframeworks and agreements

constitute discrimination against girls andwomen.

All of Plan International’s work is grounded ininternational human rights law. In line with Article 1 of
the Universal Declaration of Human Rights, we believethat “all human beings are born free and equal in dignity
and rights”. This of course includes girls and young
women. Too often however, their sexual andreproductive rights are not upheld. This cannot beensured where governments have not yet ratified
relevant conventions and agreements in relation to
SRHR.
Many countries have ratified conventions or agreed toconsensus documents, but made reservations to certain
provisions, thereby effectively undermining them. Many
countries have also ratified conventions or agreements
but have failed to implement them. This is a challenge
for the international community as it prevents real
progress in realising international frameworks andagreements and thus hinders implementation of humanrights.
Frequently, States also challenge the legality of generalcomments and international consensus agreements andfail to implement action points within these documents.
While not legally binding, these documents arenevertheless persuasive in character and indicative ofthe direction that the international law is heading.
Other shortcomings include weak legal frameworks andinadequate enforcement of laws that can result in
impunity for perpetrators.

Recommendations to promote and protect
sexual and reproductive rights:➢

Governments should adopt, budget for,implement and monitor national legislation andpolicies to ensure the effective enjoyment of theright to the highest attainable standard of sexualand reproductive health for all children,
adolescents and young people. This should
include legislation that protects girls and young
women from violence and harmful practices.
Legislation and policies should also be fully
consistent with international human rights law
and take precedence over conflicting customaryor religious laws.

➢

Governments should remove legal, regulatory
and policy barriers to sexual and reproductive
health information, education and services for
all children, adolescents and young people,
including girls and young women, and create anenabling environment so that they can havecontrol over and decide freely and responsibly
on matters related to their sexuality, including
sexual and reproductive health, free of coercion,
stigma, discrimination or violence.

➢

Governments should ratify all relevant
conventions and agreements in relation to
SRHR. Governments that have ratified
conventions but made reservations toprovisions relating to SRHR should withdraw
these reservations.

Plan International’s position:➢

Plan International believes that States must
ratify and fully implement all ratified
conventions or agreements relating to sexualand reproductive health and rights (SRHR),
including all action points that are listed in such
documents, as well as general comments andtreaty body recommendations. This requires
governments to align all national and local laws
and policies accordingly.

➢

We respect cultural traditions, religious beliefs
and social norms, but believe that they should
not constitute reasons for countries to makereservations to international conventions andagreements in relation to sexual andreproductive health and rights.

➢

We believe it is important to collect data
disaggregated by age, sex, ethnicity, religion,
disability, location, wealth, marital status, sexual
orientation and gender identity, and migratory
status (with due protections for privacy andhuman rights). This must include the age range
10 to 14 years in order to make younger
adolescent girls and their needs visible and to
track progress against commitments, policies
and programmes on girls and young women.

➢

Plan International also supports the call in theConvention on the Elimination of All Forms ofDiscrimination against Women74 for States totake all appropriate measures, including
legislation, to modify or abolish existing laws,
regulations, customs and practices which

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 11

Key SRHR issues
Having outlined the current status of SRHR for children,
adolescents and young people at a global level, thissection examines in more detail how the fulfilment of
SRHR is linked to gender and age.
This section therefore focuses particularly on thechallenges that girls and young women face to realise
their SRHR and presents Plan International’s position
and recommendations on each issue.

Social norms and gender inequality
Social norms and expectations around how girls andboys or young women and young men should behave –and perceptions about their sexuality in particular – areimportant drivers of sexual and reproductive ill healthand the non-fulfilment of rights.75 For example, theperception that female sexuality needs to be controlled
and that girls and women should not experience sexualpleasure is deep-rooted and also serves as a driver ofharmful practices such as female genital
mutilation/cutting.76 It can also result in girls and young
women entering sexual relationships under the
impression that they should be submissive and that theyshould not express their needs and desires.
Inequality, discriminatory social norms and attitudes
towards girls and young women mean that they are often
denied the voice, agency and autonomy to make theirown decisions in relation to their SRHR.
For example, a girl who engages in sexual relationships
before marriage, or who insists that her partner uses
condoms, may in some contexts be seen as
promiscuous.77 Young women, both married andunmarried, report that men’s attitudes towards
contraceptives constitute the largest barrier to theiruse.78A girl taking part in a youth consultation workshop in
Bangladesh said that one of her friends had been
expelled from her school after a condom was found inher bag. The school authority had thought that she washaving premarital sex and therefore considered her “awicked girl”. Later it was found that the girl’s sister had
mistakenly kept the condom in her bag, but the school
authority did not allow the girl to return.
Furthermore, cultural norms often glorify marriage,
motherhood and fertility in a manner that limits girls’ andwomen’s autonomy in exercising life choices.79 Girls andwomen may be valued according to their marriageabilityor their ability to produce children. This often results infamilies seeking to marry their daughters early and puts
pressure on girls to become pregnant soon after they

have entered into marriage, regardless of their often very
young age. This pressure to reproduce quickly – andideally to have male children – can lead to adverse
health consequences as a result of repeatedpregnancies spaced too closely together.80 Girls andyoung women may also be cast out of marriages if they
are considered unable to reproduce on the presumptionthat they have fertility issues.81
At the same time, perceptions of manhood andmasculinity may include expectations that boys and men
should engage in unsafe sex and other risk-taking
behaviour; that they need to use violence to resolve
conflict; and that they should be knowledgeable about
sex from an early age.82
Boys participating in a youth consultation workshop in
Bangladesh said that they are influenced by their peers,and by older boys to have premarital sex. Between
peers there might be a state of competition and there
might even be ongoing bets for relationships and sex.
Individuals like kobiraaj (quack doctors) had also
encouraged boys to engage in premarital sex “as asolution to satisfy their sexual frustrations or wants” - eg.
to “cure” wet dreams. One boy, aged 17, said that as aresult of these pressures they might go to sex workers.

These expectations may dissuade boys and men fromseeking information and services. It can also make it
difficult for them to speak out against abuse and sexual
exploitation. Inevitably, these perceptions of masculinity
have many negative consequences for the health ofboys and young men as well as girls and young women.
They also tend to fuel homo- and transphobia.83
Long-term solutions are needed to address the drivers ofgender inequality, patriarchy, the norms that perpetuate
and normalise violence against girls and women andimpunity for perpetrators as well as the inadequate
protection of human rights.84 The sexual andreproductive health of girls and young women is
intrinsically intertwined with that of boys and young
men.85 Efforts are needed to tackle the negative
attitudes of boys and men towards girls and women as
well as the negative self-images that many girls andwomen have as a result of societal norms andexpectations. Cultural and social norms influence girls’
and young women’s self-esteem through idealised body
images and objectification. The pressure to fit in andadhere to these as well as the impact of thesexualisation of girls and young women in manysocieties is significant.
Gender inequality can also affect access to and thequality of care, for example through prejudicial attitudes
to unmarried girls and women. Service providers may

Plan International’s Champions of Change programme – promoting genderequality through peer-to-peer mobilisation
Plan International has implemented Champions of Change, an innovative model for promoting gender equality and girls'
rights through youth engagement and peer-to-peer mobilisation, in countries across Latin America.
The model includes a comprehensive set of curricula for both girls and boys, providing teams with cohesive tools forpromoting girls' empowerment and engaging boys to promote gender equality. It also seeks to drive social norm change
and challenge stereotypes of gender roles and masculinities. The Champions of Change Curriculum covers all elementsof comprehensive sexuality education. It seek to provide young people with a solid foundation from which to make theirown decisions regarding their bodies and sexuality and to decide their own futures.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 12

also refuse to provide girls and young women withaccess to contraceptive information and services or
impose conditions such as spousal, parental or guardianconsent.86 This can present a significant barrier to girls’
and young women’s realisation of their rights and may
leave them unable to protect themselves against early or
unwanted pregnancy, unwanted sexual relations andsexually transmitted infections, including HIV. In
addition, social norms and taboos around sex andsexuality restrict them from gaining and practising skills,
such as negotiation skills, required to exercise agency inthese matters.
As outlined in Plan International’s Tackling Exclusion
Framework, gender norms and inequalities intersect withother forms of exclusion87 and patterns of discrimination.
For example, girls and young women who live in poverty
in rural areas, who belong to indigenous groups or who
are disabled face additional barriers to accessing sexualand reproductive health information and services.
People with disabilities have often been denied the rightto establish relationships and make decisions regarding
family planning. Lesbian, gay, bisexual, transgender,intersex, questioning adolescents and youth may also
face multiple challenges to accessing the SRHR
services required, for example due to discriminatory
laws or attitudes and lack of technical expertise among
service providers.
Part of the challenge also lies in the contradictory way inwhich society views adolescents. On the one hand,adolescents are recognised as rights holders, yet on theother hand, adolescents are also considered to bevulnerable, weak, rebellious and unable to makedecisions for themselves.88 In many countries, talking
about sexual activity and relationships is a taboo topic
between children and their parents, which can leavechildren, adolescents and young people without thenecessary knowledge to be able to make informed
decisions. In addition, there is resistance fromconservative religious and community leaders as well as
in some States to condemn child sexual activity within
marriage even though it is often coerced rather thanbased on free consent. At the same time, these actors
oppose children’s and adolescents’ access to SRHR
services and to comprehensive sexuality education.
They also oppose the notion that girls have sexual andreproductive rights rather than just sexual duties inmarriage, denying the concept of autonomy andconsent.89

Plan International’s position:➢➢

Plan International believes that it is crucial tochallenge gender inequality and social norms
which hinder fulfilment of the SRHR of children,
adolescents and young people, and in particularof girls and young women. Traditional, culturalor religious grounds should not be used tojustify these norms. Upholding sexual andreproductive rights in accordance with humanrights standards and international agreements90
is a priority for Plan International.
To bring about change in attitudes, norms andbehaviour, it is crucial to engage and promoteinter-generational dialogue on SRHR as well as
to challenge stereotypical attitudes andexpectations around sexuality and reproduction.
Dialogue should include the participation ofchildren, adolescents, young people, parents,
caregivers, traditional and religious leaders,
health workers and teachers.91➢

We believe that creating positive change inbehaviours requires an approach that engages
boys and men as much as girls and women.
Involving boys and men as beneficiaries, rights
holders and as agents of change is key tochallenging dominant norms of masculinity, andto developing equality, safety, respect andresponsibility in relationships, and thus torealising the SRHR of all children, adolescentsand young people.

➢

We also recognise the role and responsibility of
governments, including national health andeducation systems, in challenging harmful
norms and gender inequality.

➢

Plan International is committed to working withothers to challenge discriminatory attitudes,
norms and behaviours which drive stigma,
discrimination and violence towards children,
adolescents and youth who identify as lesbian,gay, bisexual, transgender, intersex,
questioning.

Recommendations for addressing genderinequality and harmful norms:➢

Governments, UN bodies and civil society
organisations should actively engage
communities, families, children, adolescents,
young people (including girls and young
women), traditional and religious leaders, healthworkers and teachers on achieving positivechange on gender equality and SRHR, in
particular with regard to sexuality andreproduction. This should be with a view to raiseawareness of children’s, adolescents’ andyoung people’s SRHR and the impact of harmfulsocial and gender norms as well as to mobilise
these actors to change harmful attitudes andnorms.

➢

Governments need to implement allinternational and regional agreements that referto governments’ commitments to work towards
achieving gender equality and engaging boys
and men, such as the Beijing Declaration andPlatform for Action, as well as more recent
agreements such as the Commission on the
Status of Women 48 agreed conclusions.

➢Boys and men should be supported and enabled
to actively participate as agents of change,
rights bearers and beneficiaries to challenge
existing gender inequalities and harmful genderstereotypes around SRHR.

➢

Local, national and international media should➢

Governments, UN bodies, and civil society
organisations should help children, adolescentsand young people, especially girls and young
women, to understand and claim their rights,
including through human rights education anddissemination of human rights information inchild- and youth-friendly formats.

engage children, adolescents and young people,
including girls and young women, to influence
how the media portrays adolescent and youth
sexuality responsibly. In particular they must
avoid reinforcing gendered stereotypes,
sensationalising sexuality and normalisingsexual violence.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 13

Comprehensive sexuality education
The provision of comprehensive sexuality education(CSE) for both boys and girls is key to promoting an
understanding and awareness of SRHR and todeveloping the skills, knowledge, autonomy, confidence
and ability to make free and informed decisions about
their sexual and reproductive lives, to enjoy fulfilling andhealthy relationships and to protect themselves and theirpartners against ill health, violence and unwanted
pregnancy. CSE intersects with the rights to education,
health, participation and protection.92
The term “comprehensive” emphasises a holistic
approach to sexuality education that encompasses thefull range of information, skills and values to enable
children, adolescents and young people to exercise theirsexual and reproductive rights, and to make decisions
about their health and sexuality.93 It includes informationon contraception and safer-sex practices and contrasts
with “abstinence-only” education. Abstinence-only
education does not take a rights-based approach, andevidence demonstrates that it is less effective inpractice.94
A technical guidance note on sexuality education from
UNESCO states that topics and learning objectives in
CSE should cover the following components:
information; values, attitudes and social norms;
interpersonal and relationship skills; and responsibility.95
These areas cover a wide range of topics that are
relevant for successfully delivering CSE. This includes
learning about relationships, gender equality, sexual andgender-based violence, sex, sexuality and SRHR.
Research shows that CSE does not lead to an earlier
onset of sexual activity, but rather can delay the age offirst sexual experience and can have a positive impact interms of safer sexual practices.96The Committee on the
Rights of the Child has clarified that adolescents’ right toinformation about HIV and AIDS is part of the right toinformation and that States should not withhold, censor
or intentionally misrepresent health information,
including sexuality education.97 The International
Conference on Population and Development
recommended that information and services should bemade available to adolescents to help them understandand enjoy their sexuality and to protect them fromunwanted pregnancies, sexually transmitted infections
and the subsequent risk of infertility. It also emphasised
the importance of addressing gender inequality andeducating young men to respect women’s selfdetermination and to share responsibility with women inmatters of sexuality and reproduction.98
Evidence demonstrates that CSE programmes, if
delivered correctly, have a positive impact. In a metaanalysis of 87 studies99 two-thirds demonstrated positive
impact on behaviour, including increased self-efficacy
related to condom use and refusing sex. 100 This same
rigorous review of evidence demonstrated increased HIV
knowledge across almost all programmes, with twothirds demonstrating positive impact on behaviour,
including a reduced number of sexual partners; delayed
sexual debut; increased self-efficacy related to condom
use and refusing sex; increased contraception andcondom use.101
At the same time, robust evidence shows that
abstinence-only approaches have proven ineffective.102
According to the same analysis, abstinence messages
actually had no impact on adolescent sexual behaviour

in terms of the initiation of sex, abstinence or a decreasein the number of sexual partners. Despite this,abstinence-only approaches are still delivered in many
countries.
Various human rights committees including theCommittee on the Rights of the Child103 and theCommittee on the Elimination of All Forms ofDiscrimination Against Women104 have also urgedStates to make CSE mandatory in primary andsecondary education. However, while there has beensome progress in introducing sexuality education inschools, there are significant gaps in coverage and thecontent is often not as comprehensive as it needs to be.
As such, access to high quality CSE is difficult or
impossible for many children, adolescents and young
people – particularly in many low- and middle-income
countries.105 This was also highlighted as a key issue inthe youth consultations.
A Plan International report from the Asia region notedthat programmes often focus on HIV prevention but
neglect other areas such as the link to the rights
framework and issues of stigma and discrimination.106
There is also a tendency for such programmes to be
driven by the national strategic plan on HIV and AIDS
without adequate alignment with education sectorplans.107
A further report commissioned by Plan International UK
in 2016108 highlighted that although a proven practice,
CSE is often poorly implemented and its success relies
heavily on adequate fidelity to the factors that ensure
effectiveness: the quality and content of the curricula,including the methods and pedagogy used; effective
linkages with SRHR services; trained facilitators; andyouth engagement.
In a workshop with young people in Bangladesh, it was
revealed that some of the participants had discussed
issues related to sex with their parents. However, theinformation provided by the parents was not complete
and consisted of taboos or misinformation. Village elders
provided participants from rural areas with traditional andincorrect information. Girls tended to have closer
relations with their mothers, who served as the main
source of information on topics related to sex. On theother hand, boys mostly received their information frompeers, who had in turn received their information fromvarious sources, including pornography. Boys
specifically mentioned their inability to talk about SRHR
with their fathers or other elders in the family.
Other critical and enabling factors include: supportive
government and school policies: supportive executive
leadership in schools; community engagement withparents, caregivers, religious leaders and the wider
community; and adequate monitoring and evaluation.
Curricula that are rights-based and gender-aware,delivered with efforts to expand access to high quality,
adolescent- and youth-friendly services, make CSE evenmore effective. In curriculum design, increased attention
is required to develop key competencies, including
critical thinking, and on examining how gender norms,
religion and culture influence learners’ attitudes andbehaviour. The most effective teaching methods are
participatory and learner-centred, providing opportunities
for self-reflection and encouraging children, adolescentsand young people to connect what they are learning in
the classroom to their wider worlds. Lack of adequate
training for CSE facilitators is a critical barrier and there

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 14

is a need to invest specifically in training educators todeliver CSE effectively.

Plan International’s position:➢

Plan International believes that all children,
adolescents and young people – without
discrimination – are entitled to comprehensive
sexuality education (CSE) to gain knowledge,
explore values and attitudes, and develop theskills they need to make conscious, healthy andrespectful choices about relationships andsexuality. Parents and educators should be
supported to embrace children’s learning about
their bodies, relationships and sexuality fromearly childhood to allow children to explore,
clarify and form life-long healthy attitudes andpractices, free from coercion, violence anddiscrimination.

➢

CSE should be accessible for all children,
adolescents and young people, in both formal
and non-formal educational settings. Cocurricular activities which complement theformal curriculum are also important as areparental and community involvement and links
to gender-responsive, child- adolescent- andyouth-friendly healthcare and other services.113
CSE should be provided in a way that is nonjudgemental, non-discriminatory, scientificallyaccurate, accessible, inclusive, rights-based,
gender-transformative and adapted to theevolving capacity of the child, adolescent or
young person.

CSE has the ability not only to empower children,
adolescents and young people to make informed,
autonomous decisions regarding their SRHR and current
and future relationships,109 but it can also be part of aholistic approach to challenging gender inequalities andpreventing and responding to gender-based violence.110
As such, it is a powerful tool in the realisation of SRHR
and can trigger positive shifts in social norms which
underpin violence against girls and women. For
example, CSE can address harmful notions ofmasculinity, gender roles and stereotypes both in school
and the wider community.111
In a youth consultation workshop held in Uganda, it was
revealed that a majority of the participants would likesexuality education to be taught in schools, using
various methods including school health clubs. One
participant said that “sex education should be taken toboth primary and secondary schools.”
In times of crisis, CSE is equally important, given
increased risks of sexual violence, sexually transmitted
infections and pregnancy, and the breakdown oftraditional methods of support for children, adolescentsand young people. However, schooling can be severely
disrupted in a crisis, resulting in significant gaps andlimitations in education, let alone in providing CSE.112
There is strong evidence to demonstrate the impact andoutcomes of CSE in terms of a range of SRHR
outcomes, notably in reducing sexually transmitted
infections, including HIV, as well as unintended
pregnancy; increasing contraceptive use; addressing
gender inequality and unequal power relations, with thepotential to reduce violence against girls and women;
increasing critical thinking, negotiation and self-efficacy
skills and the capacities of children, adolescents andyouth to claim their rights; promoting strong citizenship;
supporting educational outcomes, including the potential
to sustain school enrolment (particularly for girls) and tofoster a safer school environment. In addition, there isalso evidence to support the cost-effectiveness of CSE
programmes and their “value for money”, based on thenumber of negative health outcomes that can beaverted.

Recommendations for improving access to
CSE:➢

Governments and other service providers
should ensure the provision of universal accessto CSE for all children, adolescents and young
people, both in and out of school. CSE should
start in the pre-school years, with the content
tailored to the evolving capacities of the child.
Those conducting CSE should be trained andequipped to deliver CSE that is nondiscriminatory, inclusive and accessible, nonjudgemental, scientifically accurate, rightsbased, gender-transformative and effective.
Information should be available to parents,
caregivers, traditional and religious leaders andother gatekeepers to enhance theirunderstanding of topics covered in CSE and toincrease their support.

Plan International Bangladesh – delivering CSE in schools and madrasahs
Plan International Bangladesh has partnered with the United Nations Population Fund (UNFPA) and the Ministry of
Education to deliver sexuality education to adolescents in schools and madrasahs. By having the Ministry of Education as
an implementing partner, and through creating a platform for repeated interaction among headmasters, teachers,
bureaucrats and policy makers, the project has been able to address the sensitivity around providing SRHR education in
Bangladesh – especially in the school and madrasah setting. Plan International Bangladesh has also partnered with the
Directorate General of Family Planning as well as the Ministry of Health & Family Welfare in providing adolescent- andyouth-friendly health services.
At the same time, Plan International has made innovative use of interactive materials like board games, computer games
and a radio show to impart sexuality and gender education. As the materials are self-learning, there is less reliance onadolescent leaders who function only as facilitators for group activities. The weekly radio programme is aired nationally,
thereby reaching a wider audience than in the project areas. The programme also promotes a helpline on SRHR
counselling and referral services for adolescents, which is operated by Plan International Bangladesh.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 15➢Governments and other service providers
should ensure the provision of relevant andrights-based information about relationships,
sex, sexuality and gender equality to adults, inorder to facilitate and support inter-generational
dialogue on topics related to SRHR.

➢

Governments and donors should ensure
adequate funding of formal and non-formal CSE.
The delivery of non-formal CSE should be subcontracted to civil society organisations andother providers.

Access to adolescent- and youthfriendly SRHR services
Financial, physical, social and cultural barriers, including
harmful social norms, are hindering access to timely andquality health services. This inequity in accessparticularly affects the most vulnerable and excluded insociety, including adolescents and young people. For
example, a study across 70 developing countries foundthat only a minority of sexually active adolescent girls
who had experienced a sexually transmitted infection or
showed symptoms of one had sought care in a healthfacility.114
As such, service provision must be reviewed andpursued with the health and human rights principles ofavailability, accessibility, acceptability, affordability andquality in mind. This should be resourced with adequate
financing to ensure access for all.
In a youth consultation workshop in Uganda, thedistance to services was perceived as a major barrier toaccess, as health centres are often located far fromyoung people. Some participants also cited limited
availability of services; for example, stating that
condoms are not always easy to receive.
Also, the attitude of health workers was seen as a key
barrier to accessing services. For example, one
participant said young people would be asked “why do
you need condoms at your age?” Many participants feltthat such questions were disempowering and they
discouraged many young people from going back to thehealth facilities. One of the girls, aged 17, said that when
she went for cancer screening she was told “what are wegoing to do with you at this moment; we are only dealing
with adult women”.

In accordance with the Committee on the Rights of theChild General Comment No. 4, adolescents and young
people should have access to services for sexual andreproductive health that are of appropriate quality andsensitive to adolescents’ concerns.115 Furthermore, theservices also need to be available without coercion or
discrimination on any grounds.116
Major gaps with respect to adolescent- and youthfriendly health services include failure to ensure
adequate privacy and accessible hours of operation, theprevalence of negative and judgemental attitudes among
healthcare providers and the request for parental or
spousal consent.117 For example, social stigma is amajor barrier that adolescents face in obtaining
services.118 Girls and young women in general, andunmarried girls in particular, are likely to experience
discrimination and judgemental attitudes from service
providers. In many places, health providers will refuse toprovide unmarried adolescents with contraceptive
information and services because they do not approve ofpremarital sexual activity.119
In a youth consultation workshop in Bangladesh, theparticipants stated that they do not seek the help ofhealth services unless they have “a massive problem”;
attempts are made to address the problem at homeusing local and home remedies. All participants said thatthey tended to get medicine themselves from thepharmacy without consulting a doctor or even talking toa trained pharmacist. Some of the young people,
particularly those from rural areas, had also sought help
from kobiraaj. One boy, aged 17, said he had gone withhis friend to one of these doctors: “There they gave him
the leaves and roots of some plant, after having which
he became very sick and vomited profusely.”

Weak infrastructure for health, communications andtransport can make access to services in rural areas
particularly difficult.120 Service providers may also fail tocater for the sexual and reproductive health needs ofyoung people. Services are generally aimed at adults
and may be viewed as inappropriate sources of care byadolescents and young people.121
Among the services most needed by adolescents andyoung people are information about and access to maleand female contraception; prevention and treatment ofsexually transmitted infections, and HIV and AIDS;
menstrual hygiene management; maternal healthservices throughout pregnancy, delivery and postpartum;
safe abortion and treatment for the complications ofPlan International Uganda – youth empowerment and youth-friendly services
In Uganda, Plan International is implementing a youth-led programme, which seeks to empower adolescents and young people
with skills and knowledge to advocate for access to SRHR and for a reduction in gender-based violence.
Young people are working with Civil Society Organisations to demand that local authorities as well as the government are
accountable for implementing human rights instruments that promote and protect adolescents and young people.
The programme specifically targets adolescents and young people who are not in formal education through a peer-to-peer
approach, supplemented by community theatre and radio talk shows.
Plan International in Uganda also works to increase the availability of youth-friendly services by educating health workers andworking with the government to increase the number of youth-friendly facilities and lobbying for a particular focus on vulnerable
adolescents. Young girls and boys are linked to a toll-free, confidential telephone hotline for on-the-spot counselling and referral
services, provided by counsellors who have received training on offering youth-friendly advice.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 16

unsafe abortion, including post-abortion care; andprevention, timely detection and treatment of cancers of
the female reproductive system.122 Survivors of sexual
violence need access to quality clinical post-rape care,which includes post-exposure prophylaxis (within 72
hours) to minimise the chance of HIV transmission,
emergency contraception, antibiotics to prevent sexuallytransmitted infections, broader medical care, as well as
mental health and psychosocial support and legal
support.123 Continued efforts to improve the availability,
accessibility, affordability and resilience of adequate
services for all adolescents and young people – and girls
and young women in particular – are essential to enable
them to realise their sexual and reproductive rights.124
Improving services would increase the likelihood thatadolescents and young people will use contraceptives
and also access vital information about other relatedareas of health, such as antenatal care, HIV andsexually transmitted infections.125

on ensuring their participation in the planning,
implementation and monitoring of services.131

Recommendations for improving access toand quality of health services foradolescents and youth:➢

Dissemination of SRHR information through schools,
communities and the media have proven effective in
improving services for adolescents and young people.126
However, stand-alone youth centres and peer education
have been less successful.127➢

In humanitarian settings, the Minimum Initial Service
Package, which was introduced by the Inter-Agency
Working Group on Reproductive Health in Crises in
1998, is now the international standard for protecting the
SRHR of women and girls in the acute phase of conflicts
and disasters. However, it does not include criteria forchildren and adolescents.

➢➢

Plan International’s position:128➢

Plan International believes that SRHR services
should be gender-responsive, rights-based,adolescent- and youth-friendly and available to
all adolescents and young people, including
during conflicts and disasters. The services
should be available and accessible to the mostvulnerable and excluded adolescents and young
people, including but not limited to migrants,
those from ethnic minorities and indigenous
groups, those living with disabilities and those
identifying as lesbian, gay, bisexual,
transgender, intersex, questioning. 129➢

SRHR services should be linked withinterventions to end violence against girls andwomen.

➢

It is important that health services are available
and accessible to everyone, regardless of age or
marital status.130 Services should respectprivacy and confidentiality. They should be freeof requirements for judicial, spousal, parental or
guardian consent.

➢

We believe well-trained and supported healthpersonnel are critical to delivering quality,
gender-responsive adolescent- and youthfriendly services. A dedicated health budget forthese services is essential so that user fees andexpenses can be reduced or eliminated, making
them accessible and affordable to alladolescents and young people.

➢

In order to ensure that services are fit-forpurpose and meet the needs of adolescents andyoung people, there needs to be a greater focus➢➢

Governments need to ensure equitable accessto quality, affordable, gender-responsive,
adolescent- and youth-friendly sexual andreproductive health services for all adolescentsand young people, including those engaged in
prostitution, free of discrimination, violence or
coercion and regardless of marital status.
Services should be provided in a nonjudgemental, respectful way, guaranteeing
privacy and confidentiality. Services should be
provided in accordance with the evolving
capacities of the person in question and free ofany requirements for parental, spousal,
guardian or judicial consent.
Governments should take all necessary
measures to strengthen health systems
including by training healthcare providers. They
should ensure the delivery of sexual andreproductive health services closer tounderserved areas, especially in rural, remote
and impoverished urban areas.
Governments should ensure that the training ofhealth workers is gender-responsive andaddresses judgemental attitudes towards
adolescents and young people and theirsexuality, and in particular towards girls andyoung women.
Governments should ensure that national
strategies and plans to address sexual andreproductive health issues employ acoordinated, multi-sector approach, including
other relevant sectors such as education, justiceand child protection services to ensure thatcross-cutting issues are addressed in acomprehensive way.
Governments need to ensure systematic,
reliable and high quality data collection on
SRHR to inform service delivery and publicawareness. Data should be disaggregated byincome, gender, age, race, ethnicity, migratory
status, disability and geographic location, in linewith the commitments under the 2030
Agenda.132 Plan International further calls on
governments to also disaggregate datacollection by gender identity and sexual
orientation (with due protections for privacy andhuman rights) as these factors will be
particularly important in the context of
improving SRHR services for all.
Governments and other service providers needto develop strategies and programmes for
implementing SRHR services in consultation
with adolescents and young people, particularly
girls and young women. They should bemeaningfully engaged in the implementation,
monitoring and evaluation as well as policy
formulation.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 17

Menstruation

Plan International’s position:

Menstruation is the bleeding (also known as a period)that occurs in girls and women as part of the monthly
menstrual cycle. Menstruation can last, on average, forbetween three and five days a month.133 The first time agirl has a period is often seen as marking the onset ofpuberty, and this typically occurs between the ages ofeight and 15, although this varies greatly. If not properly
managed, menstruation can interrupt daily life. For
example, many girls and women, especially adolescent
girls, experience extremely painful periods which cannegatively affect their attendance and performance atschool.134➢

Plan International believes that the taboo natureof menstruation and sensitivity arounddiscussing this with girls at home, in school andmore broadly within society reinforces andperpetuates gender inequality. All girls andyoung women should have access to separateand hygienic sanitary facilities in all public
spaces, especially in schools, as this is criticalto ensure their attendance. They should also
have access to accurate information about
menstruation and to clean sanitary equipment.

➢

We believe that public and private water,
sanitation and hygiene service providers should
consult with girls and young women to ensure
facilities meet their needs, and to enable them topractise good menstrual hygiene management.

➢

We will work with others to contribute tostrengthening knowledge on the impact ofsocial and cultural norms around menstruationand poor menstrual hygiene management.

Menstruation is linked to girls’ and young women’sdignity and has a tremendous impact on their access to
education and performance in school, as girls will often
miss days when they are menstruating. For example, 95
per cent of girls in Ghana sometimes miss school when
they are menstruating.135 The reasons for missing school
can vary – it can be due to a lack of adequate facilities
and materials; because girls’ movements are restricted
during their period; or because they feel ashamed or“unclean”.
Myths, misconceptions and social norms restrict girls’
choices and their participation in society at the time of
their period. For example, 67 per cent of girls from Nepal
are not allowed to attend religious functions, while 28 percent are not allowed to sleep near their family
members.136 Girls and women are often expected torefrain from certain normal activities, such as bathing or
cooking.137 In fact, 51 per cent of girls in Iran do not takea bath for eight days after the onset of their period.138
These restrictions and negative attitudes towards
menstruation have a negative effect on girls’ selfesteem. For example, 90 per cent of girls in rural areasof Ghana felt ashamed during their period.
Restrictions on girls’ and women’s activities during thetime of their period are often imposed on the basis ofbeliefs that certain activities have negative
consequences for either the girls or women themselves
or for their immediate environment.139 For example, in
Bangladesh, women and girls bury their cloths to prevent
them from being used by evil spirits.140 Lack of accurate
information about menstruation can leave girls feelingscared when they first start their period, and somebelieve that menstruation is a disease.141 Girls andyoung women taking part in the youth consultation
workshop in Bangladesh also revealed several
challenges they face in relation to menstruation. A lackof information was highlighted as one of the main
obstacles, as girls are often left with only a brief,
sometimes inaccurate explanation about what happens
to their bodies.
Menstrual hygiene management (MHM) is a significant
concern. According to a conservative estimate, around
500 million girls and women lack access to adequate
facilities for MHM.142 Positive MHM requires a minimum
level of knowledge and awareness on how to manage
menstruation effectively and hygienically, while having
access to facilities to wash or dispose of used sanitarymaterials in appropriate ways.143 In addition, MHM mustalso address societal beliefs and taboos surrounding
menstruation. MHM is linked to the broader issue of
adequate and equitable access to safe water, sanitationand hygiene, which is addressed in Goal 6 of the
Sustainable Development Goals.144

Recommendations for addressing issues
related to menstruation:➢

Governments should ensure the availability ofseparate sanitary facilities particularly withregard to MHM for girls and young women in all
schools and public spaces.

➢

Ministries for health and sanitation should
ensure that all public sanitation facilities haveseparate facilities for females and males andinclude adequate facilities for MHM.

➢

Ministries of education should ensure thatnational curricula include education about
menstruation for both boys and girls as part ofcomprehensive sexuality education and also
include information about good MHM for girls.

➢

Partnerships are needed between the private
sector and civil society organisations and/or
governments in order to ensure that materials
for MHM are easily available and affordable forall girls and young women.

➢

Parents, caregivers and traditional and religious
leaders should receive scientifically correct
information in order to break down taboos andmisconceptions around menstruation.

Adolescent pregnancy
Each year, approximately 19 per cent of girls indeveloping countries become pregnant before the age of18145 and an estimated 2.5 million births occur among
girls aged 12 to 15 in developing countries,146 with thehighest rates in sub-Saharan Africa. However, by 2020,
the rate of adolescent fertility in Latin America ispredicted to surpass that of sub-Saharan Africa, tobecome the highest in the world.147 Currently, one-thirdof pregnancies in Latin America occur among girls aged
below 18 with almost 20 per cent among girls under theage of 15.148
The causes of adolescent pregnancy include a lack of
information and education as well as inadequate accessto services for adolescents and young people. Societal
expectations on girls to become mothers early can also
be a cause.149 Sexual violence is another driver,Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 18

particularly where there are significant age and power
gaps within couples (this is particularly prevalent in thecase of girls aged below 15).150
However, broader forms of gender-based violence
including psychological and economic violence havealso been linked to adolescent pregnancy.151
There is also a strong correlation between child, earlyand forced marriage and adolescent pregnancy.152
Approximately 90 per cent of births to adolescentmothers in developing countries occur within
marriage.153 However, this number varies acrossregions, with lower numbers of births to marriedadolescent girls occurring in Eastern and Southern
Africa as well as in South America.154 The highest
number of births to married adolescent girls can befound in Western Asia and Northern Africa, where 99 percent of all births to adolescents occurred within
marriage.155 Many married girls have no access tocontraception, have little power in the relationship andare often under pressure to prove their fertility shortly
after becoming married. Equally, in many societies,
those who become pregnant when unmarried comeunder pressure to marry early to avoid the stigma
attached to having a child out of wedlock. This is often
the case in Latin America, where child, early and forced
marriage often follows an unintended pregnancy.
Socio-economic factors such as the characteristics ofthe household, the parents’ income and educational
level also have a bearing on the likelihood of earlymotherhood. Adolescent girls and young women who
have a low educational level are five times more likely to
become a mother than those with higher levels of formal
education.156 At the same time, girls and young women
who become pregnant or who are married may be forced
to leave school due to policies in place or because of thestigma they face. In most countries, adolescent births
are concentrated among poorer, less educated girls andyoung women, thereby further compounding
disadvantage by disrupting school attendance andlimiting future livelihood opportunities.157 However,contextual factors such as a lack of access tocomprehensive sexuality education and to modern
methods of contraception are also contributing factors.158
About half (49 per cent) of pregnancies among
adolescents aged 15 to 19 in developing countries areunintended and more than half of these end in induced
abortion.159 In more than two-thirds of cases, theabortion occurs in countries where it is prohibited or
highly restricted.160 In these cases, adolescents typicallyresort to clandestine procedures that are often unsafe –performed by persons lacking the necessary skills or inan environment lacking minimum medical standards, orboth.161
Complications related to pregnancy and childbirth are
the second leading cause of death for girls aged 15 to
19.162 The risk of dying during pregnancy, childbirth or
postpartum is doubled for girls who become pregnant
before the age of 15.163 Physical and sexual violenceagainst girls and women during pregnancy is also linked
to higher levels of maternal mortality and induced
abortion.164 In order to meet the Sustainable
Development Goals target 3.1 of reducing the global
maternal mortality ratio to less than 70 per 100,000 live
births, efforts to tackle this issue need to be accelerated
almost three-fold.165
Girls and adolescents face increased health risks andare more seriously affected by complications relating topregnancy and childbirth than older women, in part
because they may be undernourished and may not havecompleted physical development; and in part because
they are more likely to live in disadvantaged
circumstances.166 However, context can vary greatly
both between and within countries.
Inadequate health services such as the lack ofemergency obstetric care services, low rates of skilledattendance at delivery and the persistent denial ofsexual and reproductive rights in many countries also
contribute to maternal mortality. Even where services
exist, judgemental attitudes of some service providers
and requirements for judicial, parental, spousal or
guardian consent can result in girls and young womenbeing reluctant to make use of the services on offer.167
A lack of access to adequate services can lead toserious health problems for adolescents who give birth.
For example, up to 65 per cent of women with obstetricfistula develop this as adolescents.168 This serious injury
is caused by prolonged and obstructed labour without
access to emergency obstetric care. Adolescents are atparticular risk of obstructed labour and, as a result, ofdeveloping obstetric fistula, since their bodies are notphysically mature.169 Obstetric fistula is a hole between
the birth canal and bladder or rectum, which leaves girls
and women constantly leaking urine, faeces or both.
This in turn often leads to chronic medical problems,social isolation and deepening poverty.
It is estimated that more than 2 million young women livewith untreated obstetric fistula in Asia and sub-SaharanAfrica.170 Between 50,000 and 100,000 girls and women

Plan International Togo – addressing early pregnancy and sexual violence
Plan International Togo is implementing an early pregnancy prevention project which aims to reinforce both communities’ andgirls’ capacities in fighting early, unwanted pregnancy and other sexual violence against girls. With Plan International’s support,
the implementation communities developed “Community charters for education and child protection.” These charters containcommitments that each community has given itself to ensure children’s schooling and to protect girls against sexual violenceand early pregnancy. These commitments are accompanied by sanctions that the community applies to persons who areperpetrators of abuse against girls.
The charters use the Community Based Child Protection Mechanisms (CBCPM) approach that Plan International is putting inplace progressively in the West Africa Region. The CBCPM includes complaints procedures and referral mechanisms from thecommunity level up to national, public authorities.
The girls themselves are also equipped with life skills training to help them set their own life objectives, and to give them thevoice, confidence and agency to discuss issues of concern with boys and their parents.
The system is helping to reduce the number of unwanted, early pregnancies within the implementation area.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 19are estimated to develop the condition every year.171
However, obstetric fistula is almost entirely preventableby delaying the age of childbearing, ending harmful
practices such as female genital mutilation/cutting andensuring that all girls and women have access to timely
and high quality obstetric care.172 The condition often
affects the most vulnerable and excluded girls andwomen – those who are young, poor and who live inremote and rural areas.173

Plan International’s position:➢

Plan International is committed to tacklingadolescent pregnancy, particularly pregnancy inyounger adolescents, and to supporting
adolescent mothers. We recognise thatadolescent pregnancy is a major contributor tomaternal mortality and morbidity, which are
grave violations of girls’ rights.

Adolescent pregnancy is not only associated withserious health risks for the young mother but also for her
baby. The younger the mother, the greater the risk to thebaby.174 Stillbirths and deaths in the first week of life are
50 per cent higher among babies born to mothers who
are aged 19 or younger, compared to mothers aged
between 20 and 29.175➢

We believe that early unintended and unwanted
adolescent pregnancy can and should be
prevented. This requires challenging gender
discriminatory norms and ending sexual
violence against girls; strengthening girls’
agency and ability to make autonomous andinformed decisions about their reproductive
health; ensuring the provision of comprehensive
sexuality education and ensuring that healthsystems and services meet the specific needs ofadolescents (in line with the Convention on the
Rights of the Child (CRC) General Comment No.
15, paragraph 56).

➢

Education can be a powerful tool for delaying
adolescent pregnancy and early childbirth. We
also recognise that adolescent pregnancy canbe a driver for, or a consequence of child, earlyand forced marriage. This is particularly
important for countries and regions that are
projected to experience rising rates ofadolescent pregnancy, such as Latin America.

➢

Plan International believes that all girls andyoung women have the right to access quality
maternal health and obstetric care services.
Health budgets must include adequate
resourcing for their provision including
emergency obstetric care and treatment offistula.

Premature birth and low birth weight are also morecommon among babies born to young mothers. This is inturn linked to higher risk of intellectual, language andsocio-emotional delays.176 Infants born to adolescents
face a 50 to 100 per cent higher risk of death during thefirst month of life.177
Maternal under-nutrition is also a risk factor for low birthweight, premature birth and increased child mortality,
contributing to an estimated 800,000 neonatal deaths ayear.178 Adolescent mothers are more likely to beundernourished, as scarcity of food has adisproportionate impact on pregnant and lactating girls.
Girls often face discrimination within families, which
contributes to their malnutrition,179 but are also
physiologically prone to vitamin and iron deficiencies.
Early pregnancy can exacerbate the cycle ofmalnutrition.
Increases in pregnancy rates are also common after
disasters, which can be attributed to a number ofcauses, including the desire to compensate for the lossof a child; a lack of access to information or to methodsof contraception and an increase in sexual violence.180
Risks for pregnant girls are particularly acute inhumanitarian contexts when antenatal and obstetric careinfrastructure and services may be destroyed, damaged
or disrupted.181 Without access to these services, many
women and girls give birth without access to basic
emergency obstetric and new-born care and are at
greater risk of infection, miscarriage, premature delivery,
stillbirths, unsafe abortions, severe long-term morbidity
and mortality, such as obstetric fistula, and death. Threein five maternal deaths and 45 per cent of neonatal
deaths occur in conflict, displacement and disastersituations.182
In addition, the tendency to focus on adolescentmaternity with little regard to the issue of adolescentpaternity results in limited knowledge and information
about young men as partners and fathers.183 It also
reproduces the idea that pregnancy is solely an issue forgirls and women.184
Currently, efforts and resources invested in theprevention of adolescent pregnancy often focus onadolescent girls aged 15 to 19 years. However, the mostvulnerable girls, and those with a higher risk ofcomplications related to pregnancy and childbirth arethose aged 14 or younger. They are often overlooked innational and global statistics and development
interventions. Further research is needed to provide amore holistic response to the issue.

Recommendations for addressing issues
related to adolescent pregnancy:➢ Governments with other development actors

should develop and implement strategies toprevent adolescent pregnancy. This should
include access to contraceptives and quality
safe education including comprehensive
sexuality education, for adolescents and young
people.

➢Governments, UN bodies and civil society
organisations should work with research andnational statistics institutions to increase thecollection of data and knowledge that can
inform policies and programmatic interventions,in particular for 10 to 14 year olds.

➢

Governments should implement all necessary
measures to ban and eliminate the practice ofchild, early and forced marriage, which often
leads to early pregnancies.

➢

Governments should take all necessary
measures to support pregnant girls and young
mothers of all ages to continue and complete
their education. Governments should develop
retention strategies and life skills programmes
for pregnant girls and young mothers, including
married girls, through targeted outreach andsupport programmes, initiating evening or parttime formal schooling and vocational training

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 20

opportunities, and following up with students
who drop out of school.
➢

Governments should prohibit discriminatory
practices such as mandatory pregnancy testingof girls, discrimination based on adolescentpregnancy, and expulsion of pregnant girls fromschool.

Contraception
The right to the highest attainable standard of healthincludes the right to access information and services. As
the world’s population of 15 to 19 year olds grows
beyond 600 million, countries face an increasing
demand for information about and access tocontraceptive services (including emergency
contraception) from this demographic.185 Younger
adolescents are often missed in statistics yet may also
require access to contraceptive services, particularly
where they are sexually active, married or victims ofsexual violence.
At present, 38 million girls and young women aged 15 to
19 in developing countries need contraception because
they are sexually active, but do not want a child for atleast two years.186 However, 60 per cent of these girls
and young women – that is, 23 million – are not using amodern contraception method. Of these, the vast
majority (84 per cent) are not using any contraception atall, while the remainder use traditional methods, which
are less effective than modern methods.187 Althoughyounger adolescents (aged 10 to 14) are also a criticaldemographic, far less information is available for thisage group as they are usually excluded from national
surveys.
In Africa and Asia, more than two-thirds (68 per cent and69 per cent, respectively) of sexually active adolescents(aged 15 to 19) who want to avoid pregnancy experiencean unmet need for contraception,188 as they want toprevent or delay pregnancy but do not have access tocontraception. In Latin America and the Caribbean, theproportion of adolescents who have an unmet need is 36
per cent.189
In Africa, unmet need is highest among marriedadolescents (aged 15 to 19)190 whereas in Asia, thesituation is the opposite with a higher unmet needamong unmarried adolescents (aged 15 to 19), due tothe social stigma attached to unmarried sexual activity
and pregnancy out of wedlock.191 For Latin America andthe Caribbean, unmet need is similar among bothmarried and unmarried adolescents (aged 15 to 19).192

In a youth consultation workshop held in Uganda, it was
concluded that none of the participants felt they wereable to freely access modern contraception if theyneeded to. A young man, aged 22, said:“A Village Health Team ‘denied’ young people condoms– when you go to them, they keep telling you ‘cometomorrow’, you go back the following day, they again say‘come tomorrow’. Tomorrow becomes tomorrow until you
give up.”

Adolescent girls and young women’s reasons for notusing contraception include having infrequent sex, notbeing married, concerns about side effects, breastfeeding, not having resumed menstruation after a birth,and their or their partner’s opposition to the use ofcontraception.193 In addition, many have insufficientknowledge on correct use of methods of birth control
pills. Another concern for many children and young
people is the lack of confidentiality and privacy194 andrequirements for parental, guardian, judicial or spousal
consent to access contraception services.
The limited range of contraceptive options available also
deters adolescents and young people from using theservices on offer. Nevertheless, barrier methods remain
crucial for preventing sexually transmitted infections,
including HIV.
Gender norms and lack of agency as well as power tonegotiate with male partners remains a challenge forgirls and young women when trying to use
contraception. Women, both married and unmarried,
report that the attitudes of their partners constitute thesingle largest barrier to consistent use ofcontraceptives.195
Financial and logistical barriers present a real obstacle
given that adolescents and young people are unlikely tohave control over financial resources to pay for theservices or the transport needed to get there.196 Legaland policy barriers can also impede access, for example
where they prohibit access to contraceptives foradolescents and unmarried young people. Only 49 out of
the 93 countries providing information to World HealthOrganisation have laws and regulations that allow youngadolescents to obtain contraceptives without parental or
spousal consent.197 A lack of knowledge about the legal
rights of adolescents to obtain contraception can also
hinder access198 and issues of availability of supplies
can also pose problems even where services areavailable.

Plan International Brazil – Sexual and Reproductive Rights Passbook
In Brazil, Plan International is implementing an Educational Strategy around the Carnival time with innovativeeducational materials that promote sexual and reproductive health. It has a peer-to-peer youth model focused aroundstreets and communities. The passbook includes sexual and reproductive rights information relating to methods ofcontraception as well as health information. It also includes guidance on timeframes for vaccinations, pills and themenstrual cycle. The passbook is tailored according to gender and the package includes a female and male condom.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 21

Young people participating in a workshop in El Salvador
felt that access to contraceptive information and services
was limited due to their age. According to theparticipants, adolescents younger than 18 have a lesser
chance of accessing modern contraceptive methods.
While the participants said that there had been some
progress, they recognised that overall the access tocontraceptives is limited because of taboos and the
misguided belief that contraception can be equated withabortion.

However, increased use of contraceptives could have ahuge impact in terms of preventing unwanted andunintended199 pregnancies, saving lives and improving
health.200 If all adolescents and young women who want
to use modern contraception were able to access it, this
could reduce unwanted pregnancies by 6 million a year
(59 per cent), with 3.2 million fewer abortions (57 percent), of which 2.4 million would have been unsafe.201 In
addition, maternal deaths due to complications ofpregnancy and childbearing for those aged 15 to 19
would drop from 17,000 per year to 11,500, with mostdeaths averted in Africa (4,800).202 This would also
spare girls, young women and their families the adverse
consequences of early childbearing, save considerable
costs in terms of maternal and child healthcare in
addition to improving the educational and economic
prospects of girls and young women.203 In humanitariansettings, family planning is also a sound investment witheach $1 spent on contraceptive services saving between$1.70 and $4 in maternal and new-born healthcare
costs.204
The need for contraceptive information and services
includes the need to access emergency contraception.
This is a type of contraception that is used to avoid
pregnancy after a single act of unprotected sexualintercourse (due to lack of use or failure of acontraceptive). Emergency contraceptive pills prevent
ovulation, fertilisation, and/or implantation. However,they are not effective once the process of implantation
has begun and will not cause abortion.205
Two major initiatives, Family Planning 2020 and theUN’s Global Strategy for Women’s, Children’s andAdolescents’ Health, are pushing for girls’ and women’scontraceptive need to be met.206 These initiatives also
help to advance the 2030 Agenda, in particular, Goals 3,
4 and 5, which call for improved health and educationand for gender equality and which depend on asignificant improvement in the lives and health ofadolescent girls and women.207 However, while
Sustainable Development Goals targets 3.7 and 5.6
seek to improve information about and access tocontraception, the indicators that will measure progressagainst these targets will focus solely on girls andwomen aged 15 to 49. As such, younger adolescents willcontinue to be overlooked.

Plan International’s position:➢

Plan International believes that all sexuallyactive adolescents, including younger
adolescents, and young people with an unmet
need for family planning should be able toaccess modern contraception. In line with theCommittee on Economic, Social and Cultural
Rights General Comment No. 14, contraceptive
services should be provided free of
discrimination, stigma and coercion, and free of
spousal, parental, guardian or judicial consent,

and in accordance with the evolving capacitiesof the person in question.
➢

Plan International agrees with Committee on the
Rights of the Child General Comment No. 4 thatadolescents should have access to informationand services regarding contraceptives andfamily planning.

Recommendations for improving access tocontraception:➢

Governments should take the necessary
measures to provide a full range of affordable,safe, reliable and good quality modern
contraceptive services, including counsellingand emergency contraception, to meet theneeds of all adolescents and young people,
paying specific attention to girls and young
women.

➢

Contraceptive information and services should
be provided in a non-judgemental way, withrespect for privacy and confidentiality and freeof discrimination, stigma and coercion andregardless of marital status. Information andservices should be provided in accordance withthe evolving capacities of the person in question
and free of any requirements for parental,
guardian, spousal or judicial consent.

➢

Governments should develop costed andbudgeted national action plans on increasing
access to contraceptive services, with a special
focus on populations with an unmet need forcontraception.

➢

Governments, UN bodies and civil society
organisations should work with traditional,
community and religious leaders and parents tochange negative attitudes towards use ofcontraception.

➢

Boys and men should be actively involved in theuse of contraception. They should be
encouraged to participate in decisions about
using contraception as well as actively engagedin efforts to raise awareness of the positive
impacts of using contraception to delay
pregnancy and prevent sexually transmitted
infections.

Access to safe abortion
Unsafe abortion is a preventable cause of death and illhealth among girls and women around the world and isoften a reflection of the denial of their fundamental
human rights. In particular, the right to health isundermined by lack of access to safe abortion.208
The UN Human Rights Committee concludes that
restricting legal access to safe abortion has the effect ofsubjecting girls and women to cruel, inhumane anddegrading treatment.209
The International Conference on Population andDevelopment has spelled out that all reproductive rights
rest on the recognition of the basic right of all couples
and individuals to decide freely and responsibly the
number, spacing and timing of their children.
High levels of unmet need for contraception help to
explain the prevalence of abortion.210 Most women who
undergo abortion do so because they become pregnant

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 22

when they did not intend to. Eighty-one per cent of
unintended pregnancies in developing countries occur
among women who have an unmet need for modern
contraception.211
Globally, some 56 million girls and women undergo
abortions each year.212 The proportion of abortions thatare performed under unsafe conditions is unknown, but
complications from unsafe abortions are common indeveloping regions, where the procedure is often highly
restricted. Estimates indicate that 6.9 million women indeveloping regions were treated for complications fromunsafe abortions in 2012.213 Recent figures also suggestthat approximately 40 per cent of women who
experience complications from unsafe abortion neverreceive treatment.214
Adolescents tend to delay obtaining an abortion andwhen they do, frequently resort to informal and unskilledproviders, leading to a higher rate of complications.215
Self-induced abortion is also common among
adolescents in many countries.216
The most common complications from unsafe abortion
are incomplete abortion, excessive blood loss andinfection. Recent studies also estimate that between 8
and 18 per cent of maternal deaths worldwide are due tounsafe abortion, with almost all abortion-related deaths
occurring in developing countries, the highest number
being in Africa.217 In 2014 the number of abortion-related
deaths is estimated to be in the range of 22,500 to
44,000.218 Other less common consequences include
septic shock, perforation of internal organs andinflammation of the peritoneum.219 However the impactof unsafe abortion extends beyond the immediate healthconsequences. Girls and women who have sufferedcomplications from an unsafe abortion may also see a
reduction in their economic productivity where theadverse health consequences impact on their ability towork, increasing the economic burden on poorfamilies.220
Recent figures estimate that 97 per cent of women aged
15 to 44 in Latin America and the Caribbean live incountries with restrictive abortion laws.221 This figure is
90 per cent for women of the same age range in
Africa.222 This is in spite of the large number of Africancountries that have ratified the Protocol to the African
Charter on the Rights of Women in Africa (the ‘Maputo
Protocol’), which provides for comprehensive access to
reproductive healthcare, including safe abortion.
World Health Organisation analysis of abortion laws
globally223 shows that:

•
•

•
•
•

95 per cent of all countries allow abortion to be
performed if a woman’s life is threatened;224
67 per cent and 64 per cent of countries
respectively allow women to seek abortion topreserve their physical health and to preserve theirmental health;
51 per cent of all countries permit abortion in thecase of rape and incest;
50 per cent of countries allow abortion upon
diagnosis of foetal impairment;
30 per cent of countries allow abortion upon requestof the pregnant woman.

However, the likelihood of a woman having an abortion
for an unintended pregnancy is about the same
regardless of the legal status of abortion.225 World
Health Organisation notes that: “Legal restrictions do not
result in fewer abortions, nor do they result in significant

increases in birth rates. However, a lack of legal accessto abortion services is likely to increase the number ofwomen seeking illegal and unsafe abortions, leading toincreased morbidity and mortality. Legal restrictions leadmany women to seek services from unskilled providers
or under unhygienic conditions, exposing them to asignificant risk of death or disability”.226 The evidence
demonstrates that laws and policies facilitating access tosafe abortion reduce maternal mortality due to unsafe
abortion.
Not only does the lack of access to safe, legal abortion
services put girls’ and women’s lives in danger, it
undermines their right to make decisions concerning
childbearing.227 In addition, laws that persecute girls andwomen who seek and/or obtain an abortion in countries
where it is illegal, fail to address the underlying societal
and public health issues affecting many of these girls
and women in the first place.228 Such laws lead girls andwomen to rely on less safe methods of abortion without
access to medical guidance.229 Girls and women from
low-income settings are particularly exposed to the many
legal barriers to safe abortion care, as well as to barriers
to other medical and social support for pregnancy andmiscarriage. In addition, they are also most vulnerable tobeing targets of prosecution and imprisonment.230
The UN Human Rights Committee recommended that
restrictive laws that only permit abortion where themother’s life is in danger should be reformed to allow“effective, timely and accessible procedures for
pregnancy termination”.231
To reduce the high levels of morbidity and mortality that
result from unsafe abortion, the provision of postabortion care needs to be improved and expanded.232
Particular attention needs to be paid to poor and rural
girls and women who tend to depend on unsafe methodsof abortion and on untrained providers.233
Treating medical complications from unsafe abortion
places a considerable financial burden on public healthcare systems and on girls and women and their families
in developing regions. According to estimates for 2014,
the annual cost of providing post-abortion care indeveloping countries was US$232 million. However, thisnumber does not reflect the true scale of the problem as
many girls and women are not receiving treatment – if all
those who needed treatment received it, the actual cost
would be approximately US$562 million.234
Sex-selective abortion is particularly prevalent in certain
parts of the world (for example, India, China). At least
117 million girls are “missing” across the world largely
due to sex-selection in favour of boys. This practice is a
symptom of pervasive injustices against girls andwomen, and reinforces deeply embedded genderinequality in society.

Young people participating in a workshop in El Salvador
were asked what they thought would be the mostimportant issue for Plan International to address in thisposition paper.
“Abortion”; the promotion of “an open debate on the rightto voluntarily interrupt an unwanted pregnancy”; and a
debate on “decriminalising abortion, with an emphasison having autonomy over your own body” were theanswers from three young women, aged 20, 22 and 24.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 23

Plan International’s position:➢➢➢

In line with the Committee on the Elimination of
all Forms of Discrimination against Women,235
Plan International recognises reproductive
rights to include the right of girls and women to
make autonomous decisions about their health.
Denying girls and women access to safe
abortion services prevents them from exercising
this right. Plan International does not provide
medical health services.

Irrespective of the legal status of abortion in the
country, Plan International calls on governments
to ensure the availability of quality post-abortion
care that meets World Health Organisation
guidelines, comprehensive information andservices on quality family planning andcontraception (including emergency
contraception) and psychosocial counsellingand support.

➢

Governments should make every attempt toreduce the need for abortion by ensuring timely,
confidential and affordable access to goodquality modern methods of contraception,
including emergency contraception and maleand female condoms, as well as counselling to
all persons in need, regardless of age andmarital status; and they should support
provision of information about prevention ofpregnancy and contraception through civilsociety groups, community outreach, andschool and youth programmes.

➢

We believe that the provision of services forsafe abortion should be available and accessible
to all girls and women.

➢

Where abortion is legal, the provision ofservices should be within the fullest extent of
the legal framework of the country.

➢

In countries where abortion is illegal or
restricted we recognise that girls and women
will still undergo unsafe abortions. In suchcountries, we take the stand that girls andwomen who seek or obtain abortions should
neither be prosecuted nor penalised.

➢➢

Plan International acknowledges that unsafe
abortion is a preventable cause of death and illhealth of girls and women across the world andoften a consequence of violations of girls’ andwomen’s fundamental human rights. The right tohealth and gender equality are advanced byaccess to safe and legal abortion.
Irrespective of the legal status of abortion, Plan
International believes that quality post-abortion
care as well as psychosocial counselling andsupport for all girls and women should beaccessible.

Recommendations for improving access tosafe abortion:➢➢➢

counselling about their options including
information about reducing harm from unsafe
abortion and accessing treatment for
subsequent complications.

Plan International believes that abortions shouldbe rare and that priority should be given to
avoiding unintended pregnancy, through theprovision of comprehensive sexuality education
including accurate information oncontraceptives as well as access to quality
contraceptive services (including emergency
contraception) for all girls and women.

In countries where abortion is legal or
decriminalised, governments should ensure thatgirls and women who wish to have an abortion
have access to safe, quality and affordable
abortion services to the fullest extent of the law,free of any requirements for judicial, parental or
spousal consent, and that healthcare
professionals provide accurate, nonjudgemental information on obtaining safe
abortion services.
In countries where abortion is currently
criminalised or highly restricted within the law,
governments should ensure the nonprosecution and non-penalisation of girls andwomen who want to access safe abortion
services or who have had an abortion.
Furthermore, in all countries, governments
should ensure that girls and young women areprovided with accurate information andHIV and AIDS
Sexual transmitted infections, including HIV and AIDS, in
general disproportionately affect adolescent girls andyoung women. Younger adolescents are also
increasingly affected and improving awareness andknowledge of sexually transmitted infections and how toprevent them should be part of all sexual healtheducation and services.236
Key populations are particularly vulnerable to acquiringHIV. This includes gay and bisexual men and boys,
transgender people, people who inject drugs, and people
who work in prostitution.237 Recent data from UNAIDS
suggest that 90 per cent of all new HIV infections inCentral Asia, Europe, North America, the Middle Eastand North Africa in 2014 were from these key
populations.238 In contrast, in sub-Saharan Africa, key
populations accounted for more than 20 per cent of new
infections, whilst the majority of new infections occurred
within the rest of the population.239 In Asia, data from2014 show that 95 per cent of young people aged 15 to
24 diagnosed with HIV are from at least one of these key
vulnerable populations.240
The Committee on the Rights of the Child241 has clarified
that adolescents have a right to information about HIV
and AIDS and that States should not withhold, censor or
intentionally misrepresent health information, including
sexuality education.242
While there has been a decline globally in the rate of
new HIV infections,243 the number of girls and women
living with HIV has increased significantly in recent
years. Gender inequality and intimate partner violence
prevents many girls and women, from protecting
themselves against HIV.244 Adolescent girls made up
two-thirds of the 250,000 adolescents who contracted
HIV in 2013.245
Approximately 80 per cent of women living with HIV arein sub-Saharan Africa, with 9 per cent in South andSouth-East Asia, 3 per cent in Latin America and 3 percent in Eastern Europe and Central Asia.246

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 24

In addition, while the prevention of mother-to-child HIV
transmission in pregnant women living with HIV has now
reached 62 per cent, there are significant variations incoverage within and across countries.247 Of the 125
million women who give birth each year, 1.5 million areliving with HIV, more than one-third of whom are notreceiving the antiretroviral care they need to prevent
transmission of the virus to their new-born babies and toprotect their own health.248

access to scientifically accurate information andto male and female condoms, and on developing
and ensuring access to accurate, affordable andrapid diagnostic tests and treatment, particularly
for use in low-resource and remote settings.
➢

All children, adolescents and young people,
regardless of their sex, ethnicity, gender
identity, sexual orientation or disability status
should have equal access to the necessary
health services, treatment and support which
they need, including voluntary and confidential
HIV testing and counselling and access toantiretroviral therapy. Such services shouldhave particular regard for the right to privacy
and confidentiality and be gender-responsive,child-, adolescent- and youth-friendly,
accessible, affordable and non-judgemental.
Services should be free of any requirements forjudicial, parental, guardian or spousal consent.

➢

Governments should ensure that scientificallyaccurate information about HIV and AIDS is
included as part of comprehensive sexuality
education and provided to all children, within
schools. Governments and other service
providers should also ensure that information isavailable to children, adolescents and young
people in out-of-school settings, such as youth
clubs and safe spaces particularly for girls, andon local radio stations to facilitate dialogue on
this issue.

Violence against girls and women is a driver of HIV
infections but being diagnosed with HIV can also lead toincreased vulnerability to violence, due to the stigma
attached to having HIV.249 Such stigma anddiscrimination can also create additional barriers interms of accessing services.250
In humanitarian contexts, risks of HIV infection are often
higher, with an increase in sexual violence, transactionalsex and high-risk behaviour. Yet at the same time, workon HIV prevention is often put on hold.251 For children,
adolescents and young people living with HIV,antiretroviral regimes may be disrupted as drugs may be
unavailable. Nevertheless, humanitarian settings canalso present opportunities for improved care for thoseliving with HIV or for reaching those who had notpreviously been able to access it.252

Plan International’s position:➢➢

In line with the Committee of the Rights of theChild General Comment No. 3 on HIV/AIDS andthe rights of the child,253 Plan International
believes that all children, adolescents andyoung people, including girls and young
women, should have the ability to acquire theknowledge and skills they need to protect
themselves and others from HIV infection.
Plan International strongly emphasises the needto eliminate stigma and discrimination
experienced by HIV-positive children,
adolescents and young people both on an
institutional and community or individual level.
This requires challenging negative social norms
around adolescents’ and young people’s sexual
activity, as well as the provision of scientificallyaccurate information on HIV and AIDS
transmission.

➢

We believe that all children, adolescents andyoung people should have equal access to thenecessary health services, treatment andsupport they need. All services should haveparticular regard for the right to privacy andconfidentiality.254➢

We also recognise that gender inequality is adriver of the rising number of girls and young
women living with HIV and AIDS, and that
effective approaches for prevention, treatment
and care need to be gender-transformative,
empowering girls and young women to havecontrol over their bodies and their lives.

Recommendations for improving access tohealth services and information about HIV
and AIDS:➢

Governments should address the risingincidence of HIV and AIDS for girls and womenas well as other sexually transmitted infections
by focusing on prevention, including wider

Harmful practices
Harmful practices carried out in the name of social,
cultural and religious tradition take place in many
countries across the globe. These practices impact moston children, and on girls in particular, and are intricately
linked to issues of value, power and control.255 They
constitute deep-rooted gender inequality anddiscrimination, are a form of gender-based violence anda violation of human rights.
The international community has agreed to accelerate
efforts to eradicate harmful practices. The 2030 Agenda
for Sustainable Development includes a target toeliminate these practices by 2030, specifically female
genital mutilation/cutting (FGM/C) and child, early andforced marriage (CEFM). In this paper, we focus on twoof the most pervasive harmful practices – female genital
mutilation/cutting and CEFM. Other harmful practices
linked to SRHR include breast flattening; marriage by
abduction/rape; corrective rape; virginity testing;ostracism linked to menstruation; incest and sexual
initiation practices. More research is needed on many ofthese practices in order to develop a better
understanding and response to them.

Female genital mutilation/cutting

At least 200 million girls and women alive today are
estimated to have been subjected to female genital
mutilation/cutting (FGM/C).256 These procedures, which
are typically carried out on young girls, involve partial or
total removal of the external female genitalia, or otherinjury to the female genital organs for non-medical
reasons.257 FGM/C is a violation of the human rights ofgirls and women. It is traumatic and painful andcommonly results in complications both immediate(including infection, haemorrhage, psychological trauma
and even death) and long-term (including chronic pain,

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 25chronic urinary problems, obstetric complications
including fistula and sexual problems).258 FGM/C has no
known health benefits. Although the practice isbecoming less common, owing to population growth thenumber of girls and women actually being cut isincreasing.259 The practice is most common in thewestern, eastern and north-eastern regions of Africa, insome countries in the Middle East and Asia as well as
among migrants from these areas.260 As such, it is an
issue of global concern.
Gender inequality and discriminatory social, cultural andreligious norms relating to girls’ and women’s positionsin the family, community and society underlie harmful
practices such as FGM/C and prevent girls and womenfrom enjoying their human rights.261 In many cases,
parents and perpetrators of FGM/C do not intend tocause girls deliberate harm and believe that suchpractices are necessary to secure the girls’ future andacceptance in the community, to make them viable formarriage or to protect them from violence.262 However,these perceptions and beliefs stem from patriarchal
structures and power relations that drive the control or
suppression of girls’ and women’s sexuality.263 It isbelieved that by mutilating the girl’s genital organs, her
sexuality will be controlled and her virginity before
marriage will be guaranteed.264 Tackling these views andchanging norms and attitudes is critical to eliminating
FGM/C. Research shows that if practising communities
themselves decide to abandon FGM/C, the practice canbe eliminated very quickly.265
In 2012, the United Nations General Assembly adopted
a milestone resolution calling on the international
community to intensify efforts to end the practice of
FGM/C.266 However, current progress is insufficient tokeep up with increasing population growth and there is adanger of FGM/C increasing significantly in the next 15
years if current trends continue.267

Plan International’s position:
➢

➢

➢

➢

Plan International strongly condemns female
genital mutilation/cutting (FGM/C) under all
circumstances. FGM/C is a human rights
violation and needs to be treated as such.
FGM/C is linked to harmful norms and genderstereotypes as well as a perceived need tocontrol female sexuality. Plan International
believes that every girl and woman should havethe autonomy and necessary knowledge to beable to make free and informed decisions about
her body. Local actors need to be supported tochallenge social norms and successful projects
should be scaled up.
Plan International believes that it is important totackle FGM/C both through effective legislation
as well as through awareness-raising about thephysical and mental harm and long-term
adverse impacts that can result from thispractice.
Engaging families, communities and traditionaland religious leaders in changing attitudes andnorms around this harmful practice is crucial toensure that it is no longer perceived to be
acceptable, beneficial or tolerated and is instead
condemned as a human rights violation whichneeds to be eliminated.

➢

Plan International notes that achieving the target
to eliminate FGM included in the 2030 Agenda
for Sustainable Development will require urgent
attention, given current population growth
rates.268

Recommendations for ending FGM/C:➢

Governments should put in place effective
legislation banning FGM/C, including forbidding
the medicalisation of the practice. The bans
must be fully implemented and enforced.

➢

Governments and other development actors
should invest in awareness-raising about girls
as rights holders and about the laws that protect
them from FGM/C. They should support
behaviour change by working with traditional,
community and religious leaders as well as
parents, teachers, girls, boys and community
members, to bring about an end to the practice.

➢

Governments should strengthen the healthsector response to FGM/C, providing
appropriate guidelines, training and support tohealth professionals on how to detect FGM/C
and providing medical care and counselling to
all girls and young women who are living with
FGM/C. Health workers should be penalised if
found to perform FGM/C and should be engaged
as agents of change to address social norms
and attitudes in relation to FGM/C.

➢

Communities should be engaged intransforming social norms and gender roles inorder to address root causes of FGM/C.

Child, early and forced marriage

The practice of child, early and forced marriage269(CEFM) is another example of a deeply concerning
harmful practice which is also a powerful driver of earlychildbearing, maternal mortality and morbidity and ahuman rights violation.270
Across the globe, more than 700 million women alive
today were married before their 18th birthday.271 Morethan one in three – about 250 million – were married
before age 15.272 In spite of considerable efforts to tackle
the issue of CEFM, progress needs to be accelerated
eight-fold in order to meet the Sustainable Development
Goals 5.3 target of ending child marriage by 2030.273
Higher proportions of girls and women marry duringadolescence in Africa (particularly sub-Saharan Africa)
than in Asia, Latin America and the Caribbean.274 Mostof the 25 countries with the highest rates of childmarriage are considered as fragile states or at high riskof natural disaster.275 However, in all those regions,poor, rural girls and women marry younger than those
who are wealthier and living in urban areas.276
CEFM also affects boys, but to a far lesser degree than
girls. Data on the number of boys affected by childmarriage is scarce, but data from 2016 suggests that innine countries, more than 10 per cent of boys are
married before age 18.277 CEFM is driven by issues ofgender inequality and compounds the impact of poverty.
This results in the loss of educational and economic
opportunities for girls and women and limits the powerthat they have in a wider range of matters.
Girls who marry are not only denied their childhood, they
are often socially isolated – cut off from family andfriends and other sources of support.278 Child brides are

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 26

often unable to effectively negotiate safer sex due to thepower imbalance, leaving them vulnerable to sexuallytransmitted infections, including HIV, along with earlypregnancy.279 There is also a strong link between CEFM
and sexual violence.280
The pressure to become pregnant once married can behigh, and child brides typically end up having many
children to care for while still young. In Nepal, forexample, more than one-third of women aged 20 to 24
who married before their 15th birthday had three or morechildren. This compares to only 1 per cent of women
who married as adults having three or more children.
Child brides are also less likely to receive proper medicalcare while pregnant.281
There is evidence that crises can exacerbate theproblem of CEFM, especially in protracted displacement
settings. It is sometimes viewed by families as a meansof protecting the “honour” of young girls, which may be
at risk if food insecurity forces girls to resort to survival ortransactional sex.282 Studies have found that duringcrises the practice of CEFM may be expanded amongfamilies that would not have considered it before, andthreatens even younger girls.283
Birth registration is an essential element in the effective
prevention of child marriage, as it provides girls with
proof of their age.284 However, only half of all children
under the age of five in the developing world have had
their births registered.285

Plan International’s position:286➢

Plan International strongly condemns thepractice of child, early and forced marriage287(CEFM) and calls for the prohibition of thepractice under national and customary law, andfor the full and effective enforcement of theselaws. In line with the CRC General Comment No.
4, Plan International believes that the minimum
age for marriage should be 18 and that thisshould apply equally to both men and women,
regardless of any provisions concerning
parental or judicial consent.

➢

Engaging communities and traditional andreligious leaders, as well as girls and boys
themselves, is critical to changing norms andeliminating this practice.

➢

We recognise that education is a powerful tool
for preventing CEFM. Girls who benefit from aquality education are less likely to marry while
they are still children. Therefore, governments
must ensure all girls, including married girls,
can access and complete primary andsecondary education in line with theircommitments to the 2030 Agenda.

Recommendations for ending CEFM:➢➢

Governments should set a minimum legal age of
18 for marriage for both men and women,
regardless of parental, judicial or religious
consent. This should also override any
conflicting customary or religious provisions
regarding the age of marriage.
When implementing legislation that seeks toeliminate CEFM, governments should also
engage, sensitise and provide relevant training
to judges, including customary judges, as wellas to traditional, community and religious
leaders.

➢

Governments should ensure that support
systems and mechanisms are available to girls
and women who have been married as children
or against their will. This requires a multisystemic response from the local level to thenational level, including legal assistance,
healthcare, psychosocial support andeducational services.

➢

Governments should ensure efficient andeffective linkages with and coordination
between relevant sectors with a child protection
remit, including the health, education andjustice sectors.

➢

Governments should strengthen civil
registration and vital statistics systems in orderto achieve universal birth registration, which
can help protect girls against CEFM byproviding evidence of their age.

➢

Governments and other development actors
should also work with communities, traditionaland religious leaders, girls and women, boys
and men to change attitudes and norms that
accept CEFM.

➢

Governments should invest in raising publicawareness of how CEFM is a violation of the law
and children’s rights, as well as the harmful
consequences of the practice.

Gender-based violence
It is estimated that 120 million girls globally –approximately one in ten – have experienced rape orother sexual coercion.288 For most girls their firstexperience of being sexually victimised occurs between
the ages of 15 and 19,289 but across 15 countries, one infive girls reported this first happening between the agesof 10 and 14. Girls who become pregnant before 18
years also face a heightened risk of experiencing
violence during pregnancy within marriage orpartnership, in comparison with girls who get pregnant
after 18 years.
However, data also indicates that the proportion ofadolescent girls who have experienced sexual violence
varies widely. One study of 40 countries found that 22
per cent of adolescent girls in Cameroon had
experienced sexual violence, while there were noreported cases in Kyrgyzstan.290 Comparable data on
forced sexual intercourse and other forced sexual acts
among boys are only available for four countries: Bolivia,
Cameroon, Mozambique and Uganda. In Mozambiquefor example, adolescent girls were three times as likely
as adolescent boys to have reported experiences ofsexual violence.291 Likewise, in Uganda, adolescentboys were nearly two times less likely than their female
counterparts to have reported forced sexual intercourse
or other forced sexual acts.292
Lesbian, gay, bisexual, transgender, intersex,
questioning children, adolescents and youth are often
targeted as a result of their sexual orientation or identity.
One study conducted in Thailand found that 56 per centof self-identified lesbian, gay, bisexual and transgenderstudents had been bullied within the past month.293
Among them, 31 per cent experienced physical abuse,
29 per cent verbal abuse, 36 per cent social abuse and24 per cent sexual abuse.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 27

In a youth consultation workshop in Bangladesh,participants from both genders admitted that boys would
blackmail and threaten girls into doing sexual acts,
sometimes through the use of hidden cameras or
incriminating photos or videos.
Every year, an estimated 246 million children suffer
school-related violence.294 One of the major forms of thisviolence is gender-based sexual violence, including
explicit threats or acts of sexual violence, harassment,
abuse, coercion, exploitation and rape. Research has
shown that girls are more likely to experience sexual
violence in school than boys; it is estimated to haveaffected 150 million girls and 73 million boys under 18
across the world.295 Globally, nearly half of all sexualassaults are committed against girls under the age of
16.296
Evidence strongly suggests that most cases of sexual
violence are perpetrated by someone known to the child,including teachers. While teachers are often key allies inpreventing violence at school, they can also exploit theirauthority and power over their students and pressurise
girls, and boys, to engage in sex for grades or thewaiving of school fees.297 School-related gender-based
sexual violence is a major barrier in the achievement of
global quality education, and a serious violation ofchildren’s rights.
In a youth consultation workshop in Bangladesh, it was
revealed that several participants had experienced
violence. Various scenarios and examples werediscussed, ranging from cases of domestic violence,
where mothers had been tortured and abused by fathers
for failing to produce sons (with children in the family
also abused); sexual harassment such as taunts andmolestation in public places, public transport or even inschools; and girls getting into abusive or exploitative
relationships after their families had failed to provide for
their needs.

Gender-based violence (GBV) disproportionately affects
girls and women because of their subordinate status tomen and boys. World Health Organisation has labelled
violence against girls and women as a “global healthproblem of epidemic proportion.”298 More than one-thirdof all women have reportedly experienced either physicaland/or sexual intimate partner violence or sexual
violence by a non-partner at some point in their lives.299
However, actual numbers may be even higher, as data
can only be collected when survivors of GBV report this.
Due to the shame and stigma that survivors often facewhen coming forward, current global statistics do notreveal the true magnitude of gender-based and sexual
violence.300
GBV is the result of unequal power dynamics anddiscriminatory social and gender norms. It has many
forms and has significant consequences for the physical,
sexual and mental health of girls and young women,301
including a range of sexual and reproductive healthproblems, both short and long term.302 Violence against
girls and women permeates all sections of society and isprevalent in every country in the world. In recognition ofthis, eliminating violence against girls and women is oneof the targets included in the 2030 Agenda.303
While there is some variation in figures, all regions
across the world have unacceptably high rates ofviolence against girls and women.304 The most common
perpetrators of sexual violence against girls and womenare a current or former boyfriend, husband or partner.305
Intimate partner violence causes emotional,
psychological and physical harm, and can ultimately
cause death306 – almost half of female homicide victims
are killed by their intimate partner or by family members,
whereas the rate for men is much lower at 1 in 20.307
The youth consultation workshop in Bangladesh
revealed that while bullying was particularly common
among boys, girls had experienced high levels of sexual
violence, either in public spaces or in their homes.
Girls also face a heightened risk of being subjected toviolence when they are pregnant.308 Data collected from30 countries showed that the prevalence of physicalviolence against pregnant girls ranged from 1 per cent,
up to 17 per cent in Pakistan.309 In six of the countries
studied – Cameroon, the Democratic Republic of Congo,
Equatorial Guinea, Gabon, Haiti and Pakistan – morethan 10 per cent of girls had experienced physicalviolence during pregnancy. In several countries,
including Haiti and Pakistan, the rates of physicalviolence during pregnancy for adolescents were also
found to be substantially higher than those among older
women. In many cases, the violence is perpetrated by
the victim’s partner.
In humanitarian contexts, levels of violence often
increase. Pre-existing forms of sexual violence may be
exacerbated in addition to the emergence of new threats
for girls and women. Sexual violence and the systematic
rape of girls and women is a common occurrence in thecontext of wars and armed conflict310 and theInternational Criminal Court has recognised that it canconstitute a war crime or a crime against humanity.
Sexual violence can have long-term consequences forchildren. A Plan International study in Liberia found thatchildren who had been abused by the fighting forces
during the war had significantly higher rates ofdepressive illness and thoughts of suicide, with most of
those girls having survived multiple and repeatedepisodes of rape and gang rape. They were also
exposed to different forms of violence and brutality, but
the experiences of sexual violence were neverthelessmajor traumatic events in their lives.311
The study in Liberia also found that girls who had
experienced sexual violence were much more likely to
be engaged in transactional sex later in their lives. Other
studies have corroborated this, and shown that a highproportion of women in prostitution suffered sexual
abuse during their childhood.312 Some girls who had
experienced rape reported that they viewed themselves
and their bodies differently and that one method ofprotecting themselves from traumatic memories was totrivialise sexual intercourse and use it for survival andincome.313 Girls and women in prostitution also run avery high risk of being subjected to violence, including
sexual assault and rape.314
Girls are also particularly vulnerable to trafficking. Twoout of three child trafficking victims are girls.315 There
has been a continued increase in the number ofdetected trafficked children, particularly girls under theage of 18, who currently comprise one-fifth of traffickedpersons worldwide.316 Girls who are trafficked are often
exposed to grave human rights abuses, including sexual
exploitation and abuse.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 28

Alarmingly, the majority of girls and women who
experience violence do not seek help or support. There
are various reasons for this though a major barrier is thepersistence of discriminatory attitudes and social norms
that permit GBV against girls and women and lead to it
being viewed as acceptable. Other factors include issues
with the quality of the support services that are available
which often fail to provide respectful, adequate, genderresponsive treatment, as well as concerns about
victimisation and stigmatisation. Other shortcomings
include weak legal frameworks and inadequate
enforcement of laws that can result in impunity for
perpetrators – for example, where the law dictates that aperpetrator will not be punished if he agrees to marry his
victim.317

Plan International’s position:318➢

Plan International believes that all children andyoung people have the fundamental human rightto live free from violence.319➢

We recognise that GBV disproportionately
affects girls and women. The root causes of
GBV are discriminatory social norms andunequal power dynamics between men andwomen. Changing these deep-rooted norms andattitudes that normalise and excuse violenceagainst girls and women is critical to ending
GBV.

➢

We also recognise the critical role that childprotection services can play in preventing abuseand extending assistance to victims.

➢

Plan International stresses the importance of theprovision of care and support to survivors ofviolence, including the provision of safe houses.
Healthcare providers and support services
should respond to GBV in a way that does not
reinforce harmful attitudes.

➢

Protective measures for victims of violence,
including sexual violence and rape, should
include effective mechanisms to ensure care,
support and protection, including access tohealthcare (including emergency contraception),
psychosocial support, access to safe abortion
services and effective means to seek justice andredress.

Recommendations for addressing genderbased violence:➢

Governments should take action – including bypassing and implementing relevant legislation –to eliminate all forms of violence againstchildren and young people, particularly girls andyoung women.

➢

Governments should ensure efficient andeffective linkages with and coordination
between relevant sectors with a child protection
remit, including the health, education andjustice sectors to effectively prevent andrespond to GBV.

➢

Governments should provide universal accessto and gender-responsive critical services for all
survivors of violence. This includes access toappropriate health services, including
emergency contraception and psychosocial
support; legal assistance; confidential reporting

services; and safe houses.
➢

Members of the emergency response system,
police and judiciary at local, regional andnational levels should be required to undergo
training on detection and response to GBV andgender sensitivity to ensure appropriate judicial
and health response mechanisms to incidencesof harmful practices, sexual violence andexploitation.

➢ Government, working with others, should takeeffective action to challenge social norms that
accept GBV and that dictate the subordinationof girls and young women as well as support
initiatives that enable girls and young women toexercise their agency.

SRHR in humanitarian contexts
Many risks that children, adolescents and young people– and especially girls and young women – face tend tomultiply in humanitarian contexts, including genderbased and sexual violence, child, early and forced
marriage, trafficking, sexually transmitted infections(including HIV), unintended pregnancy, maternal
morbidity and death.320 Children and adolescents withdisabilities – especially girls – as well as unaccompaniedand separated girls are also particularly vulnerable toabuse and exploitation. In fact, around three-fifths of allmaternal deaths take place in humanitarian and fragile
contexts.321 At the same time, structures, networks andsystems that can protect girls may be weakened or
destroyed. Access to SRHR information and services
may also be hindered or limited in times of crisis.
In humanitarian situations, issues concerning safety andsecurity can restrict girls’ and women’s social roles aswell as their free movement. Families might place tighter
restrictions on girls’ movements or give them increased
responsibilities around the home.322 This can create
further barriers for girls and women in relation toaccessing SRHR services.
During crises, usual protection mechanisms can also be
eroded due to factors such as the lack of parental care,and the breakdown of community structures. Lack ofprotection mechanisms particularly affects girls whoseparents have died or been injured, and who are in thecare of a relative, or an unrelated adult, or an institution.
Because of their sex and age, adolescent girls are
particularly susceptible to exploitation and violence –including rape, abuse, early marriage and abduction –both during and in the immediate aftermath of a natural
disaster or conflict.323 The nature of humanitariancontexts can also increase the exposure of girls andwomen to risks of sexual violence. They often have towalk further for fuel and water, and experience a lack ofprivacy, adequate lighting and security in displacement
settings such as refugee camps.
Furthermore, girls and women may face abuse by thevery people who are meant to protect them – including
camp officials, humanitarian workers, peacekeepers,
government employees and teachers – a situation again
made more likely by weaker protection, reporting andresponse mechanisms.
In addition, women and girls can also become
systematic targets for sexual violence in conflictsituations. Sexual violence can become a weapon toterrorise and break apart families and communities andin some instances to change the ethnic make-up of

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 29

services, especially at the local level, in order toensure the continuity of services during
disasters, crises and conflicts. This includes
investing in strong primary healthcare systems
that incorporate sexual and reproductive healthservices; developing the capacity of healthworkers in applying and implementing disasterrisk reduction approaches and ensuring thatsexual and reproductive health and the specificneeds of girls and young women are part ofpreparedness measures within the health andeducation sectors.

future generations. Where sexual violence is deployedsystematically, to achieve military or political objectives,
it constitutes a war crime under international law.324
When rape, sexual slavery, enforced prostitution, forced
pregnancy, enforced sterilisation or another form of
sexual violence is committed as part of a widespread orsystematic attack directed against a civilian population, it
constitutes a crime against humanity.325 Perpetrators of
sexual violence in conflict and post-conflict settings areoften allowed to act with impunity, leaving survivors withlittle chance of accessing justice, reparations or the careand services they need.326
Adolescent girls as a group are often missed in
traditional child protection interventions in emergencies,
but may also not be reached with the programming used
to reach adult women.327 For example, adolescent girls
may not feel comfortable visiting a safe spacedesignated for adult women. Adolescent girls may also
be missed by efforts to provide sexual and reproductive
health services; the Minimum Initial Service Package,
which is the international standard for protecting
women’s and girls’ SRHR in the acute phase of conflicts
and disasters, does not include criteria for children andadolescents.

➢

Governments (both host and donor), UN bodies
and civil society organisations should ensurethat disaster needs assessments reflect the
specific needs and risks faced by girls andyoung women, including those related to SRHR.
This includes measures such as ensuring thatteams are gender-balanced, integrating fully
disaggregated data into all disaster needs
assessments, including data on sexual andreproductive health indicators, and ensuring theparticipation of girls and young women in theassessment process.

➢Providers of humanitarian assistance shouldcommit to the full and swift implementation of
the Minimum Initial Service Package including
awareness-raising about sexual andreproductive health services, and the earliest
transition to comprehensive services andsupplies based on a detailed needs assessment
and longer-term programme planning. The
Minimum Initial Service Package should also be
strengthened to incorporate specific criteria onadolescent sexual and reproductive health.

➢

Providers of humanitarian assistance shouldtake all possible measures to address sexualand gender-based violence during all phases ofa crisis.

➢

All governments and international institutions
must systematically hold all perpetrators of
sexual violence and war crimes to account andstop the rampant impunity that is witnessed inhumanitarian contexts around the world. Statesthat have not already adopted national
legislation in line with international norms,
including the outlawing of all forms of genderbased violence, particularly against girls andwomen, must do so without delay. In addition,
the national justice system must respond swiftly
to any instances of sexual violence and ensure
access to justice.

➢

Donors should increase funding for SRHR inemergency responses, with a particular focus
on girls’ and young women’s SRHR as aneglected area.

Plan International’s position:➢

Plan International believes that human rights
should be ensured in times of crises and allactors involved in humanitarian responses
should take all possible measures to ensure that
all children, adolescents and young people,
including girls and young women, are able torealise their SRHR.

➢

Sexual and reproductive health and rights are
not only critical in their own right, but also toachieving humanitarian objectives in othersectors such as child survival and education.
The SRHR of children and young people should
be protected and fulfilled before, during andafter disasters and conflicts.

➢

Disaster risk reduction, resilience building andthe planning and implementation ofhumanitarian responses must take full accountof the risks faced by children, adolescents andyoung people, in particular girls and young
women, and protect and fulfil their SRHR. Plan
International also firmly believes that all
humanitarian actors should ensure that agender and age lens is applied to all aspects ofhumanitarian response, and that all possible
measures are taken to prevent and respond tosexual and gender-based violence.

Recommendations for improving SRHR in
humanitarian contexts:➢

Governments and UN bodies should ensure thatthe assessment of disaster risk and planning fordisaster risk reduction and preparedness takes
into account the specific and intersecting risks
and vulnerabilities faced by girls and young
women. The development of disaster risk
reduction policies and plans should involve thedirect participation of girls and young women.

➢

Governments should take measures to enhance
the resilience of sexual and reproductive healthSexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 30

Plan International’s work on
SRHR
Plan International supports a large number of SRHR
programmes – and it is a growing area of work, whichlinks closely to other areas such as child, early andforced marriage, child protection and female genital
mutilation/cutting.
In 2015, 82 per cent of all country offices reported thatthey have SRHR programmes (including familyplanning); 66 per cent have HIV and AIDS prevention,
treatment and care programmes; and 80 per centsupport comprehensive sexuality education and life skills
programmes.328 In 2015, €25 million was invested in
SRHR programmes, including sexuality education, familyplanning and HIV and AIDS programmes.329➢

To transform harmful social and gender norms that
underpin violations of sexual and reproductive
rights, including harmful practices such as child,early and forced marriage and female genital
mutilation/cutting, and structural drivers such as
poverty and gender inequality that impact negatively
on SRHR.

➢To build on our existing SRHR work to progressively
strengthen our capacity to contribute to the deliveryof the Minimum Initial Service Package inemergencies. 330➢

To conduct joint research, consultations with girls aswell as advocacy with the United Nations Special
Rapporteur on Disability on the SRHR of girls withdisabilities.

Plan International’s Regional Office in Latin America
created the first regional framework on SRHR in 2010.
This covered the importance of working with disabilities,
lesbian, gay, bisexual, transgender, intersex, questioning
populations and SRHR in the context of emergencies.
Plan International has made advances in taking a multisectoral approach to promoting SRHR, involving a wide
range of stakeholders (including civil society
organisations, children, adolescents and young people,
parents, communities, religious and community leaders,
government institutions, teachers and service providers).
Plan International also engages in advocacy to improve
legal frameworks and to ensure that they are being
effectively implemented.
Plan International’s overall programme and influencing
objectives are to contribute to the realisation of sexualand reproductive health and rights and the protection of
bodily autonomy for all children, adolescents and young
people, including girls and young women, children,
adolescents and youth with disabilities and those who
identify as lesbian, gay, bisexual, transgender, intersex,
questioning.
Under the new global strategy these objectives will
support our work across the four global outcome areas
Learn, Lead, Decide and Thrive.
Key areas of focus include the following:➢

To support all children, adolescents and young
people to access high quality, rights-based andgender-transformative comprehensive sexuality
education in formal and non-formal settings.

➢

To strengthen the provision of quality, nonjudgemental, gender-responsive, child-, adolescentand youth-friendly SRHR and HIV services that areaccessible, affordable, acceptable, equitable,
appropriate and effective.

➢

To influence legal and policy reform and budgetary
support to meet children’s, adolescents’ and young
people’s SRHR, including the particular needs andrights of girls and young women. This includes work
relating to Sustainable Development Goals
influencing and monitoring the progress ofgovernments to implement the 2030 Agenda as wellas other human rights commitments.

➢

To support meaningful engagement and leadershipin SRHR programmes and decision-making bychildren, adolescents and young people, including
by girls and young women.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 31

Annex 1: Human rights
standards and international
commitments relating to
SRHR
Sexual and reproductive rights are derived from anumber of international human rights instruments andconsensus documents. These include (but are notlimited to) the United Nations Convention on the Rightsof the Child, the Convention on the Elimination of All
Forms of Discrimination Against Women, theInternational Convenant on Economic, Social andCultural Rights, the Programme of Action of theInternational Conference on Population andDevelopment at Cairo (the International Conference on
Population and Development Programme of Action), theBeijing Declaration and Platform of Action and the 2030
Agenda for Sustainable Development. There are also a
number of regional human rights instruments andframeworks that address SRHR. However, for the
purpose of this paper, we will be focusing just on theinternational documents.
Although there is no internationally agreed formal
definition of sexual rights, nor any legally binding treaty
that enshrines these rights per se, sexual rights areinterpreted and understood from other human rights
contained in and protected by international human rights
standards and law.331 These are elaborated further inother international consensus documents that, while notlegal in nature, are nevertheless persuasive in characterand indicative of the direction that the international law isheading. Furthermore, in 2004 the UN Special
Rapporteur on the right to health commented that he had“…no doubt that the correct understanding offundamental human rights principles, as well as existing
human rights norms, leads ineluctably to the recognitionof sexual rights as human rights. Sexual rights include
the right of all persons to express their sexual
orientation, with due regard for the well-being and rights
of others, without fear of persecution, denial of liberty orsocial interference”.332

International Conference on Population
and Development Cairo 1994

In terms of shaping the current discourse around SRHR,
the International Conference on Population andDevelopment (ICPD) in Cairo in 1994 marked asignificant turning point with the recognition that sexualand reproductive health is fundamental to the wellbeingof all persons, couples and families, as well as for thesocial and economic development of communities andnations. This position was developed further in the ICPD
Programme of Action, which states in Principle 8:“Everyone has the right to the enjoyment of the highest
attainable standard of physical and mental health. Statesshould take all appropriate measures to ensure, on abasis of equality of men and women, universal access tohealth-care services, including those related toreproductive health care, which includes family planningand sexual health”.
The Programme of Action also clarified that reproductive
rights include certain human rights that are alreadyrecognised in national legal frameworks, international
human rights law and other relevant documents of theUnited Nations and“…rest on the recognition of the basic right of all couples
and individuals to decide freely and responsibly the
number, spacing and timing of their children and to havethe information and means to do so, and the right toattain the highest standard of reproductive health. It also
includes their right to make decisions concerning
reproduction free of discrimination, coercion andviolence, as expressed in human rights documents”.333
The Programme of Action also helped draw attention to
the sexual and reproductive health needs of refugees:“Refugees, particularly refugee women, should be
involved in the planning of refugee assistance activities
and in their implementation. In planning andimplementing refugee assistance activities, special
attention should be given to the specific needs ofrefugee women and refugee children. Refugees should
be provided with access to adequate accommodation,
education, health services, including family planning,and other necessary social services.”334
In relation to SRHR services, the 20-year review of the
ICPD335 in 2014 noted that few countries had mademeasurable progress towards integrated sexual andreproductive health services or comprehensive
education on human sexuality for all adolescents andyouth. The review document went on to emphasise that:“…if women are to enjoy their human rights andcontribute fully to the enrichment and growth of society,to innovation and to sustainable development, they must
be able to decide on the number and timing of theirchildren, free from discrimination, violence and coercion,with access to sexual and reproductive health services
necessary to prevent illness, disability or death and withconfidence in the probable health and survival of theirchildren”.

Beijing Declaration 1995

One year later, during the IV World Conference on
Women in Beijing (1995), the positions taken at theInternational Conference on Population andDevelopment were endorsed and built upon. The
Platform of Action from the Beijing Conference alsoestablished that human rights include the right of womenfreely and without coercion, violence or discrimination tohave control over and make decisions concerning theirown sexuality, including their own sexual andreproductive health.336
While the Cairo and Beijing agreements are not legallybinding per se, they hold significant weight as the vast
majority of governments have endorsed them.337 Bothconferences adopted without a vote the final documents
on 13 September 1994 and 15 September 1995
respectively and the documents were subsequently
endorsed by resolutions of the United Nations General
Assembly.338 As such, it has been argued that they“embody globally accepted policy norms andrecommendations”.339
In 2014, two decades after the Cairo conference, theInternational Conference on Population andDevelopment+20 review process took stock of the statusof the Cairo Programme of Action in terms of
implementation. While progress had been made onareas such as maternal mortality and primary school
enrolment and completion, SRHR remained a neglectedissue. In a similar vein, the recent review document of
the Beijing Declaration and Platform of Action340 notedthat 20 years on, many of the barriers and challenges
remain in place, with serious stagnation and evenregression in some areas.

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 32

As such the recommendations contained in theInternational Conference on Population andDevelopment and the Beijing Declaration and Platform of
Action remain as relevant as ever. Furthermore, the2030 Agenda makes explicit reference to theseframeworks and their review documents in Sustainable
Development Goal 5.6, which concerns universal accessto sexual and reproductive health and reproductive rights
though it does not explicitly refer to sexual rights.

“(a) develop and implement programmes that provide
access to sexual and reproductive health services,
including family planning, contraception and safe
abortion services where abortion is not against the law,adequate and comprehensive obstetric care andcounselling; (b) to foster positive and supportive
attitudes towards adolescent parenthood for theirmothers and fathers; and (c) to develop policies that willallow adolescent mothers to continue their education”. 350

Convention on the Rights of the ChildThe Committee on the Rights of the Child General
Comment No. 15 on the right of the child to theenjoyment of the highest attainable standard of health isalso relevant as it emphasises the need for the bestinterests of the child to be assessed and taken as a
primary consideration in all health-related decisions
concerning a child.351 It also emphasises the importanceof children’s participation, allowing children to express
their views and to have those views seriously taken into
account.352 The freedom to control their health and body,
including to make choices about their sexual andreproductive health and to access a range of facilities,
goods and services is also noted.353

Convention on the Rights of the Child (CRC) Article 24
makes clear that all children have the right to enjoy thehighest attainable standard of health and that no childshould be deprived of his or her right to access such
healthcare services.341 Article 24 also imposes anobligation on States parties to ensure appropriate
prenatal and postnatal healthcare for mothers, to provide
family planning education and services and to take allmeasures with a view to abolishing traditional practices
which are harmful to the health of children.
The Committee on the Rights of the Child General
Comment No. 3 on HIV/AIDS and the rights of thechild342 notes the extent to which children are at theheart of HIV and AIDS epidemics, with girls and women
becoming increasingly affected. The General Commentemphasises the obligation on States to ensure thatchildren have the ability to acquire the knowledge andskills to protect themselves and others as they begin to
express their sexuality, clarifying that children should
receive“…relevant, appropriate and timely information which
recognizes the differences in levels of understanding…istailored appropriately to age level and capacity andenables them to deal positively and responsibly with
their sexuality in order to protect themselves from HIV
infection”.343
The General Comment also calls on States to guarantee
the equal access of children to all relevant services withparticular regard for the child’s right to privacy andconfidentiality.344 It also emphasises the need forservices to be friendly and supportive, accessible,
affordable, non-judgemental and free from any
requirement for parental consent.345
The Committee on the Rights of the Child General
Comment No. 4 on Adolescent Health and Developmentin the Context of the Convention on the Rights of theChild places particular emphasis on the need to respectadolescents’ rights to privacy and confidentiality
including with respect to advice and counselling on
health matters.346 It calls on States to take effective
measures to ensure that adolescents are protected fromall forms of violence, abuse, neglect and exploitation347
and emphasises that early marriage and pregnancy are
significant factors in health problems related to sexualand reproductive health, recommending that Statesreform legislation to provide for a minimum age ofmarriage with and without parental consent to 18 years
for both boys and girls.348 The General Comment alsoemphasises the need for States to provide adolescentswith access to sexual and reproductive information,
including on family planning and contraceptives, thedangers of early pregnancy, the prevention of HIV and
AIDS, and the prevention and treatment of sexuallytransmitted diseases, regardless of marital status andwhether their parents or guardians consent.349
With regard to access to essential services, the General
Comment urges States parties to:

Paragraph 31 provides that“…in accordance with their evolving capacities, children
should have access to confidential counselling andadvice without parental or legal guardian consent, where
this is assessed by the professionals working with thechild to be in the child’s best interests”.
It also calls on States to“…review and consider allowing children to consent tocertain medical treatments and interventions without thepermission of a parent, caregiver or guardian, such as
HIV testing and sexual and reproductive health services,
including education and guidance on sexual health,contraception and safe abortion”.
Paragraph 56 also specifically refers to the high rates ofpregnancy among adolescent girls and asks States toensure that healthy systems are able to meet the
specific SRHR needs of adolescents including familyplanning and safe abortion services. It also calls on
States to ensure that girls can make autonomous andinformed decisions on their reproductive health and toprohibit discrimination based on adolescentpregnancy.354 Furthermore, the Committee on the Rightsof the Child has expressed concern about maternalmortality in adolescent girls stemming from unsafe
abortion – a violation of their right to life – and urgedStates to reform punitive abortion legislation and ensure
access to safe abortion services, irrespective of thelegality of abortion.355
The Committee on the Rights of the Child has also
accepted that the age at which individuals can givesexual consent is not the age at which they attainadulthood (age 18). It also clearly distinguished the ageof sexual consent from the age of marriage (which is set
at 18) and made clear that the age at which individuals
can consent to homosexual and heterosexual activity
should be the same.356

Convention on the Elimination of All Formsof Discrimination Against Women
Article 12 of the Convention on the Elimination of All
Forms of Discrimination Against Women (CEDAW)357 iscentral to the health and wellbeing of girls and women. It
requires States to eliminate discrimination in access tohealthcare services throughout the life cycle, particularlyin the areas of family planning, pregnancy andSexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 33

confinement and during the postnatal period. In
particular, it requires States to take“… all appropriate measures to eliminate discrimination
against women in the field of health care in order toensure, on a basis of equality of men and women,
access to health care services including those related tofamily planning”.
It goes on to require States parties to also ensure thatwomen have appropriate services for “pregnancy,
confinement and the post-natal period, granting freeservices where necessary, as well as adequate nutrition
during pregnancy and lactation”.
The Committee on the Elimination of All Forms ofDiscrimination Against Women General
Recommendation No. 24358 provides further clarificationon the scope of Article 12 of CEDAW and makes clearthat its recommendations apply equally to girls andadolescents as well as to women. Of particular note, theGeneral Recommendation clarifies that the convention
not only aims to put women on equal footing with men interms of access to healthcare, but that States also needto recognise the particular (reproductive) needs ofwomen:”Measures to eliminate discrimination against womenare considered to be inappropriate if a health caresystem lacks services to prevent, detect and treat
illnesses specific to women. It is discriminatory for a
State party to refuse to legally provide for the
performance of certain reproductive health services for
women. For instance, if health service providers refuse
to perform such services based on conscientious
objection, measures should be introduced to ensure thatwomen are referred to alternative health providers.”
It goes on to also note that States should not restrict
women’s access to health services on the grounds thatthey lack the authorisation of their husbands, partners or
health authorities or because they are unmarried or
women.359 The General Recommendation further
recommends that
“States parties should ensure the rights of female andmale adolescents to sexual and reproductive healtheducation by properly trained personnel in speciallydesigned programmes that respect their right to privacy
and confidentiality”.360
It also calls on States to“…prioritise the prevention of unwanted pregnancy
through family planning and sex education and reducematernal mortality rates through safe motherhood
services and prenatal assistance. When possible,
legislation criminalizing abortion should be amended, inorder to withdraw punitive measures imposed on women
who undergo abortion”.361
In conflict settings, General Recommendation No. 30 of
the Committee on the Elimination of All Forms ofDiscrimination Against Women, has called on
governments to:“Ensure that sexual and reproductive health careincludes access to sexual and reproductive health andrights information; psychosocial support; family planning
services, including emergency contraception; maternal
health services, including antenatal care, skilled delivery
services, prevention of vertical transmission andemergency obstetric care; safe abortion services; postabortion care; prevention and treatment of HIV/AIDS andother sexually transmitted infections, including postexposure prophylaxis; and care to treat injuries such as

fistula arising from sexual violence, complications ofdelivery or other reproductive health complications,among others”.362
The Committee on the Elimination of All Forms ofDiscrimination Against Women has also made clear thatthe fundamental principles of non-discrimination andequality require that the rights of a pregnant woman begiven priority over an interest in prenatal life.363

International Covenant on Economic,
Social and Cultural Rights – General
Comment 22 on the right to sexual andreproductive healthGeneral Comment 22 makes clear that the right tosexual and reproductive health is an integral part of theright of everyone to the enjoyment of the highest
attainable standard of physical and mental health, whichis enshrined in Article 12 of the International Covenant
on Economic, Social and Cultural Rights. As such, itcalls on States to ensure unhindered access to a whole
range of health facilities, goods, services and informationthat ensure all people full enjoyment of the right tosexual and reproductive health.
It emphasises the need for available, accessible,
affordable, acceptable and quality goods, informationand services related to sexual and reproductive healthfor all and recognises the discrimination, coercion andviolence which many girls and women face in trying torealise their SRHR. To address this situation, it notesthat States need to repeal or amend discriminatory laws,
policies and practices in the area of sexual andreproductive health (including through liberalising
restrictive abortion laws and provisions requiring
parental, spousal or judicial consent) and remove
barriers that prevent girls and women from accessing
SRHR information, goods and services. Among theinformation and services which need to be madeavailable and accessible, the General Comment lists
safe and effective contraceptives, comprehensive
sexuality education, guaranteeing girls and women
access to safe abortion services and quality postabortion care.364
Of particular note, it also makes clear that States are
obliged to ensure that adolescents have full access toappropriate information on sexual and reproductive
health regardless of their marital status and whether
their parents or guardians consent, with respect for theirprivacy and confidentiality.365

Convention on the Rights of Persons with
Disabilities
Article 23 of the Convention (CRPD) states:“States Parties shall take effective and appropriate
measures to eliminate discrimination against persons
with disabilities in all matters relating to marriage, family,
parenthood and relationships, on an equal basis withothers, so as to ensure that:a.

The right of all persons with disabilities who are of
marriageable age to marry and to found a family on
the basis of free and full consent of the intending
spouses is recognized;b.

The rights of persons with disabilities to decide
freely and responsibly on the number and spacingof their children and to have access to ageappropriate information, reproductive and familyplanning education are recognized, and the means

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 34

necessary to enable them to exercise these rights
are provided;c.

Persons with disabilities, including children, retain
their fertility on an equal basis with others.”

Article 25 of the CRPD366 confirms that persons withdisabilities have the right to enjoyment of the highest
attainable standard of health, including sexual andreproductive health, without discrimination on the basisof disability. Article 25a provides that States Parties shall“Provide persons with disabilities with the same range,
quality and standard of free or affordable health care andprogrammes as provided to other persons, including in
the area of sexual and reproductive health andpopulation-based public health programmes.”
General Comment No. 2367 emphasises the importanceof accessibility in health services:“Health care and social protection would remain
unattainable for persons with disabilities without accessto the premises where those services are provided (…)
All information and communication pertaining to theprovision of health care should be accessible throughsign language, Braille, accessible electronic formats,alternative script, and augmentative and alternativemodes, means and formats of communication. It isespecially important to take into account the genderdimension of accessibility when providing health care,particularly reproductive health care for women and girls
with disabilities, including gynaecological and obstetricservices.”

The 2030 Agenda for Sustainable
Development

The 2030 Agenda for Sustainable Development includes
direct targets on SRHR as well as some that address
underlying factors that hinder the realisation of SRHR,
such as child, early and forced marriage; poverty;
gender inequality; violence; stigma and discrimination.
Two targets need specific mention, namely Sustainable
Development Goal 3.7 and Sustainable Development
Goal 5.6.
Target 3.7 provides: “By 2030, ensure universal accessto sexual and reproductive health-care services,
including for family planning, information and education,and the integration of reproductive health into national
strategies and programmes”.
Target 5.6 provides: “Ensure universal access to sexualand reproductive health and reproductive rights asagreed in accordance with the Programme of Action of
the International Conference on Population andDevelopment and the Beijing Platform for Action and theoutcome documents of their review conferences”.
However, the 2030 Agenda has come under somecriticism for failing to include explicit provisions
concerning sexual rights, comprehensive sexuality
education, discrimination on the basis of sexual
orientation or gender identity; the right to access quality,

safe abortion services; and the importance of highquality, confidential and timely sexual and reproductive
health services, including for children and adolescents. It
will also be imperative to ensure that the goals andtargets set out in the 2030 Agenda apply equally in timesof crisis and in refugee settings if it is to achieve its
objective of leaving no one behind.

Global Strategy for Women’s, Children’sand Adolescents’ Health (2016–2030)

The Global Strategy for Women’s, Children’s andAdolescents’ Health (2016–2030) and its accountability
framework was launched by the UN Secretary Generalin 2015 to help countries begin implementing the 2030
Agenda. It goes further than the 2030 Agenda in
explicitly referencing some critical SRHR issues whichwere not included in the 2030 Agenda such ascomprehensive sexuality education, safe abortion, postabortion care and sexual orientation.

Joint general recommendation No. 31 of
the Committee on the Elimination ofDiscrimination against Women/Generalcomment No. 18 of the Committee on the
Rights of the Child on harmful practices
The committees state that governments who have
ratified the conventions“…have a duty to comply with their obligations torespect, protect and fulfil the rights of women andchildren. They also have a due-diligence obligation toprevent acts that impair the recognition, enjoyment or
exercise of rights by women and children and ensurethat private actors do not engage in discrimination
against women and girls, including gender-based
violence… ”.

The Sendai Framework for Disaster Risk
Reduction

This framework368 contains a stronger gender
perspective than its predecessor, the Hyogo Framework
for Action, and emphasises the importance of including
women in planning and designing disaster
preparedness. It also makes specific reference to theimportance of sexual and reproductive health services,
stating:“At national and local levels, it is important to…
strengthen the design and implementation of inclusive
policies and social safety-net mechanisms, including
through community involvement, integrated withlivelihood enhancement programmes, and access tobasic health care services, including maternal, newborn
and child health, sexual and reproductive health … toempower and assist people disproportionately affectedby disasters.”369

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 35

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 36

References
1 See CEDAW Article 2f.
2 Including the ICPD Programme of Action, the Beijing Platform of Action and the 2030 Agenda and human rights instruments suchas the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination Against Women.
3 An integrated multi-sectoral approach is required, for example, using methods such as inter-generational dialogues, the GREAT
strategy (Gender Roles Equality and Transformation) and Community Score Cards (CSD).
4 Plan International (2010) Sexuality education in: are we delivering?
5 Plan International, Impact Area Overview: Sexual and Reproductive Health and Rights (2015)
6 ibid7 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
8

Convention on the Elimination of All Forms of Discrimination Against Women Committee, Concluding Observations: Sierra Leone, para. 32, U.N. Doc.
CEDAW/C/SLE/CO/6 (2014).

9 Committee on the Rights of the Child, General Comment No. 3 (2003), CRC/GC/2003/1
10 Ibid para 36(3)11 Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation
12 A forthcoming position paper on CEFM will be developed in 2017.
13 As stated in the Universal Declaration of Human Rights, as well as other conventions, including CEDAW and CRC.
14 Reproductive health indicators. Guidelines for their generation, interpretation and analysis for global monitoring. Geneva: World
Health Organization; 2006. Accessible here: https://www.unfpa.org/sites/default/files/event-pdf/icpd_eng_2.pdf.
15 UNICEF State of the World’s Children 2011: Adolescence: An Age of Opportunity. UNICEF, February 2011.
Available at: http://www.unicef.org/sowc2011/pdfs/SOWC-2011-Main-Report_EN_02092011.pdf
16 Convention on the Rights of the Child (CRC), Article 1.
17 WHO, What do we mean by availability, accessibility, acceptability and quality (AAAQ) of the health workforce?
See http://www.who.int/workforcealliance/media/qa/04/en/
18 CRC General Comment 4, para 30.
19 UNESCO (2009) Sexuality Education, [online] www.unesco.org/new/en/hiv-and-aids/our-priorities-in-hiv/sexuality-education/(accessed 22 June 2016)
20 UN Women, Virtual Knowledge Centre to End Violence Against Women. Glossary of Terms from Programming Essentials andMonitoring and Evaluation Sections. Available at: http://www.endvawnow.org/en/articles/347-glossary-of-terms-from-programmingessentials-and-monitoring-and-evaluation-sections.html
21 Plan UK and Plan Sweden (2015) Strengthening support to LGBTIQ adolescents.
22 ICPD Programme of Action, 1994, Article 7.2
23 ICPD Programme of Action, Article 7.3
24 WHO working definition 2006a.
25 The Yogyakarta Principles (2007) Principles on the application of international human rights law in relation to sexual orientationand gender identity.
26 WHO working definition 2006a, updated 2010, abridged here
27 WHO working definition 2006a.
28 Ibid.
29 General Assembly Resolution 48/104 Declaration on the Elimination of Violence against Women, 1993.
30 United Nations, Definition of Youth. Available at: http://www.un.org/esa/socdev/documents/youth/fact-sheets/youth-definition.pdf
The Secretary-General first referred to the current definition of youth in 1981 in his report to the General Assembly on International
Youth Year (A/36/215, para. 8 of the annex) and endorsed it in ensuing reports (A/40/256, para. 19 of the annex).
31 A/CONF.171/13: Report of the ICPD (94/10/18)
32 Resistance from States to recognise sexual rights stems from their negative attitude to access to safe abortion, rights for people
who identify as lesbian, gay, bisexual, transgender, intersex, questioning, and guaranteeing girls and women control over their own
sexuality including making decisions that are linked to their sexuality.
33 United Nations Economic and Social Council. Framework of Actions for the follow-up to the Programme of Action of theInternational Conference on Population and Development (ICPD) Beyond 2014. E/CN.9/2014/4
34 Defined as individuals and groups who are systematically blocked from accessing rights, opportunities and resources.
35 Ibid CEDAW General Comment, No. 30
36 WHO 2014 http://www.who.int/mediacentre/news/releases/2014/focus-adolescent-health/en/
37 United Nations Children’s Fund, Harnessing the Power of Data for Girls: Taking stock and looking ahead to 2030. UNICEF, New
York, 2016.
38 Ibid.
39 WHO Fact sheet N°348, Maternal mortality, Updated November 2015. Available at:
http://www.who.int/mediacentre/factsheets/fs348/en/
40 Neal, S., Matthews, Z., Frost, M. et al. Childbearing in adolescents aged 12–15 years in low resource countries: A neglectedissue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand. 2012; 91: 1114–1118
41 WHO Fact sheet N°348, Maternal mortality, Updated November 2015. Available at:
http://www.who.int/mediacentre/factsheets/fs348/en/
42 WHO, Adolescent pregnancy. See http://www.who.int/maternal_child_adolescent/topics/maternal/adolescent_pregnancy/en/
43 ibid
44 Guttmacher Institute. May 2016 Fact sheet. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescentsin Developing Regions. Available at: https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-of-adolescents

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 37

45 WHO Fact sheet N°364: Adolescent pregnancy. Updated September 2014. Available at:
http://www.who.int/mediacentre/factsheets/fs364/en/
46 UNICEF. Annual Results Report 2014: HIV and AIDS. UNICEF, July 2015, p. 10.
47 World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical
Medicine, South African Medical Research Council (2013). Global and regional estimates of violence against women: prevalenceand health effects of intimate partner violence and non-partner sexual violence.
48 ‘The World’s Women 2015, Trends and Statistics, Chapter 6, Violence against Women’, UNDESA 2015. 68 per cent of everpartnered women in Kiribati had been subjected to violence by an intimate partner.
49 CEDAW Committee, General Recommendation No. 30 on women in conflict prevention, conflict and post conflict situations.
CEDAW/C/GC/30. 18 October 2013
50 UNICEF (2016) Female genital mutilation/cutting: A global concern
http://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf
51 Child marriage is only projected to fall from 25 per cent to around 22 per cent between 2015 and 2030. See Nicolai, S., Hoy, C.,
Berliner, T. and Aedy, T. Projecting Progress: Reaching the SDGs by 2030. Overseas Development Institute 2015.
http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/9839.pdf
52 UNICEF Data. http://data.unicef.org/
53 CEDAW Committee, General Recommendation No. 30 on women in conflict prevention, conflict and post conflict situations.
CEDAW/C/GC/30. 18 October 2013
54 Plan International. Ending Harmful Practices Against Children, 201555 CEDAW Committee, General Recommendation No. 30 on women in conflict prevention, conflict and post conflict situations.
CEDAW/C/GC/30. 18 October 201356 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
57 United Nations Population Fund (2015). State of the World Population 2015: Shelter form the Storm. New York.
58 CEDAW Committee, General Recommendation No. 30 on women in conflict prevention, conflict and post conflict situations.
CEDAW/C/GC/30. 18 October 201359 United Nations Economic and Social Council. Framework of Actions for the follow-up to the Programme of Action of theInternational Conference on Population and Development (ICPD) Beyond 2014. E/CN.9/2014/4
60 UNFPA State of the World Population 2014.
61 Although there is no internationally agreed formal definition of sexual rights, nor legally binding treaty that enshrines these rights
per se, sexual rights are interpreted and understood from other human rights contained in and protected by international humanrights standards and law.
62 Convention on the Rights of the Child 1989, entered into forced on 2 September 1990.
63 Ibid para 16
64 Ibid para 24
65 Ibid para 7
66 Ibid para 8
67 Committee on the Rights of the Child, General Comment No. 3 (2003), CRC/GC/2003/1
68 Ibid para 36(3)69 Ibid para 17
70 CEDAW General Recommendation No. 24: Article 12 of the Convention. Adopted at the 20th session of the Committee on the
Elimination Against Women (1999) A/54/38/ Rev.1, chap.1)
71 Ibid General recommendation No. 24, para 11.
72 Ibid General recommendation No. 24, para 14
73 Ibid General recommendation No. 24 para 18
74 See CEDAW Article 2f.
75 Promundo and UNFPA (2016). Adolescent Boys and Young Men.
76 Studies undertaken by WHO show that FGM is consistently closely linked to the deep-rooted belief that female sexual pleasure
should be controlled; the clitoris is believed as a site for sexual urge and, if it is not removed, can make a women’s sexual desire‘insatiable’. FGM is practiced as part of this deep-rooted patriarchal desire to control female sexual pleasure, ensure virginity before
marriage, and fidelity and passivity during it. See http://www.who.int/reproductivehealth/topics/fgm/fgm-sexuality/en/
77 Promundo and UNFPA (2016). Adolescent Boys and Young Men.
78 Elizabeth Presler-Marshall and Nicola Jones. Charting the future: Empowering girls to prevent early pregnancy. Overseas
Development Institute 2012. Citing: Ndaruhuye et al, 2009; Kamran, 2011; Cleland et al, 2011.
79 Shalev, Rights to Sexual and Reproductive Health – the ICPD and the Convention on the Elimination of All Forms ofDiscrimination Against Women (1998)
80 Ibid
81 Ibid82 Promundo and UNFPA (2016). Adolescent Boys and Young Men.
83 Ibid
84 Ibid85 Promundo and UNFPA (2016). Adolescent Boys and Young Men.
86 UNFPA, The right to contraceptive information and services for women and adolescents, (NY,2010). Available at
http://www.unfpa.org/sites/default/files/resource-pdf/Contraception.pdf
87 Exclusion is the process that prevents certain people or groups from fulfilling their rights. This process involves complex social,
cultural, economic, spatial and environmental factors and dynamics that create inequality in people’s access to and control overopportunities and resources. Tackling Exclusion Framework, Plan International (March, 2016)
88 Ibid
89 International Council on Human Rights Policy. Sexuality and Human Rights (2009)

Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 38

90 Including the ICPD Programme of Action, the Beijing Platform of Action and the 2030 Agenda and human rights instruments
such as the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination Against
Women.
91 An integrated multi-sectoral approach is required, for example, using methods such as inter-generational dialogues, the GREAT
strategy (Gender Roles Equality and Transformation) and Community Score Cards (CSD).
92 The right to the highest attainable standard of health and to health care is established in various human rights documents,
including the Universal Declaration on Human Rights, Article 12 of the Covenant on Economic, Social and Cultural Rights andArticle 24 of the Convention on the Rights of the Child.
93 UNESCO 2009 op cit
94 The Federal Centre for Health Education (BZgA), the WHO Regional Office for Europe (2010) op. cit.
95 UNESCO (2009) International Technical Guidance on Sexuality Education Volume II
96 UNESCO, Volume I The rationale for sexuality education, International Technical Guidance on Sexuality Education: An
evidence-informed approach for schools, teachers, and health educators. December 2009. Available at:
http://unesdoc.unesco.org/images/0018/001832/183281e.pdf
97 Committee on the Rights of the Child, General Comment 3, para 4.
98 International Conference on Population and Development 1994, para 7.4
99 Kirby D. (2007) op. cit., p16
100 Kirby D. (2007) op. cit.
101 UNESCO (2009) op. cit.
102 Kirby D. (2007) op. cit.
103 CRC/C/15(2004) and CRC/C/TTO/CO (2006)
104 CEDAW/C/LTU/CO/4 (2008)
105 ibid
106 Plan International (2010) Sexuality education in Asia: are we delivering?
107 Ibid
108 Comprehensive Sexuality Education: An analysis of global guidance, best practice and evidence, with recommendations forPlan International’s CSE programming
109 Holden, J., et al (2015) ‘We want to learn about good love’ – Findings from a qualitative study assessing the links between
comprehensive sexuality education and violence against women and girls. London: Plan International UK and Social Development
Direct110 Ibid.
111 Holden, J., et al (2015) ‘We want to learn about good love’ – Findings from a qualitative study assessing the links between
comprehensive sexuality education and violence against women and girls. London: Plan International UK and Social Development
Direct112 UNFPA. State of the World Population 2015: Shelter from the Storm. UNFPA, New York: 2015. Available at:https://www.unfpa.org/sites/default/files/sowp/downloads/State_of_World_Population_2015_EN.pdf
113 Plan International (2010) Sexuality education in Asia: are we delivering?
114 Ibid.
115 CRC General Comment 4, paragraph 35 ( c )116 ibid
117 Tylee, A. et al (2007) Youth-friendly primary-care services: how are we doing and what more needs to be done? Lancet 2007;
369: 1565–73
118 Vanessa Woog, Susheela Singh, Alyssa Browne and Jesse Philbin, Adolescent Women’s Need for and Use of Sexual andReproductive Health Services in Developing Countries. Guttmacher Institute, August 2015.
119 Ibid.
120 Ibid.
121 UNFPA Framework on Action for Adolescents and Youth. Opening Doors With Young People: 4 Keys.
122 United Nations Economic and Social Council. Framework of Actions for the follow-up to the Programme of Action of theInternational Conference on Population and Development (ICPD) Beyond 2014. E/CN.9/2014/4
123 Casey, S. E. et al. 2015. “Progress and Gaps in Reproductive Health Services in Three Humanitarian Settings: Mixed Methods
Case Studies. Conflict and Health 9 (Suppl 1): S3. doi:10.1186/1752-1505-9-S1-S3.
124 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
125 Darroch, J. et al, ‘Adding it Up:Costs and Benefits of meeting the contraceptive needs of adolescents (2016), Guttmacher
Institute.
126 Denno DM, et al. Effective strategies to provide adolescent sexual and reproductive health services and to increase demandand community support, Journal of Adolescent Health, 2015, 56(1 Suppl), s22-s41.
127 Chandra-Mouli et al. What does not work in adolescent sexual and reproductive health: a review of evidence on interventions
commonly accepted as best practices, Global Health: Science and Practice, 2015, 3(3): 333-340
128 Plan International recognises that in some instances, services also need to be responsive to needs of children, for example,
girls who have undergone FGM, or children living with HIV and AIDS.
129 Plan International, Impact Area Overview: Sexual and Reproductive Health and Rights (2015)
130 ibid
131 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
132 Target 17.18
133 https://www.womenshealth.gov/publications/our-publications/fact-sheet/menstruation.html#a
134 UNICEF, ‘WASH in Schools: Empower Girls’ Education’ (New York, 2012), p.5.
135 House, S. et al (2012) ‘Menstrual Hygiene matters. A resource for improving menstrual hygiene around the world’.
136 Ibid.
137 Ibid.
138 Ibid.
139 Ibid.
Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 39

140 Ibid
141 House, S. et al (2012) ‘Menstrual Hygiene matters. A resource for improving menstrual hygiene around the world’.
142 UNICEF and World Health Organization (2015) ‘25 years of Progress on Sanitation and Drinking Water – 2015 update and
MDG assessment’, p.45.
143 Plan International (2016) Impact Area Overview: The Right to Water, Sanitation and Hygiene
144 Ibid.
145 UNFPA, The State of World Population 2013: Motherhood in Childhood: Facing the challenge of adolescent pregnancy. UNFPA2013. Available at: https://www.unfpa.org/sites/default/files/pub-pdf/EN-SWOP2013-final.pdf
146 Neal, S., Matthews, Z., Frost, M. et al. Childbearing in adolescents aged 12–15 years in low resource countries: A neglectedissue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand. 2012; 91: 1114–1118
147 Rodríguez, J. (2013). “High adolescent fertility in the context of declining fertility in Latin America”. Expert Paper, No. 2013/14.
CELADE-Population Division of ECLAC. New York: United Nations. Plan and Unicef (2014) ‘Experience and accounts of pregnancy
amongst adolescents’.
148 Plan and Unicef (2014) ‘Experience and accounts of pregnancy amongst adolescents’.
149 ibid
150 ibid
151 ibid
152 UNFPA, The State of World Population 2013: Motherhood in Childhood: Facing the challenge of adolescent pregnancy. UNFPA
2013.
153 World Health Organization. 2008a. “Adolescent Pregnancy.” Making Pregnancy Safer (MPS) Notes. 1(1). Geneva: WHO.
154 WHO, Early Marriages, Adolescent and Young Pregnancies. Report by the Secretariat for the Sixty-fifth World Health
Assembly, Provisional agenda item 13.4, (16 March 2012), p.2. Statistics according to National Research Council & Institute for
Medicine, 2005, from Demographic and Health surveys in 51 countries, late 1990s to mid-2000s.
Available at http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_13-en.pdf?ua=1
155 Ibid.
156 Plan and Unicef (2014) ‘Experience and accounts of pregnancy amongst adolescents’
157 Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries
Nove, Andrea et al. The Lancet Global Health , Volume 2 , Issue 3 , e155 - e164
158 Ibid
159 Darroch JE et al (2016). ‘Adding it up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents’ Guttmacher
Institute.
160 Sedgh G et al., (2012) ‘Induced abortion: incidence and trends worldwide from 1995 to 2008, The Lancet, 379(9816): 625-632
161 Darroch JE et al (2016). ‘Adding it up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents’ Guttmacher
Institute.
162 WHO 2014 http://www.who.int/mediacentre/news/releases/2014/focus-adolescent-health/en/
163 Plan and Unicef (2014) ‘Experience and accounts of pregnancy amongst adolescents’.
164 WHO. Understanding and addressing violence against women (2012)
http://apps.who.int/iris/bitstream/10665/77431/1/WHO_RHR_12.43_eng.pdf
165 Nicolai, S., Hoy, C., Berliner, T. and Aedy, T. Projecting Progress: Reaching the SDGs by 2030. Overseas Development
Institute 2015. Available at: http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/7724.pdf
166 Darroch JE et al (2016). ‘Adding it up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents’ Guttmacher
Institute.
167 UN Women (2015) Summary Report: The Beijing Declaration and Platform for Action Turns 20 (E/CN.6/2015/3)
168 ibid
169 UNFPA, Fact sheet. When Childbirth Harms: Obstetric Fistula. Updated with technical feedback December 2012.
170 WHO, 10 facts on obstetric fistula, Updated May 2014.
171 Ibid.
172 Ibid.
173 UNFPA, Fact sheet. When Childbirth Harms: Obstetric Fistula. Updated with technical feedback December 2012.
174 WHO, Adolescent pregnancy. Fact sheet 364. Updated September 2014.
175 UNFPA. Adolescent pregnancy: A review of the Evidence. UNFPA, New York, 2013.
176 An equal start: why gender inequality matters for child survival and maternal health. Save the Children 2011
177 WHO. Maternal, newborn, child and adolescent health. Adolescent pregnancy. Available at:
http://www.who.int/maternal_child_adolescent/topics/maternal/adolescent_pregnancy/en/
178 An equal start: why gender inequality matters for child survival and maternal health. Save the Children 2011
179 Plan International, State of the World’s Girls 2012: Learning for Life. Plan International, Woking, 2012.
180 Human Rights Watch. ‘“Nobody Remembers Us”: Failure to Protect Women’s and Girls’ Right to Health and Security in PostEarthquake Haiti.’ Human Rights Watch, August 2011.
181 Casey, S. E. et al. 2015. “Progress and Gaps in Reproductive Health Services in Three Humanitarian Settings: Mixed Methods
Case Studies. Conflict and Health 9 (Suppl 1): S3. doi:10.1186/1752-1505-9-S1-S3i
182 UNFPA. State of the World Population 2015: Shelter from the Storm. UNFPA, New York: 2015. Available at:https://www.unfpa.org/sites/default/files/sowp/downloads/State_of_World_Population_2015_EN.pdf
183 Plan and Unicef (2014) ‘Experience and accounts of pregnancy amongst adolescents’.
184 ibid
185 HIP. Adolescent –friendly contraceptive services- mainstreaming adolescent-friendly elements into existing contraceptive
services (2015)
186 Guttmacher Institute. May 2016 Fact sheet. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs ofAdolescents in Developing Regions. Available at: https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-ofadolescents
187 Ibid.
Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 40

188 Ibid.
189 Ibid.
190 Darroch, J. et al, ‘Adding it Up:Costs and Benefits of meeting the contraceptive needs of adolescents (2016), Guttmacher
Institute.
191 ibid.
192 ibid
193 Guttmacher Institute. May 2016 Fact sheet. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs ofAdolescents in Developing Regions. Available at: https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-ofadolescents
194 HIP. Adolescent –friendly contraceptive services- mainstreaming adolescent-friendly elements into existing contraceptive
services (2015)
195 Elizabeth Presler-Marshall and Nicola Jones. Charting the future: Empowering girls to prevent early pregnancy. Overseas
Development Institute 2012. Citing: Ndaruhuye et al, 2009; Kamran, 2011; Cleland et al, 2011.
196 Michaels-Igbokwe C, Lagarde M, Cairns J, Terris-Prestholt F. Using decision mapping to inform the development of a statedchoice survey to elicit youth preferences for sexual and reproductive health and HIV services in rural Malawi. Soc Sci Med.
2014;105:93-102.
197 WHO, Selected policies on adolescent friendly health services in low and middle income countries 2014
198 HIP. Adolescent –friendly contraceptive services- mainstreaming adolescent-friendly elements into existing contraceptive
services (2015)
199 Most research measures levels of unintended pregnancy, whereas many human rights instruments talk about unwanted
pregnancy. Whilst a pregnancy may not have been intended, this does not necessarily mean that it is unwanted.
200 Guttmacher Institute. May 2016 Fact sheet. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs ofAdolescents in Developing Regions. Available at: https://www.guttmacher.org/fact-sheet/adding-it-meeting-contraceptive-needs-ofadolescents
201 ibid
202 ibid
203 Darroch, J. et al, ‘Adding it Up: Costs and Benefits of meeting the contraceptive needs of adolescents (2016), Guttmacher
Institute.
204 UNFPA, State of World Population, 2015
205 IPPF. Compendium on young people’s SRHR policies in Europe. November 2012
206 Family Planning 2020: accelerating progress strategy for 2016-2020, 2015,
http://www.familyplanning2020.org/microsite/strategy; Every Woman Every Child, Global Strategy for Women’s, Children’s andAdolescents’ Health (2016-2030), 2015,
http://globalstrategy.everywomaneverychild.org/pdf/EWEC_globalstrategyreport_200915_FINAL_WEB.pdf
207 Darroch, J. et al, ‘Adding it Up: Costs and Benefits of meeting the contraceptive needs of adolescents (2016), Guttmacher
Institute.
208 The right to health is recognised in the International Covenant on Economic, Social and Cultural Rights, Article 12; theConvention on the Rights of the Child (CRC), Article 24; the Convention on the Elimination of All Forms of Discrimination against
Women (CEDAW), Articles 11 (1) (f), 12 and 14 (2) (b); the 2006 Convention on the Rights of Persons with Disabilities, Article 25;
the International Convention on the Elimination of All Forms of Racial Discrimination, Article 5 (e) (iv); and the International
Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, Article 28.
209 Human Rights Committee monitoring the implementation of the International Covenant on Civil and Political Rights CCPR/C/116/D/2324/2013 para 9
210 Guttmacher Institute. Fact Sheet: Induced Abortion Worldwide (2016.
211 Guttmacher Institute 2016. Induced Abortion Worldwide. (2016)
212 Guttmacher Institute 2016. Induced Abortion Worldwide. Global Incidence and Trends.
213 Singh S and Maddow-Zimet I, Facility-based treatment for medical complications resulting from unsafe pregnancy termination in
the developing world, 2012: a review of evidence from 26 countries, BJOG, 2015, doi:10.1111/1471-0528.13552.
214 Guttmacher Institute. Fact Sheet: Induced Abortion Worldwide (2016.
215 ibid
216 IPAS, Adolescents, unwanted pregnancy and abortion 10 (2004)
217 Singh S, Darroch JE and Ashford LS, Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health2014, New York: Guttmacher Institute, 2014; Kassebaum NJ et al., Global, regional, and national levels and causes of maternalmortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013, The Lancet, 2014, 384(9947):980–
1004.; Say L et al., Global causes of maternal death: a WHO systematic analysis, The Lancet Global Health, 2014, 2(6):e323–e333.
218 ibid
219 Guttmacher Institute. Fact Sheet. Abortion in Africa (2016)
220 Ibid.
221 Guttmacher Institute. Fact Sheet: Abortion in Latin America and the Caribbean. (2016)
The most restrictive abortion laws are those which ban the procedure entirely or only allow abortion when the pregnancy threatens awoman’s life. 66 countries have such extremely restrictive abortion laws as of June 2013. The next layer of abortion laws are thosewhich authorise abortion to preserve a woman’s life or health; some countries’ laws specify that abortion is available only if thephysical health of a woman is at danger, whereas others permit abortion if her mental or physical health is at risk. 59 countries havesuch restrictive abortion laws as of June 2013. See Centre for Reproductive Rights, Fact Sheet: The World’s Abortion Laws Map
2013 Update. Available at
http://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/AbortionMap_Factsheet_2013.pdf
222 Guttmacher Institute. Fact Sheet. Abortion in Africa (2016)
223 WHO. Safe abortion: Technical & policy guidance for health systems. Legal and policy considerations. Available at:
http://apps.who.int/iris/bitstream/10665/173586/1/WHO_RHR_15.04_eng.pdf?ua=1
224 Six countries outlaw abortion in all circumstances: Chile; Dominican Republic; El Salvador; Malta; Nicaragua; and the Vatican
State.
Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 41

225 Abortion rates in countries where abortion is prohibited or allowed only to save a woman’s life is 37 per 1000 girls and women
aged 15 to 44. Abortion rates in countries where abortion is available on request is 34 per 1000 girl and women aged 15 to 44.
See: https://www.guttmacher.org/infographic/2016/restrictive-laws-do-not-stop-women-having-abortions, quoting Sedgh G etal., Abortion incidence between 1990 and 2014: global, regional, and sub-regional levels and trends, The Lancet, 2016.
226 WHO. Safe abortion: Technical & policy guidance for health systems. Legal and policy considerations, p. 2. Available at:
http://apps.who.int/iris/bitstream/10665/173586/1/WHO_RHR_15.04_eng.pdf?ua=1
227 Centre for Reproductive Rights. Adolescents Need Safe and Legal Abortion (2005)
228 Rowan, A. Prosecuting Women for Self-Inducing Abortion: Counterproductive and Lacking Compassion, Guttmacher Policy
Review, vol 18, issue 3. Guttmacher Institute, 2015
229 ibid
230 ibid
231 Human Rights Committee monitoring the implementation of the International Covenant on Civil and Political Rights CCPR/C/116/D/2324/2013 para 9
232 Guttmacher Institute. Fact Sheet. Abortion in Africa (2016)
233 Guttmacher Institute. Fact Sheet: Abortion in Latin America and the Caribbean. (2016)
234 Singh S, Darroch JE and Ashford LS, Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health2014, New York: Guttmacher Institute, 2014.
235

Convention on the Elimination of All Forms of Discrimination Against Women Committee, Concluding Observations: Sierra Leone, para. 32, U.N.
Doc. CEDAW/C/SLE/CO/6 (2014).

236 While we recognises that adolescents and young people are vulnerable to acquiring a range of sexually transmitted infections(STIs), in this position paper we focus on HIV and AIDS as a critical SRHR issue.
237 UNAIDS, ‘Global Aids Update 2016’, p.1. Figures are estimates, with between 1.8 million and 2.4 million new HIV infections,and a total of between 34.0 million and 39.8 million people living with HIV worldwide. Available at
http://www.who.int/hiv/pub/arv/global-AIDS-update-2016_en.pdf?ua=1/
238 Ibid.
239 Ibid.
240 UNESCO (2014) 'In or Out? Asia-Pacific Regional Review of the Inclusion of Young Key Populations in National AIDS Strategic
Plans', p.vi. Available at http://unesdoc.unesco.org/images/0022/002285/228565E.pdf
241 The committee monitoring the Convention on the Right of the Child
242 Committee on the Rights of the Child, General Comment 3, para 4.
243 United Nations Economic and Social Council. Framework of Actions for the follow-up to the Programme of Action of theInternational Conference on Population and Development (ICPD) Beyond 2014. E/CN.9/2014/4
244 UNAIDS (2014) 'The Gap Report'
245 UNICEF. Annual Results Report 2014: HIV and AIDS. UNICEF, July 2015.
246 United Nations Joint Programme on HIV/AIDS, The Gap Report, (UNAIDS, Geneva, 2014)
247 United Nations Economic and Social Council. Framework of Actions for the follow-up to the Programme of Action of theInternational Conference on Population and Development (ICPD) Beyond 2014. E/CN.9/2014/4
248 248 Singh S, Darroch JE and Ashford LS, Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health2014, New York: Guttmacher Institute, 2014
249 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
250 Alli, F. et al (2013) 'Interpersonal relations between health care workers and young clients: barriers to accessing sexual andreproductive health care' Journal of Community Health 38(1):150-155
251 Oxfam International. ‘Reducing Vulnerability to HIV before and after Disasters.’ UNICEF, 2008.
252 UNAIDS. 2015. HIV in Emergency Contexts: Background Note. Agenda Item 9. Thirty-sixth Meeting, 30 June–2 July.
Programme Coordinating Board. Geneva: UNAIDS
253 Committee on the Rights of the Child, General Comment No. 3 (2003), CRC/GC/2003/1
254 Ibid para 36(3)255 Plan International, Ending Harmful Practices Against Children, 2015
256 UNICEF (2016) Female genital mutilation/cutting: A global concern
http://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf
257 WHO Fact sheet, Female Genital Mutilation, updated February 2016.
258 WHO Fact sheet, Female Genital Mutilation, updated February 2016.
http://www.who.int/reproductivehealth/topics/fgm/health_consequences_fgm/en/
259 United Nations Children’s Fund, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics ofChange (New York, 2013)
260 WHO Fact sheet, Female Genital Mutilation, updated February 2016
261 United Nations General Assembly (2014).Report of the Secretary General on intensifying global efforts for the elimination of
female genital mutilations. A/69/211
262 Plan International, Ending Harmful Practices Against Children, 2015
263 Ibid
264 Ibid
265 WHO Fact sheet, Female Genital Mutilation, updated February 2016
266 A/RES/67/146
267 http://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf
268 Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation
269 A full position paper will be developed on CEFM in 2017.
270 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
271 United Nations Children’s Fund, Ending Child Marriage: Progress and prospects, UNICEF, New York, 2014.
272 ibid

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273 Child marriage is only projected to fall from 25 per cent to around 22 per cent between 2015 and 2030. See Nicolai, S., Hoy, C.,
Berliner, T. and Aedy, T. Projecting Progress: Reaching the SDGs by 2030. Overseas Development Institute 2015.
http://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/9839.pdf
274 Darroch, J. et al, ‘Adding it Up:Costs and Benefits of meeting the contraceptive needs of adolescents (2016), Guttmacher
Institute.
275 World Vision. ‘Untying the Knot: Exploring Early Marriage in Fragile States.’ UK: World Vision, March 2013.
276 Darroch, J. et al, ‘Adding it Up:Costs and Benefits of meeting the contraceptive needs of adolescents (2016), Guttmacher
Institute.
277 UNICEF global databases, 2016, based on DHS and MICS, 2007–2014.
278 United Nations Children’s Fund, Ending Child Marriage: Progress and prospects, UNICEF, New York, 2014.
279 ibid
280 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
281 United Nations Children’s Fund, Ending Child Marriage: Progress and prospects, UNICEF, New York, 2014.
282 Plan International (2013). The State of the World’s Girls 2013. In Double Jeopardy: Adolescent Girls and Disasters. Available
at: https://plan-international.org/state-worlds-girls-2013-adolescent-girls-and-disasters#download-options
283 CARE. 2015. “To Protect Her Honor” Child Marriage in Emergencies—The Fatal Confusion between Protecting Girls andSexual Violence. CARE International
284 Plan International Bangladesh, Child marriage in Bangladesh. June 2013.
285 Only half of all children under the age of 5 in the developing world have had their births registered.
286 Plan International will produce a position paper on CEFM in 2017 in which we will expand on our position and work on CEFM.
287 A forthcoming position paper on CEFM will be developed in 2017.
288 UNICEF, ‘Hidden in Plain Sight: A Statistical Analysis of Violence against Children’, 2014. p. 167. Available at:
http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
289 Ibid. This was true for all but 3 out of 21 countries with comparable data.
290 UNICEF, ‘Hidden in Plain Sight: A Statistical Analysis of Violence against Children’, 2014. p. 65. Available at:
http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
291 Ibid. Only 3 per cent of adolescent boys in Mozambique reported that they had ever been victims of sexual violence, compared
to 9 per cent of adolescent girls.
292 Ibid.
293 UNESCO Bangkok Office. THA/DOC/HP2/14/016. Available at: http://unesdoc.unesco.org/images/0022/002277/227752E.pdf
294 Plan International, A Girls’ Right to Learn Without Fear: Working to end gender-based violence at school, (Woking, 2013), p. 11
295 UNESCO, School-related gender-based violence is preventing the achievement of quality education for all (NY, 2015). Policy
Paper 17. Available at http://unesdoc.unesco.org/images/0023/002321/232107e.pdf
296 Plan International, A Girls’ Right to Learn Without Fear (2013), p.7.
297 Plan International, A Girls’ Right to Learn Without Fear (2013), p.17.
298 WHO News release, Violence against women: a ‘global health problem of epidemic proportions’ 20 June 2013: Geneva.
299 The World’s Women 2015 Trends and Statistics, Chapter 6 Violence Against Women, United Nations Department of Economic
and Social Affairs, 2015
300 UNFPA, The Role of Data in Addressing Violence against Women and Girls, (NY, 2013), p.4. Available athttps://www.unfpa.org/sites/default/files/resource-pdf/finalUNFPA_CSW_Book_20130221_Data.pdf
301 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
302 Jewkes, R et al; Sexual Violence. In: Krug EG et al, editors. World report on violence and health. Geneva: World HealthOrganisation. 2002.
303 Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking andsexual and other types of exploitation
304 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
305 The World’s Women 2015, Trends and Statistics, Chapter 6, Violence against Women’, UNDESA 2015. 68 per cent of everpartnered women in Kiribati had been subjected to violence by an intimate partner
306 ibid
307 United Nations Office on Drugs and Crime, Global Study on Homicide (Vienna, 2013)
308 UNFPA has found that girls who get pregnant before the age of 18 are more likely to experience violence within marriage orpartnership than girls who postpone child-bearing. See: UNFPA, Adolescent Pregnancy: A review of the evidence, (NY, 2013).
Available at https://www.unfpa.org/sites/default/files/pub-pdf/ADOLESCENT%20PREGNANCY_UNFPA.pdf
309 UNICEF, ‘Hidden in Plain Sight: A Statistical Analysis of Violence against Children’, 2014.. Available at:
http://files.unicef.org/publications/files/Hidden_in_plain_sight_statistical_analysis_EN_3_Sept_2014.pdf
310 Plan WARO (2009), Adolescent Sexual Health in West Africa: Rights, Realities, Responses, p. 16-17
311 Behrendt A, Mbaye SM (2008) Mental health of children formerly associated with the fighting forces in Liberia: A cross section
study in Lofa County. Plan West Africa; Dakar, Senegal.
312 See Farley, M. et al. (2003), Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress
Disorder, Journal of Trauma Practice, Vol. 2, No. 3/4, 2003, pp. 33-74
313 Behrendt A, Mbaye SM (2008) Mental health of children formerly associated with the fighting forces in Liberia: A cross section
study in Lofa County. Plan West Africa; Dakar, Senegal.
314 European Parliament Policy Department C Citizens’ Rights and Constitutional Affairs. Sexual exploitation and prostitution andits impact on gender equality. Study 2014.
315 UNODC, Global Report on Trafficking in Persons 2014. (NY, 2014), p.5. Available at https://www.unodc.org/documents/dataand-analysis/glotip/GLOTIP_2014_full_report.pdf
316 Ibid, p. 29.
317 These provisions exist in a number of countries, including Lebanon, Malta and Palestine. See Equality Now, Words & Deeds:
Holding Governments Accountable in the Beijing +20 Review Process: Ending Sex Discrimination in the Law. January 2015.
318 A forthcoming position paper on Freedom from violence and fear will address gender-based violence in more detail.
Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 43

319 As stated in the Universal Declaration of Human Rights, as well as other conventions, including CEDAW and CRC.
320 For more info, see for example UNFPA, State of the world population 2015. Shelter from the Storm.
321 United Nations Population Fund (2015). State of the World Population 2015: Shelter form the Storm. New York.
322 DFID Briefing Paper, October 2013. Violence Against Women and Girls in Humanitarian Emergencies: CHASE Briefing Paper.
323 Women’s Refugee Commission (2014). I’m Here: Adolescent Girls in Emergencies. Available at:https://womensrefugeecommission.org/resources/document/1078-i-m-here-report-final-pdf
324 Article 8 (2) of the Rome Statute of the International Criminal Court states: “For the purpose of this Statute, ‘war crimes’ means:... (b) Other serious violations of the laws and customs applicable in international armed conflict, within the established framework ofinternational law, namely, any of the following acts: ... (xxii) Committing rape, sexual slavery, enforced prostitution, forced
pregnancy, as defined in article 7, paragraph 2 (f), enforced sterilization, or any other form of sexual violence also constituting agrave breach of the Geneva Conventions”.
325 Article 7 of the Rome Statute of the International Criminal Court states: ”For the purpose of this Statute, ‘crime against
humanity’ means any of the following acts when committed as part of a widespread or systematic attack directed against any civilian
population, with knowledge of the attack: ... (g) Rape, sexual slavery, enforced prostitution, forced pregnancy, enforced sterilization,or any other form of sexual violence of comparable gravity”.
326 http://www.un.org/en/women/endviolence/orangedayaugust2013.shtml
327 Women’s Refugee Commission (2014). I’m Here: Adolescent Girls in Emergencies. Available at:https://womensrefugeecommission.org/resources/document/1078-i-m-here-report-final-pdf
328 Plan International in numbers/ Plan 2015 global reporting survey
329 Plan International Our priorities in sexual and reproductive health. [online] https://plan-international.org/what-we-do/ourpriorities/sexual-and-reproductive-health (accessed 29 January 2016) [check and update date]
330 Plan International commitments to World Humanitarian Summit
331 Plan International ROA (2011): Plan’s Reference Framework for the Realisation of Sexual and Reproductive Rights 2011-2016.
332 Hunt, Paul. (2004) UN Doc. E/CN.4.2004.49.En
333 Para 7.3 ICPD
334 Para 10.25
335 United Nations Economic and Social Council. Framework of Actions for the follow-up to the Programme of Action of theInternational Conference on Population and Development (ICPD) Beyond 2014. E/CN.9/2014/4
336 Para 96 of United Nations, Beijing Declaration and Platform of Action, adopted at the Fourth World Conference on Women, 27
October 1995
337 Approximately 180 governments agreed on the Cairo Programme of Action. The Beijing Declaration and the Platform of Action
was agreed unanimously by 189 countries. The Main Committee of the ICPD also adopted ad referendum the entire Programme of
Action on 12 September 1994.
338 UN GA Res. 49/128 of 19 December 1994; UN GA Res. 50/124 of 20 December 1995; and GA Res. 50/123 of 23 February
1996
339 Erikkson, M (2000). Reproductive Freedom in the context of International Human Rights and Humanitarian Law, [referencing L
Katzive and K.H.Martinez, Roe v Wade in the Global Context: International Recognition of Abortion Rights, ASIL, Human Rights
International Group Newsletter, 1998, vol 8, No.1, p.4]
340 UN Women (2015) The Beijing Declaration and Platform of Action Turns 20 (Summary Report)
341 Convention on the Rights of the Child 1989, entered into forced on 2 September 1990.
342 Committee on the Rights of the Child, General Comment No. 3 (2003), CRC/GC/2003/1
343 Ibid, para 13.
344 Ibid para 36(3)345 Ibid para 17
346 Ibid para 7
347 Ibid para 8
348 Ibid para 16
349 Ibid para 24
350 Ibid para 27
351 Committee on the Rights of the Child, General Comment 15, para 12.
352 Committee on the Rights of the Child, General Comment 15, para 19.
353 Committee on the Rights of the Child, General Comment 15, para 24.
354 Committee on the Rights of the Child, General Comment 15, para 56.
355 See, e.g., CRC Committee, concluding Observations to: Chad, 30, U.N. Doc. CRC/C/15/Add.107 (1999); Chile, 55, U.N. DOC.
CRC/C/CHL/CO/3 (2007); Palau, 46, U.N. DOC. CRC/C/15/Add.149 (2001); Uruguay, 51, U.N. Doc. CRC/C/URY/CO/2 (2007) );CRC Committee, General Comment No. 15: The right of the child to the enjoyment of the highest attainable standard of health,(62nd Sess., 2013), in Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty
Bodies, 70, U.N. Doc. CRC/C/GC/15 (2013).
356 Committee on the Rights of the Child, Concluding Observations: Austria, (1999) UN Doc. CRC/C/15/Add.98; see also Councilof Europe, L. and V. v. Austria, Applications nos. 39392/98 and 39829/98, Judgement of 9 January 2003, and S.L. v. Austria,
Application No. 45330/99, Judgement of 9 January 2003.
357 Convention on the Elimination of All Forms of Discrimination Against Women 1979.
358 CEDAW General Recommendation No. 24: Article 12 of the Convention. Adopted at the 20th session of the Committee on the
Elimination Against Women (1999) A/54/38/ Rev.1, chap.1)
359 Ibid General recommendation No. 24, para 14
360 Ibid General recommendation No. 24 para 18
361 Ibid. General Recommendation No. 24 para 31(c)362 Committee on the Elimination of Discrimination Against Women, General Recommendation No. 30, para 52(c)363 This statement is an interpretation of the CEDAW View No. 22/2009 case L.C. v. Peru the where CEDAW Committee found thatthe government had violated a pregnant girl’s rights by prioritising the foetus over her health. The CEDAW Committee held that thedenial of a therapeutic abortion and the delay in providing the surgery constituted gender-based discrimination and violated her
Sexual and Reproductive Health and Rights: Plan International’s Position Paper - 2016 - 44

rights to health and freedom from discrimination. (L.C. v. Peru, CEDAW Committee, Commc’n No. 22/2009, 8.15, U.N. Doc.
CEDAW/C/50/D/22/2009 (2011).
364 Committee on Economic, Social and Cultural rights, General Recommendation No. 22 (paras 28, 34, 41)
365 Committee on Economic, Social and Cultural rights, General Recommendation No. 22 (para 44)
366 Convention on the Rights of Persons with Disabilities 2006, entered into force on 3 May 2008
367 Committee on the Rights of Persons with Disabilities, General comment No. 2, para 40
368 The framework was adopted by UN Member States in March 2015 as the first major agreement of the Post-2015 development
agenda. It aims to achieve “the substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic,
physical, social, cultural and environmental assets of persons, businesses, communities and countries.”
369 UNISDR (United Nations International Strategy for Disaster Reduction). 2015. Sendai Framework for Disaster Risk Reduction
2015-2030. Geneva: United Nations Office for Disaster Risk Reduction. Paragraph 30j states: “At national and local levels, it isimportant to…. strengthen the design and implementation of inclusive policies and social safety-net mechanisms, including throughcommunity involvement, integrated with livelihood enhancement programmes, and access to basic health care services, including
maternal, newborn and child health, sexual and reproductive health, … to empower and assist people disproportionately affected bydisasters.”

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