The right to health and the sexual and reproductive rights of women and girls in Cameroon: what guarantee in a fragile economic context?
Keywords:
sexual and reproductive rights- women-girl-right to health-CameroonAbstract
The guarantee of the sexual and reproductive rights of women and girls in Cameroon, in spite of the sectoral health strategies, programmes and reproductive health policies that have succeeded one another over the years, remains insufficient. Although women and girls are considered a vulnerable segment of the population - apart from the disabled, the elderly and children - because of their exposure to the risks associated with sexual activity, the reality of the right of access to sexual and reproductive health services and care for women and girls still faces enormous inadequacies, of which material and financial resources are the most obvious. Indeed, state efforts to improve the enjoyment of these human rights are compromised by a climate of crisis where public resources allocated to health are the lowest in Africa and remain below the average for sub-Saharan African countries, and where 36% of households affected by poverty meet most of their health needs. It therefore seems logical to question the real capacity of the Cameroonian State to implement, through measures adapted to the needs of this target population, the commitments it has undertaken to protect their sexual and reproductive rights. This article provides an opportunity to assess the State's contribution to the exercise by women and girls of these rights enshrined in international, regional and national texts. The methodology envisaged consists of a critical analysis of State initiatives aimed at achieving and improving the protection of sexual and reproductive rights, with a view to identifying some of the shortcomings in the national system for the provision of sexual and reproductive health services and proposing strategies to strengthen the guarantee of these rights, so that the right to health is truly meaningful.
References
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2. To underline the inequity of these rights with other human rights, the Committee specified that: "The right to health implies both freedoms and rights. Freedoms include the right to control one's own health and body, including the right to sexual and repro ductive freedom, as well as the right to integrity, including the right not to be subjected to torture and not to be subjected without consent to medical treatment or experimentation (...)".
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4. The ICPD defines reproductive health in its Programme of Action as " the general physical, mental and social well -being of the human person, in all matters relating to the reproductive system and to its functions and processes, and not merely the absence of disease or infirmity’’.
5. In its General Regulation 21; equality of the family, 1994, § 22, the CCEDAW establishes the fact that "the woman is the main concerned in this case, because she is the one who carries the pregnancies; pregnancy planning contributes to improving the genera l quality of life and health of the population; to preserving the environment and the voluntary limitation of population growth, etc. (…)”.
6. The UN has highlighted the close interaction between the protection of the right to sexual and reproductive health and development in the setting of the Millennium Development Goals (MDGs). Three of the MDGs are components of sexual and reproductive rights: MDG4=reducing child mortality; MDG5=improving maternal health; and MDG6= combating HIV/AIDS.
7. The criteria of end owment, i.e. the availability of available resources; acceptability by users; adaptability in the sense that the provision of resources adapts to social changes; and the criterion of accessibility, which implies the absence of discrimination whether physic al, cultural or economic, are the fundamental elements to be found in any health system. On this subject, see Roman D, La justiciabilité des droits sociaux ou les enjeux de l'édification d'un Etat de droit JHRLP (2020) 75–89 © Law Journals 2020. All Rights Reserved Page 85 social. La Revue des droits de l’homme [Internet] 2012 [cited 2020 Jan 26] ; 1 :1 - 41p. Available from : http//revdh.revues. org/635.
8. Physical access to health facilities; the quality of care; the existence of an incentive system for health personnel; and the management of the health system, constitute indicators of the functioning of a health system, while health indicators include data on life expectancy at birth; crude birth rate; maternal; infant; neonatal; and child mortality rates, among others. Health indicators in Cameroon show that the health -related Millennium Development Goals that were to be achieved by 2015 have not been met in the country. Source: Ministry of Public Health. Sectoral Strategy for health (2001 - 2015) Report. Yaoundé: Ministry of Public Health; 2014. 130p. Moreover, according to th e 2018 UNDP report on human development indices and indicators, Cameroon is 151st out of 189 countries, ranking it as a country with an average human development index.
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10. Health policies as enacted by the African Charter for Health Development; the 1978 Alma-Ata Decla ration on Primary Health Care; the 2001 Abuja Declaration, etc., are not always in line with the principles of the African Charter for Health Development.
11. Article 12 of the ICESCR defines this right as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (...). The measures that the States Parties to the Covenant shall take ... shall include: (a) the creation of conditions which would assure to all medical service and medical attention in the event of sickness".
12. Diaz. O. L, Plat D, Pochet P. Se déplacer pour se soigner. Pratiques et obstacles à Conakry et à Douala. Cahiers de géographie du Québec. Dpt. of Geography. Laval Univ. 2011; 55 (156): p 3.
13. In terms of geographical accessibility to health facilities, 80.4% of households are within 5kms of health training, although disparities between urban and rural areas still persist, and also depend on the type of training, i.e. whether it is a hospital, o r a health centre or other. Source : United Nations Population Fund. Pourquoi investir dans la santé de la reproduction au Cameroun ? Report. Yaounde: United Nations Population Fund; 2012. The Report stresses that access to health infrastructure is not a p roblem in Cameroon in general.
14. Access to information and sex education has enabled nearly 96% of women and girls to have extensive knowledge about sexually transmitted infections and HIV/AIDS and their prevention.
15. National Institute of Statistics . Enquête Démographique et de Santé (2018), Report. Yaoundé : National Institute of Statistics ; 2019.71p. The Report states that t he prevalence rate among men rose from 4.1% in 2004 to 2.9% in 2011 and 1.9% in 2018, while a mong women and girls it rose from 6.6% to 5.6%, then 3.4% during the same period. Overall, the HIV prevalence rate is 2.7% in 2018 compared to 5.4% in 2004
16. Article 14 (1) - (2) of the Convention on the Elimination of Discrimination against Women calls on a ll States Parties to "take all appropriate measures to eliminate discrimination against women in health care with a view to ensuring on the basis of gender equality, the means to access medical services, including those related to family planning (...) ». States guarantee women during pregnancy, during childbirth and after childbirth, appropriate services and, if necessary, free services (...)”.
17. 72% in urban areas against 49% in rural areas. 78% of those with secondary education; 83% with higher education a nd 33% of those with no education or a very low level of education receive post -natal care immediately after delivery. Source: Institut National De La Statistique. Enquête Démographique et de Santé (2018), Report. Yaoundé: Institut National de la Statistique; 2019.71p. JHRLP (2020) 75–89 © Law Journals 2020. All Rights Reserved Page 86
18. 59% of births in 2004 took place in a health facility compared to 67% in 2018, while 59% in 2004 compared to 69% in 2018 represents the rate of skilled attendants involved in childbirth, Ibid. p.35
19. 68% of uneducated women and girls receive antenatal care, compared to 99% of educated women and girls. Economic status influences the provision of such care. 68% among women in the lowest welfare quintile; compared to 83% among those in the second quintile and 99% among th ose in the highest economic welfare quintile. Ibid. p.32
20. World Health Organization/ Cameroon, Strategy for cooperation, An overview. Report. Yaounde: World Health Organization; May 2018. 2p.
21. United Nations Population Fund . Pourquoi investir dans la santé de la reproduction au Cameroun? Report. Yaounde: United Nations Population Fund; 2012. 38p.
22. The expected level for each country in 2015 for the main health indicators was 25 deaths per 1000 live births for infant mortality and 250 deaths per 100,000 live births for maternal mortality. See Ministry of Public Health. Sectoral Strategy for health (2001 -2015) Report. Yaoundé: Ministry of Public Health; 2014. p7.
23. By way of illustration, in communication No. 17/2008 (2011), Lour des Da Pimentel v. Brazil, the Committee on the Convention on the Elimination of Discrimination against Women (CCEDAW) concluded that the State's refusal to provide the complainant with access to obstetric care constituted a violation of the Convention. Li kewise, the Inter-American Court of Human Rights in the case of Communidal Indigena Xakmok Kasek v. Paraguay, of 24/08/2010, decided that the impossibility for poor indigenous women to have access to adequate obstetric care constituted a violation of the right to life. The European Court of Human Rights, in the matter of reproductive rights, decided in the case of V.C v. Slovakia (2011) that "forced sterilisations constitute a major interference with a person's reproductive health status (...). This practic e affects multiple aspects of a person's personal integrity, including his or her physical and mental well -being, as well as his or her emotional, spiritual and family life”.
24. The CESCR emphasizes in its General Comment 22 that "the achievement of the highest attainable standard of sexual and reproductive health consists in "facilitating access to a range of health goods, services and information that will enable everyone to enjoy fully the right to sexual and reproductive health as set out in article 12 of the Covenant".
25. Ministry of Public Health. Sectoral Strategy for health (2016 -2027) Report . Yaoundé: Ministry of Public Health; 2016. pp 68-69
26. The share of the state budget allocated to the health sector is 5.5%, which is below the average for sub-Saharan African countries and below the WHO recommendation and the Abuja Declaration recommendation of 10% and 15% respectively. See Raju Jan S. Cahiers économiques du Cameroun, vers une plus grande équité. Special number on health. Jul. 2013.
27. United Nations Population Fund . Pourquoi investir dans la santé de la reproduction au Cameroun? Report. Yaounde: United Nations Population Fund; 2012. P 19. The report notes that in terms of geographical coverage in UN health facilities, there are nearly 03 per 500,000 inhabitants; the Northern Region has none. Out of 07 regions surveyed in 2011, the average of 2.99 is well below the norm.
28. In Mauritania, 72% of the subsidies paid to hospitals benefit the richest 40% of the population; in Ghana 1/3 of public health expenditure benefits the richest quintile while 12% goes to the poorest quintile. This unequal distribution of spending is also f ound between urban and rural spending. See Jacquemot P. Les systèmes JHRLP (2020) 75–89 © Law Journals 2020. All Rights Reserved Page 87 de santé en Afrique et l’inégalité face aux soins. De Boeck Supérieur « Afrique contemporaine ». 2012 ; 3 (243) : 97
29. Articles 14 & 14 (2) (a) of the Convention on the Elimination of All Forms of Discrimination against Women and the Optional Protocol to the Charter on Human and Peoples' Rights on the Rights of Women (2003 Maputo Protocol), respectively.
30. Most qualified doctors are concentrated in the Central, Western and Coastal regions. 40% of doctors are in the Central region which has 18% of the national population, compared to 8% of doctors in the Far North region which also has 18% of the country's total population. In addition, there is 1 hospital per 45,000 inhabitants and 1 health centre per 12,000 inhabitants. See World Health Organization/Ministry of Public Health. Mapping and evaluation of drug supply and distribution systems, (indicators and determinants of health in Cameroon). Report. Yaoundé: Ministry of Public Health ; 2009.pp15-16
31. The WHO forecasts 01 doctor per 1000 inhabitants, yet in Cameroon there are 01 doctors per 10,000 inhabitants. See Edimo F. Regard sceptique sur le droit à la santé au Cameroun. Juridical Tribune. 2013 ; 3 (2) : p75
32. These harmful practices, which can be assimilated to acts of torture, inhuman and degrading treatment, are common in nearly 29 African countries, according to the AU. The organization reveals that by 2050, one in three births will occur in countries where these violations of bodil y integrity are committed.
33. According to the UNFPA report, 44% of women and girls in sub -Saharan Africa suffered physical, physiological and sexual violence in the year 2018. 06 out of 10 countries with the highest prevalence of child marriage are in West and Central Africa, according to the 2018 UNICEF report. The proportion of girls aged 20 -24 who are married before the age of 15 -18 remains the highest in the world.
34. Africa has a high rate of unwanted pregnancies. Sexual violence, opposition to contr aceptive use by partners/guardians/parents, failed health policies and lack of access to contraception due to weak health systems contribute to low contraceptive use. According to the 2018 UNFPA report, 46% of women have unmet need for family planning, one of the consequences of which is the high maternal mortality ratio: 676 maternal deaths per 100,000 live births in Central and West Africa; 455 maternal deaths for the same number of live births in Eastern and Southern Africa.
35. The 2011 Demographic and Health Survey found that in the Northern and Northwestern regions, the age of marriage is between 8 and 9 years; 28.1% of women aged 25-49 years were married by the age of 15 years and 62% by the age of 18 years. According to the UN, 20% of women have been forced to have their first sexual intercourse; See Ngono A. E. Violence à l’égard des femmes: cas du Cameroun. Fundacion recover (Cameroon) [serial one]. 2018 Nov 25 [cited 2019 Dec 02] Available from : https://www. fundacionrecover.org/blog/violence-a- legard-des-femmes-cas-du-cameroun
36. There is a high prevalence in the Far North region (5.4%); in the Northern region it was 2.2% in 2004. 20% of the female population undergoes such practices; the regions most affected a re the Far North, the North and the South-West. See for this purpose, Direction des recherches, Commission de l'immigration et du statut du réfugié. Information on Female Genital Mutilation (FGM), including the frequency of the practice and the ethnic groups most affected; laws on the subject and protection offered by the State. [Internet]2005 May 25[cited 2019 Dec 02];Available from https://www.refworld.org/docid/42df60c6 2.html (accessed 10/12/2019).
37. Genital mutilation is legal only if undertaken by an "a uthorized person" and in accordance with the law.
38. The Universal Declaration of Human Rights (arts. 3, 5, 7, 8, 12, 25); the International Covenant on Civil and Political Rights (arts. 7 and 17; 9; 24); the International Covenant on Economic, JHRLP (2020) 75–89 © Law Journals 2020. All Rights Reserved Page 88 Social and Cul tural Rights (arts. 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24); the International Covenant on Economic, Social and Cultural Rights (arts. 12, 23, 24); the International Covenant on Economic, Social and Cultural Rights (arts. 12, 24, 25); the Inter national Covenant on Civil and Political Rights (arts. 7 and 17; 9; 24); the International Covenant on Economic, Social and Cultural Rights (arts. 12 ); the Convention on the Elimination of All Forms of Discrimination against Women (art. 1): art. 3 of the Convention on the Rights of the Child which establishes the notion of the "best interests" of the child and art. 24(3) which establishes the State as ultimately responsible for these best interests. Arts.5 of the Maputo Protocol; 4(1); 3; 5(2); 10; 14(1) a nd 21(1) of the African Charter on the Rights and Welfare of the Child are international instruments that prohibit, albeit implicitly, the commission of female genital mutilation.
39. The Convention on the Elimination of All Forms of Discrimination against Wom en does not specifically mention FGM, but refers to it in General Comments Nos. 14, 19 and 24 of the Convention Committee. These General Comments highlight the serious consequences of FGM on the health of women and girls who undergo it. While indicating th at these practices constitute violence against women, the Committee recommends that States take measures to eradicate them.
40. The Committee on Economic, Social and Cultural Rights, in its General Comment 14§59, stated that any victim of violations of the right to health should have access to effective judicial or other appropriate remedies at the national and international levels.
41. According to the Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of Int ernational Human Rights Law and Serious Violations of International Humanitarian Law, UN General Assembly Resolution 60/147 of 16 December 2005, § 18, reparations must redress the consequences of the violation and must take the form of restitution, compensation, rehabilitation, and guarantees of non-repetition.
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45. In vitro fertilization (IVF) costs between 800,000 and 1,500,000 CFA francs in Cameroon, according to Dr Ernestine Gwet Bell, gynaecologist -obstetrician. Read on this subject, Abdoulaye Diarra . Dr Ernestine Gwet Bell, à l’origine du premier bébé né in vitro en Afrique centrale. Info Afrique. Economie e t numérique [Internet]. 2012 Dec 26[cited 2019 Dec 13]; Available from https:// www.info-afrique.com/dr-ernestine-gwet- bell-a-lorigine-du-premier-bebe-ne-in- vitro-de-lafrique-centrale/
46. The article states: "The States Parties to the present Covenant recognize the right of everyone to enjoy the benefits of scientific progress and its applications".
47. Irradac. Couverture santé universelle au Cameroun : enjeux et perspectives. 2018 ; Yaoundé JHRLP (2020) 75–89 © Law Journals 2020. All Rights Reserved Page 89
48. The objective of the target of universal health coverage as defined in the agenda is to ensure that everyone benefits from health insurance that includes protection against financial risks and provides access to quality essential health services and safe, effective, quality and affordable essential drugs and vaccines.
49. Swiss Refugee Aid Organization. Cameroon: Access to health care and special education. Report . Bern: Swiss Refugee Aid Organization; Feb 2019. See Atcha E. Le Cameroun devra mobiliser 1.300 milliards Fcfa pour l a couverture santé universelle. Afrique La Tribune [Internet].2017 Dec 16[cited 2020 Dec 16]; Available from https://afrique. latribune.fr/afrique-centrale/cameroun/ 2017-12-16/le-cameroun-devra-mobiliser- 1-300-milliards-fcfa-pour-la-couverture- sante-universelle-761984.html Cite this Article Kamgang Simeu Christelle Corinne . The Right to Health and the Sexual and Reproductive Rights of Women and Girls in Cameroon: What Guarantee in a Fragile Economic Context?. Journal of Human Rights Law and Practice . 2020; 3(1): 75–89p.
