This document provides information on sexual and reproductive health and rights for migrants, sex workers, and adolescents and youth. It discusses key objectives and learning outcomes, human rights frameworks, and international, regional, and national legal instruments relevant to migrants' access to healthcare. The document also defines sexual and reproductive health and rights, outlines considerations for migrants, women, sex workers, and adolescents, and proposes a minimum healthcare package to promote these populations' sexual and reproductive health and rights.

1. Module 3
Sexual and Reproductive Health
and Rights
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2. Objectives
To promote the SRH rights of migrants, sex
workers and AYP
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3. Learning Outcomes
By the end of this session, participants should be
able to
• Identify different global, regional and national
policy instruments that impact on migrants’,
AYPs and sex workers rights to health.
• Demonstrate an understanding of the SRHR of
migrants, AYPs and sex workers.
• Describe the minimum SRHR package for
migrants and migration affected communities
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4. Human rights
• Human rights are the basic rights and freedoms that
belong to all human beings (people) from the time of
birth until death.
• These are applied irrespective of nationality, country of
residence, sex, race, color, religion, language, or any
other status.
• rights are aimed at safeguarding the inherent dignity and
equal worth of everyone; they are inalienable,
interdependent and interrelated
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5. Features of human rights
Human Only human beings are entitled to human rights. Other legal entities (e.g.
businesses), animals or the environment are not entitled to human rights
Universal They apply to all persons throughout the world
Fundamental They are important basic rights and should be given special protection by law
Treat all as equal Human rights recognize that all humans are born free and equal in dignity
and rights
Protect individuals
from the state
States can’t take away these rights; they must respect, protect and fulfil human
right
Inalienable They cannot be forfeited (given up), transferred or lost
Inter-related and inter-
dependent
Human rights are linked and dependent on each other. The use and
enjoyment of a human right is dependent on an individual having all other
rights as well
Recognize the
principle of humanity
Certain rights are absolute, for example, the rights to life, freedom from torture
and freedom from slavery cannot be limited. Other human rights can only be
limited in specific circumstances
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6. Migration and the Law
• All migrants, by virtue of their human dignity and
without discrimination, are protected by
international human rights law, on the same
footing as nationals.
• International human rights instruments prohibit
discrimination on ground of one’s place or
country of origin. Therefore, migrants (just like
nationals/citizens) are entitled to the enjoyment
of civil, political, economic, social and cultural
rights, including health-related rights
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7. Legal and policy instruments
International
Regional
National
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8. International Instruments
A series of international human rights treaties and other
instruments adopted since 1945 have conferred legal form on
inherent human rights and developed the body of international
human rights. There are 9 core human rights instruments whose
implementation is monitored by different committees.
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9. Core human rights instruments
1) International Convention on the Elimination of All Forms of Racial
Discrimination
2) International Covenant on Civil and Political Rights
3) International Covenant on Economic, Social and Cultural Rights
4) Convention on the Elimination of All Forms of Discrimination
against Women
5) Convention against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment
6) Convention on the Rights of the Child
7) International Convention on the Protection of the Rights of All
Migrant Workers and Members of Their Families
8) International convention for the protection of all persons from
enforced disappearance
9) Convention on the rights of persons with disabilities
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10. Migration, Health SRHR instruments
International Convention on the Protection of the Rights of all Migrant
Workers and Members of their Families adopted by GA resolution 45/158 of
1990, entered into force 1 July 2003
• “any medical care that is urgently required for the preservation of their life
or the avoidance of irreparable harm to their health on the basis of
equality of treatment with nationals of the State concerned” (Article 9).
Resolution on Health of Migrants, 61st World Health Assembly (WHA), 2008
• adopted during the 61st WHA in May 2008. It calls upon member states
to: promote equitable access to health promotion and care for migrants;
establish health information systems in order to assess and analyze trends
in migrants’ health; and devise mechanisms for improving the health of all
populations, including migrants
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11. Migration, Health SRHR instruments
Declaration of Commitment on HIV and AIDS, United Nations General
Assembly Special Session on HIV and AIDS (UNGASS), 2001
• The relationship between the HIV/AIDS epidemic and migration was
recognized by the UNGASS in June 2001. Paragraph 50 of the Declaration
of Commitment on HIV and AIDS stipulates member states should:
“develop and begin to implement national, regional and international
strategies that facilitate access to HIV and AIDS prevention programmes
for migrants and mobile workers, including the provision of information on
health and social services.
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12. Migration, Health SRHR instruments
Political Declaration on HIV and AIDS, United Nations General Assembly
High Level Meeting on AIDS, 2011
• the Declaration calls upon Member States to ensure that financial
resources for prevention are “...targeted to evidence-based prevention
measures that reflect the specific nature of each country’s epidemic
focusing on... population vulnerable to HIV infection...”, and to ensure that
“...particular attention is paid to... migrants and people affected by
humanitarian emergencies...” (Paragraph 60).
• in Paragraph 84, the Declaration calls upon Member States to, “Commit to
address, according to national legislation, the vulnerabilities to HIV
experienced by migrant and mobile populations and support their access
to HIV prevention, treatment, care and support.”
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13. The rights Migrants (summarized)
• Right to the highest attainable standard of health
• Freedom of Movement (right to leave any country; right to liberty of movement
and freedom to choose residence within the territory; and right to enter one’s own
country)
• Protection against arbitrary detention
• Right to freedom from torture or cruel, inhuman or degrading treatment or
punishment
• Protection of the family (including family reunification & rights of the child)
• Right to education
• Right to life
• Right to shelter
• Right to adequate and clean drinking water
• Right healthy and safe working conditions
• The right to seek asylum
• The right to freedom from slavery of servitude
• The right to recognition as a person before the law
• The right to freedom of thought, conscience and religion
• Right to a clean and conducive environment, etc.
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14. The rights Migrants cont…
The International Convention on the Protection of the Rights of
All Migrant Workers and Members of Their Families (article 28)
states:
• all migrant workers and their families have the right to
emergency medical care to protect their lives or to prevent
harm to their health
• this care must be provided regardless if they are
undocumented or employed (United Nations, 1990) migrant
workers must be protected in the workplace and that they
shall enjoy the same treatment as nationals of the
Government of employment (article 25).
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15. Regional instruments
Governments have acknowledged the impact of migration
on development. Therefore, there are various regional
instruments and initiatives that support and call upon
Member States to address migration and health, including
but not limited to the following:
(Draft) SADC Policy Framework on Population Mobility
and Communicable Diseases, draft April 2009
• This Policy Framework provides guidance on the
protection of the health of cross-border mobile
populations with regard to communicable diseases and
guidance on the control of communicable diseases as
people move across borders
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16. Regional instruments
SADC Declaration and Code of Conduct on TB in the Mining
Sector, expected August 2012
• The subsequent draft Declaration on TB in the Mining Sector
outlines the justification, and outlines the priority areas for
urgent action for TB, HIV, Silicosis and other occupational
respiratory diseases in the mining sector
EAC Regional Integrated Multi-sectoral Strategic Plan for HIV &
AIDS 2008–2012
• The East African Community (EAC) HIV strategy aims to reduce
incidence of HIV infection as a step towards securing
sustained sub-regional socio-economic development
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17. Regional instruments
COMESA-EAC-SADC Tripartite Agreement
• In a June 2008 summit convened in Kampala, Heads of State
from 26 countries established a tripartite agreement aiming
to achieve the African Union (AU) objectives of accelerating
economic integration and achieving sustainable economic
development – thus alleviating poverty and improving quality
of life for the people of East and Southern Africa.
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18. National instruments
Most States have also adopted constitutions and other laws
which formally protect basic human rights. Respect for human
rights requires the establishment of the rule of law at the
national and international levels.
Laws can create both the guarantees to human rights and the
limitations. Laws that are not in harmony with SRH rights can
exclude or deter people from seeking and receiving the
information and services they need and to which they have a
right
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19. National instruments…..
• The majority of SADC countries do not have policy
frameworks that clearly set out the rights of migrants, AYP,
and sex workers, to access SRH services. For example, sex
work is illegal in many SADC countries; and same-sex
relationships are criminalised.
• Migrants, AYP, and sex workers often face different forms of
stigma and violence from the police, health care workers and
an active denial of health services.
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20. PROMOTION OF SRHR IN MIGRANTS,
SEX WORKERS AND AYP
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21. The right to health
The right to health is recognized by the international treaties listed below, as
well as in other declarations and statements, both international and
regional:
• Universal Declaration of Human Rights
• International Covenant on Economic, Social and Cultural Rights (ICESCR)
• International Convention on the Elimination of All Forms of Racial
Discrimination (ICERD)
• Convention on the Rights of the Child (CRC)
• Convention on the Elimination of All Forms of Discrimination against
Women (CEDAW)
• International Convention on the Protection of the Rights of All Migrant
Workers and Members of Their Families (ICPRMW)
• Convention on the Rights of Persons with Disabilities (CRPD)
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22. Definitions and concepts of SRHR
Sexual and Reproductive Health Rights (SRHR) encompass the right of all
individuals to:
• make decisions concerning their sexual activity and reproduction free
from discrimination, coercion, and violence
• Specifically, access to sexual and reproductive health rights ensures
individuals can choose whether, when, and with whom to engage in sexual
activity;
• choose whether and when to have children; and to access the information
and means to do so.
When human rights relate to people’s sexuality or reproduction, we call
them ‘sexual rights’ or ‘reproductive rights’. This is generally referred to as
SRH rights (SRHR).
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23. SRHR and migrants
• Migrants often have problems to access SRH and
other health services. This includes migrants who
require ongoing treatment for HIV.
• It is often difficult for migrants to enjoy the right
to health because of discrimination, language and
cultural barriers, or their legal status. Some
countries only provide in terms of “essential care”
or “emergency health care” for non-citizens
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24. SRHR and Women’s rights
• Women are entitled to all of the human rights
mentioned at the beginning of the section. Yet
almost everywhere around the world, women
and girls are still denied them, often simply
because of their gender.
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25. The minimum SRHR package:
 FP,
 HIV &STIs prevention & treatment,
 harmful cultural & traditional practices,
 gender, SGBV,
 migrants, sex workers & child rights,
 SRHR & Migration policies);
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26. Sex work and SRH rights
National or regional laws addressing commercial sex work among
women, children, and others who may solicit work informally or through
organized prostitution reflect varying cultural norms. Laws addressing
commercial sex work vary widely:
• Some countries fail to legislatively address the practice altogether. In these
places, sex work is not explicitly prohibited, but workers may still be selectively
targeted, harassed, and abused via prosecution for various infractions, such as
loitering, vagrancy, breach of public order, or lack of appropriate documentation
(e.g., passports, residency permits).
• Some countries permit informal sex work but seek to regulate its practice through
worker licensure, mandatory health screenings, and safe sex requirements.
• Other countries—examples include many countries of the developing world and
the Middle East, as well as most jurisdictions in the United States—prohibit sex
work by criminalizing related activities, such as solicitation, exchange of sex for
money, management of sex workers, and procurement.
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27. Sex work and SRH rights
Laws criminalizing sex work, by providing a legislative deterrent,
• are thought to reduce the incidence of sex work.
• These laws are meant to reduce the transmission of HIV and other sexually transmitted diseases
among sex workers, whose rates of HIV infection typically are significantly higher than those of the
general population.
However, criminalizing sex work, although it may reflect social norms in many countries, can actually
derail efforts to reach sex workers through public health interventions.
• Fear of prosecution, stigmatization, and discrimination keep sex workers from accessing
appropriate public health services or availing themselves of legal protections against rape and
sexual violence.
• Their claims of sexual violence are often disregarded or dismissed because of discrimination. In
effect, criminalization drives commercial sex work underground.
• With limited treatment options, scant information on the risks of HIV infection, and their own
inability to negotiate safer sex, millions of commercial sex workers are highly at risk of contracting
(and exposing others to) HIV.
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28. Sex work and SRH rights
For these reasons, UNAIDS72 and other international
organizations have supported the decriminalization of
commercial sex work that does not involve victimizing
individuals.
Protecting commercial sex workers also entails
• decriminalizing victims of international and domestic
trafficking.
• Historically, victims of trafficking were regarded
criminals subject to prosecution for prostitution, illegal
entry, and falsification of documents and were
sometimes forced to testify against traffickers.
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29. Adolescent SRH rights
• As children enter adolescence, as their bodies change
and as many of them start to explore their sexuality,
access to SRH information and services becomes
critical to the enjoyment of their human rights, their
health and wellbeing and their growing skills to make
informed decisions.
• Governments need to remove all barriers to SRHR
information and services, including those related to
marital status, parental or guardian consent and stigma
from providers.
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30. Adolescent SRH rights
SRH services and information should cater for the particular
needs of adolescents. Adolescent SRH programmes should:
• Improve adolescents’ knowledge about reproductive health
• Encourage a responsible and healthy attitude toward
sexuality
• Delay onset of sexual activity among younger adolescents
• Decrease risky behaviors among adolescents who are
already sexually active
• Provide youth-friendly services by trained service providers
and peer educators
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31. Rationale….
Why do SRHR matter?
• Sexual and reproductive health rights include the right to dignity, autonomy,
privacy, information and health.
Improving SRHR matters for:
• promoting gender equality, and
• because investment in SRH has personal, social and economic benefits, including:
 saving and improving people’s lives;
 slowing the spread of HIV;
 encouraging greater equality across genders;
 providing essential support to LGBTI people who have, historically, been excluded
from accessing sexual and reproductive health services in most parts of the world.
Improved access to SRHR can also stabilize population growth and reduce poverty.
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32. Rationale….
• Reproductive health is a lifetime concern for both
women and men, from infancy to old age.
• Evidence shows that reproductive health in any of
these life stages has a profound effect on one's
health later in life.
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33. Module 3 33
Component Summary of services
Sexuality: desire, pleasure and function Provide age-appropriate sexual health information, education and counselling for safe and satisfying sexuality, including on:
sexual development; sexual function and pleasure; mutually respectful sexual and
reproductive decision making; and all dimensions of the essential sexual and reproductive health and rights package
- Provide community education on cultural values that foster sexual and
reproductive health and rights and positive health seeking behaviours, and
support these values
Sexual and gender based violence Prevent and manage sexual and gender based violence
Promote cultural values that decrease the incidence of sexual and gender
based violence
Fertility Provide comprehensive contraception services
Provide safe termination of pregnancy
Address infertility
Maternal, perinatal and newborn
health
Provide antenatal care
Prevent mother-to-child transmission of HIV
Provide safe delivery care
Provide postpartum care
Provide postnatal care
Sexually transmitted infections,
including HIV and AIDS
Prevent and manage sexually transmitted infections
Initiate HIV counselling and testing
Manage HIV and AIDS
Initiate antiretroviral treatment
Follow up clients on antiretroviral treatment
Provide adherence and self-management support
Cancers of the reproductive system Prevent and manage cervical cancer
Prevent and manage breast cancer
Prevent and manage male reproductive tract cancers

34. Exercise
• Exercise 2.1 Migration And Health
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35. QUESTIONS
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