Eszter Kismodi

Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11)

Abstract The World Health Organization is developing the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), planned for publication in 2017. The Working Group on the Classification of Sexual Disorders and Sexual Health was charged with reviewing and making recommendations on disease categories related to sexuality in the chapter on mental and behavioural disorders in the 10th revision (ICD-10), published in 1990. This chapter includes categories for diagnoses based primarily on sexual orientation even though ICD-10 states that sexual orientation alone is not a disorder. This article reviews the scientific evidence and clinical rationale for continuing to include these categories in the ICD. A review of the evidence published since 1990 found little scientific interest in these categories. In addition, the Working Group found no evidence that they are clinically useful: they neither contribute to health service delivery or treatment selection nor provide essential information for public health surveillance. Moreover, use of these categories may create unnecessary harm by delaying accurate diagnosis and treatment. The Working Group recommends that these categories be deleted entirely from ICD-11. Health concerns related to sexual orientation can be better addressed using other ICD categories.

Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach

We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, womens health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality.

Criminalising Consensual Sexual Behaviour in the Context of HIV: Consequences, Evidence, and Leadership

This paper provides an overview of the use of the criminal law to regulate sexual behaviour in three areas of critical importance: (1) HIV exposure in otherwise consensual sex, (2) sex work and (3) sexual activity largely affecting sexual minorities. It analyses criminal law pertaining to these three distinct areas together, allowing for a more comprehensive and cohesive understanding of criminalisation and its effects. The paper highlights current evidence of how criminalisation undermines HIV prevention and treatment. It focuses on three specific negative effects of criminalisation: (1) enhancing stigma and discrimination, (2) undermining public health intervention through legal marginalisation and (3) placing people in state custody. The paper also highlights gaps in evidence and the need for strong institutional leadership from UN agencies in ending the criminalisation of consensual sexual activity. This paper serves two goals: (1) highlighting the current state of research and emphasising where key institutions have or have not provided appropriate leadership on these issues and (2) establishing a forward-looking agenda that includes a concerted response to the inappropriate use of the criminal law with respect to sexuality as part of the global response to HIV.

Advancing sexual health through human rights: the role of the law.

Since the International Conference on Population and Development, definitions of sexuality and sexual health have been greatly elaborated alongside widely accepted recognition that sexual health requires respect, protection and fulfilment of human rights. Considerable progress has also been made in enacting or changing laws that affect sexuality and sexual health, in line with human rights standards. These measures include legal guarantees against non-discrimination and violence, decriminalisation of consensual sexual conduct and guaranteeing availability, accessibility, acceptability and quality of sexual health information and services to all. Such legal actions have had positive effects on health and specifically on sexual health, particularly for marginalised populations. Yet in all regions of the world, laws still exist which jeopardise health, including sexual health, and violate human rights. In order to ensure accountability for the rights and health of their populations, states have an obligation to bring their laws into line with international, regional and national human rights standards. These rights-based legal guarantees, while insufficient alone, are essential for effective systems of accountability, achieving positive sexual health outcomes and the respect and protection of human rights.

Conscientious objection to provision of legal abortion care

Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to womens health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing womens access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when referral is not possible. In addition, states should take all necessary measures to ensure that all women and adolescents have the means to prevent unintended pregnancies and to obtain safe abortion.

Maternal mortality and human rights: landmark decision by United Nations human rights body

Despite global commitment and prevention through well-known interventions progress has been slow towards Millennium Development Goal 5 of reducing global maternal mortality. The United Nations (UN) Human Rights Council has highlighted maternal mortality as an issue bearing not just on development but also on human rights. In August 2011 the Committee on the Elimination of Discrimination against Women became the first UN human rights body to issue a decision on maternal mortality. The case Alyne da Silva Pimentel v. Brazil established that States have a human rights obligation to guarantee women of all racial and economic backgrounds timely and non-discriminatory access to appropriate maternal health services. After the death of this Brazilian woman who died from pregnancy-related causes after a misdiagnosis and delay in provision of emergency obstetric care the Convention of All Forms of Discrimination against Women (CEDAW) argued that there was no effort to establish professional responsibility and that she was unable to obtain justice in Brazil. The Committee found violations of the right to access health care and effective judicial protection in the context of non-discrimination; cases like this furnish opportunities for international and domestic accountability. The Committee made several general recommendations intended to reduce preventable maternal deaths which include ensuring women’s rights to safe motherhood and emergency obstetric care providing professional training for health workers and implementing Brazil’s national Pact for the Reduction of Maternal and Neonatal Mortality.

Sexual Rights as Human Rights: A Guide for the WAS Declaration of Sexual Rights

It is with absolute pleasure that I introduce this technical document that provides supplementary information and materials to support our updated 2015 Declaration of Sexual Rights. This document h...

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH’s proposals for Paraphilic Disorders in ICD-11 are based on the WHO’s role as a global public health agency and the ICD’s function as a public health reporting tool.

Sexual rights as human rights: a guide to authoritative sources and principles for applying human rights to sexuality and sexual health

Abstract This Guide seeks to provide insight and resources to actors interested in the development of rights claims around sexuality and sexual health. After engaging with the vexed question of the scope of sexual rights, it explores the rules and principles governing the way in which human rights claims are developed and applied to sexuality and sexual health, and how that development is linked to law and made a matter of state obligation. This understanding is critical to policy and programming in sexual health and rights, as it supports calling on the relevant range of human rights, such as privacy, non-discrimination, health or other universally accepted human rights, as well as demanding the action of states under their international and national law obligations to support sexual health. Résumé Ce Guide cherche à transmettre des connaissances et des ressources aux acteurs intéressés par le développement de revendications relatives aux droits autour de la sexualité et la santé sexuelle. Après avoir abordé la question controversée de la portée des droits sexuels, il explore les règles et les principes qui gouvernent la manière dont les revendications fondées sur les droits de l’homme sont développées et appliquées à la sexualité et la santé sexuelle, et comment ce développement est lié à la législation et devient une obligation étatique. Cette compréhension est essentielle pour définir les politiques et la programmation en matière de santé et droits sexuels, car elle soutient les actions exigeant de bénéficier de tout l’éventail des droits de l’homme, comme la protection de la vie privée, la non-discrimination, la santé ou d’autres droits fondamentaux acceptés universellement, tout en demandant aux États de prendre des mesures au titre de leurs obligations juridiques nationales et internationale de soutenir la santé sexuelle. Resumen Esta Guía tiene como objetivo brindar conocimientos y recursos a los actores interesados en la formulación de afirmaciones de derechos relacionados con la sexualidad y salud sexual. Después de abordar la controvertida cuestión del alcance de los derechos sexuales, explora las reglas y principios que rigen la manera en que las afirmaciones de derechos humanos son formuladas y aplicadas a la sexualidad y salud sexual, y cómo esa formulación está vinculada con la ley y pasa a ser cuestión de obligación del Estado. Este entendimiento es fundamental para las políticas y programación en salud y derechos sexuales, ya que apoya hacer un llamado a los diversos derechos humanos pertinentes, tales como privacidad, no discriminación, salud u otros derechos humanos aceptados universalmente, así como exigir que los Estados tomen medidas, de conformidad con sus obligaciones de derecho internacional y nacional, para apoyar la salud sexual.

Abortion in Poland: politics, progression and regression

On the 23rd March 2018, tens of thousands of Polish citizens came together to stage protests opposing the “Stop Abortion” bill. In what has become known as the #BlackProtest movement, people dressed in black to mark their solidarity against attempts to restrict abortion. Their protest continues the line of an enduring movement, not only in Poland but across the world, for women’s right to safe abortion. Reproductive Health Matters (RHM) – a long-standing voice in support of women’s right to safe abortion – joined more than 200 other groups from across the world in support of the Polish protest movement to oppose the bill tightening abortion law in Poland. A letter called on members of Poland’s parliament to “listen to the voices of women across Poland and to reject this regressive legislative proposal and protect women’s health and human rights”. The “Stop Abortion” bill was approved for debate in January this year and got through the parliamentary committee in March. If passed, legislation will further confine the grounds on which abortion can be lawfully accessed. Poland has restrictive abortion laws which currently allow the procedure to be legally performed only if there is severe danger to the life of a woman or foetus, or if the pregnancy is a result of a criminal act, such as rape or incest. In the latest attempt to change the law, the ruling party in Poland is seeking to ban abortion in cases where the foetus has a severe abnormality. Slightly over one thousand abortions were legally performed in Poland in 2016. It is believed that there are many more illegal abortions, with estimates lying between 50,000 and 200,000. Women also travel to neighbouring countries in Europe to seek abortion, while others purchase abortion pills from the internet. Modern contraceptive methods are not freely available in Poland. The morning after pill, for example, requires a prescription and a consultation with a doctor. The condom is the only over the counter contraception available. In 2015, the use of modern methods of contraception was 47.7% among married or inunion women aged 15–49 years, one of the lowest in Europe.