2.4.7 Application of Rights and its Impact on Different Kinds of Inequality

Facts/messages: “Health is the human right that in practice brings racial, social, and economic differences most sharply to the fore front”. The rights-based perspective is incompatible with the existence of inequalities of such magnitude that they result in functionings that fall below minimum standards in some groups (in the terminology of Amartya Sen). While capabilities to function represent the real opportunities a person has or the positive freedom of choice between different life-styles, functionings are described as what people may value being and doing. Funtionings include basic functions such as literacy and avoidance of preventable diseases, as well as community participation and self-respect. With regard to sexual and reproductive health (SRH), for example, a rights-based perspective can accept differences in secondary conditions for child delivery care (individual hospital bedroom or public ward, telephone or TV in room, etc.), but cannot accept differences in the probability of death during delivery in a hospital by social class. The latter are not mere inequalities, but inequities. “It is important to distinguish between inequality and inequity in health. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the first case it may be impossible or ethically or ideologically unacceptable to change the health determinants and so the health inequalities are unavoidable. In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair. The resulting health inequalities may also lead to inequity in health.”

As efforts advance to guarantee these rights, it is expected that inequities and hence the corresponding inequalities will be reduced. However, the extent to which this happens may depend on various factors. In this context, it may be important to differentiate between the extension of rights by means of targeted care or by means of universal policies. Although the extension of rights through targeted care may have a more immediate effect on the reduction of some inequalities, universal policies are preferred from the viewpoint of guaranteeing rights in the long term. One should also take into account that results may vary according to the sensitivity of political processes and interventions. For example, in countries in which almost all childbirths take place in hospitals, the responsibility of the state in guaranteeing minimal quality of care is immediate; however, if many of the childbirths take place at home, in isolated places, the processes necessary to guarantee the equality of results are more complex. The key issue in this section is to show the government’s response to the challenge of resolving inequality and whether or not it is thought that these actions are moving in the right direction. An example would be to allocate, train, skill midwives with Life Saving Skills (LSS) and link them to Emergency Obstetric Care.

A human rights-based approach to programming must ensure that processes of data collection and use are in line with human rights principles, and requires taking into account the extent to which existing services are available, accessible, acceptable and of high quality to the population. Here, the principles of participation and inclusion are critical to all population and development activities. The principle of accountability is crucial: through data collection, an evidence base is created for use in shaping development policies and programmes. Principles of universality and inalienability, indivisibility, interdependence and interrelatedness can strengthen population and development programmes by emphasizing intersections between human rights. Principles of equality and non-discrimination can contribute to increasing equity and to improving effectiveness of poverty reduction strategies in the long term. In order to determine a population’s needs with regard to services, assess the extent to which existing services are available, accessible, and acceptable and of high quality. The participation of a wide range of stakeholders is critical to all population and development activities, and it is important to recognize that partners and other stakeholders might require capacity-building in order to engage in such processes. The concept of accountability, and especially government accountability, is crucial in the whole area of population and development, especially with respect to data confidentiality.

Methodology: Analyze, on the one hand, the progress in extension of rights through the analysis of legal frameworks and policies and programmes and their implementation. In this context, it is necessary to characterize the kinds of measures (targeted, universal), the areas of intervention, and to estimate their potential impact in terms of the population that will potentially benefit from them. It is also important to identify those population segments that are unlikely to benefit and the reasons for their exclusion.

With respect to human rights-based programming UNFPA developed a manual on Human Rights-Based Approach to Programming – Practical Information and Training Materials. This Manual, produced through collaboration between UNFPA and the Harvard School of Public Health, provides step-by-step guidance on how to apply a culturally sensitive, gender-responsive, human rights-based approach to programming in each of UNFPA’s core areas of work, including population and development. The manual emphasizes that the work on population and development must pay special attention to culture and that there is a clear need for improved appreciation of linkages between population and poverty, requiring sensitivity to the cultural context. Culture, religion and tradition can have major impacts on individual reproductive choices, and thus on broader population and development matters.

Primary Sources:

  • Legislation and the country’s policy frameworks;
  • Moreover, the same sources cited under the previous sections, but analyzed from the perspective of the evaluation of legal and programmatic measures, to see, for example, if the main improvements correspond to the population segments that benefit most from these measures.

Secondary Source:

87   Booker and Minter (2001). Global Apartheid. In: The Nation, July 9, 2001, New York.
88   WHO. Webpage on Health Impact Assessment: http://www.who.int/hia/about/glos/en/index1.html (accessed last on 1 Oct. 2010).