WUNRN
http://www.wwda.org.au/confpaps2006.htm
‘Women With
Disabilities and the Human Right to Health’
Written by
Paper presented by Karin Swift
on behalf of WWDA at the Australian Women’s Health Network Conference,
NB: This is an edited version of the paper
presented to the Australian Women’s Health Network Conference. The full version
of this paper along with a powerpoint presentation is available on WWDA’s
website at: www.wwda.org.au/confpaps2006.htm
Women With
Disabilities
Women With Disabilities
Australia (WWDA) is the peak organisation for women with all types of
disabilities in
Our work is grounded in a
rights based framework which links gender and disability issues to a full range
of civil, political, economic, social and cultural rights. This rights based
approach recognises that equal treatment, equal opportunity, and
non-discrimination provide for inclusive opportunities for women and girls with
disabilities in society. It also seeks to create greater awareness among
governments and other relevant institutions of their obligations to fulfil,
respect, protect and promote human rights and to support and empower women with
disabilities, both individually and collectively, to claim their rights.
Introduction
The right to
the highest attainable standard of health is a human right recognised in a
number of international human rights treaties and instruments to which
The denial
and infringement of women with disabilities right to health can be seen in an
array of human rights violations: they experience violence at higher rates than
their non-disabled sisters, experience less control over what happens to their
bodies, have less access to vital health care services, such as cervical and
breast cancer screening and, face discrimination, societal prejudice and stigma
when it comes to determining their reproductive rights.
This paper
examines what is meant by women with disabilities right to health. It places
this fundamental human right in the context of
The status
of women with disabilities in
There are
more than two million women with disabilities living in
§
are less likely to be in paid work;
§
are in the lowest income earning bracket;
§
spend a greater proportion of our income on medical care and health
related expenses;
§
are less likely to receive appropriate health services;
§
are substantially over represented in public housing and more likely to
be institutionalised;
§
are often forced to live in situations in which we experience, or are at
risk of experiencing, violence, abuse and neglect;
§
are more likely to be unlawfully sterilised;
§
are more likely to face medical interventions to control our fertility;
§
are more likely to be assaulted, raped and abused;
§
are at particular risk of severe forms of intimate partner violence;
§
are more likely to experience marriage breakdown and divorce;
§
are less likely to have children; and,
§
are more likely to be single parents.
The many
issues facing women with disabilities in
Understanding
the ‘human right to health’
In
international human rights law, health is understood as the ‘state of complete physical, mental, and social
wellbeing and not merely the absence of disease or infirmity. [4]’ Health is also understood and
recognised as ‘the fundamental right of
every human being’ [5] and ‘indispensable
for the exercise of other human rights.’[6] The human right to health encompasses
both freedoms and entitlements. The freedoms include the right to control one's
health and body, including sexual and reproductive freedom, the right to
participate in decisions about one’s health, the right to be free from
interference, such as non-consensual medical treatment and experimentation. By
contrast, the entitlements include the right to a system of health protection
which provides equality of opportunity for people to enjoy the highest
attainable level of health. This includes for example, an adequate supply of
safe food, nutrition and housing, healthy occupational and environmental
conditions and access to health-related education and information [7].
Women with disabilities right to
health –
The right to
the highest attainable standard of health is a human right recognised in a
number of international human rights treaties and instruments to which
Australia is a party, including the International
Covenant on Economic, Social and Cultural Rights (CESCR), the Convention on the Elimination of All Forms
of Discrimination against Women (CEDAW), and the Convention on the Rights of Persons with Disabilities (CRPD). The
most authoritative interpretation of the right to health is outlined in Article
12 of the CESCR, which was ratified by
Access to
health care is a basic right under CEDAW, ratified by the Australian Government
in 1983. General Recommendation 18 of CEDAW makes explicit the need for
Governments to take special measures to address the needs of women with
disabilities. In meeting its obligations to women with disabilities’ right to
health under CEDAW, the Australian Government has a responsibility to implement
interventions aimed at both the prevention and treatment of diseases and
conditions affecting women with disabilities; respond to violence against women
with disabilities; and ensure access for women with disabilities to a full
range of high-quality and affordable health care, including sexual and
reproductive health services.
The CRPD –
which aims to ensure that persons with disabilities enjoy human rights on an
equal basis with others - is the most recent international human rights treaty
ratified by the Australian Government, entering into force in
The denial of women with disabilities right to health
Despite
Regrettably,
examples of the infringements of the health rights of women with disabilities
abound.
Women with
disabilities are denied their right to bodily integrity, to control their own
bodies and to be free from interventions – evidenced by the practices of forced
sterilisation, menstrual suppression, forced contraception and coerced
abortion. Their right to reproductive freedom is denied in a myriad of other
ways, including pressure to undergo tubal ligations and hysterectomies,
systematic denial of appropriate reproductive health care and sexual health
screening, limited contraceptive choices, a focus on menstrual control, denial
of access to assisted reproductive technologies, and, poorly managed pregnancy,
birth and post natal care [10].
Women with
disabilities are denied their right to freedom from exploitation, violence and
abuse – they experience alarmingly high rates of all forms of violence and
abuse from a range of perpetrators yet remain excluded from violence prevention
legislation, policies, services and supports [11]. They experience psychiatric
assault through practices such as forced medication, chemical restraint,
deprivation of liberty, the use of seclusion and restraints, and compulsory
administration of psychoactive drugs and procedures such as electroconvulsive
therapy [12].
Women with
disabilities are denied the right to experience their sexuality, to have sexual
relationships and to found and maintain a family. They experience
discriminatory attitudes and widely held prejudicial assumptions which question
their ability and indeed, their right to experience parenthood. They remain
invisible and ignored in maternity, obstetric, parenting and related health
care policies, programs and services, and face overt discrimination and
inequitable access to assisted reproductive technologies. They have their
babies and children removed by child welfare authorities without evidence of
abuse, neglect and/or parental incapacity, and lose their children in custody
disputes simply because they are women with disabilities. They battle against
political agendas and social commentaries which cast their children as ‘young
carers’ at risk of parentification and themselves as burdens of care [13].
Women with
disabilities have a significantly high level of unmet need for services and
support to enable them to live independently and with dignity in the community,
and to maintain optimal levels of health. They remain largely ignored in
Australian health related research, legislation, policies, and services [14].
Women with disabilities have less access to community health programs, such as
breast and cervical screening services than any other group of women [15].
Women with
disabilities bear a disproportionate burden of poverty, experience significant
un/underemployment, and are in the lowest income earning bracket, yet have more
than three times the average yearly health care expenditures of other women
[16]. They are less likely than their male counterparts to receive adequate vocational
rehabilitation or gain entry to labour market programs, and are more likely to
be in low paid, part time, short term casual jobs [17].
Women with
disabilities experience serious violations of the right to an adequate standard
of living, including adequate housing. They experience social isolation and
segregation, multiple forms of discrimination, inaccessible public
environments, poor access to services, and are marginalised, excluded or
ignored in decision-making processes which affect their lives [18].
The
effective realisation of women with disabilities right to health
The full
enjoyment of the right to health still remains a distant goal for women with
disabilities. Strategies to improve women with disabilities’ right to health
must take full account of the underlying determinants of health – particularly
gender inequality and discrimination– and must address the specific structural,
socioeconomic and cultural barriers that hamper women with disabilities in
protecting and improving their health. These strategies must be placed in the
broader context of government and broader society recognising, acknowledging
and safeguarding the inherent dignity and equal worth of women with
disabilities, as a fundamental pre-requisite to women with disabilities
realising their right to health.
The
obligation to respect, protect and fulfil women with disabilities’ right to
health, clearly requires Australian Governments to do much more than merely
abstain from taking measures which might have a negative impact on women with
disabilities. The obligation in the case of women with disabilities is to take
positive action to reduce structural disadvantages and to give appropriate
preferential treatment to women with disabilities in order to achieve the
broader objectives of full participation and equality within society for all
persons with disabilities, [19] and the specific objectives of ensuring that
women with disabilities enjoy all human rights and fundamental freedoms. This
invariably means that additional resources will need to be made available for
this purpose and that a wide range of specially tailored measures will be
required. These obligations cannot remain words on paper. They must be
reflected in all relevant legislation, national policies and programs, and
operationalised at the service system level.
Women with
disabilities will only effectively realise their right to health when the
structural, socioeconomic and cultural barriers that currently deny them this
right, are genuinely and fully addressed. The following section of this paper
therefore looks at key areas of policy where the Australian Government should
take positive action and specific measures to respect, protect and fulfil women
with disabilities’ right to health.
Accountability
As rights-holders,
women with disabilities are entitled to effective remedies, without which there
has been, and continues to be, failure on the part of the Australian Government
to fully comply with its obligations under the international human rights
treaties to which it is a party. As duty-bearers, there must therefore be a
commitment and willingness by Australian Governments to examine and redress the
violations of human rights experienced by women with disabilities, both
historically and currently.
As a priority,
the Australian Government should therefore:
§
Act immediately to redress the human rights violations against women and
girls with disabilities who have been sterilised without their consent. This must
include a process of reconciliation which incorporates financial compensation
and an official apology for discrimination.
§
Address the abuse, neglect, mistreatment, and discrimination of women
with disabilities living in institutions.
§
Address the over-representation of parents with intellectual
disabilities in care and protection proceedings.
Legislation
In keeping
with Australia’s obligations under CESCR, CEDAW and the CRPD, the Australian
Government has a responsibility to review, evaluate and revise legislation,
policies and procedures that enable the violations of women with disabilities
human rights and where necessary, create legislation to protect women and girls
with disabilities against human rights violations [20,21,22]. For example,
there is a clear need for the Australian Government to develop national uniform
legislation which prohibits the sterilisation of girls with disabilities in the
absence of a threat to life or health [23]. The need for this legislation was
identified by the United Nations more than four years ago, [24] yet successive
Australian Governments have failed to act on this recommendation. Domestic and
family violence legislation is another example of current legislation that
warrants revision in order to be inclusive of women with disabilities.
Definitions that specifically encompass the range of settings in which women
with disabilities may live, and which take into account the context in which
violence against women with disabilities occurs, is critical.
As a
priority, the Australian Government should therefore:
§
Act under its external affairs power to legislate to prohibit
non-therapeutic sterilisation of girls with disabilities unless there is a
serious threat to health or life;
§
Address discrimination in legislation and protocols that enables the
removal of babies and children from parents with intellectual disabilities;
parents with mental health illnesses and parents with psychiatric disabilities;
§
Investigate the feasibility of the development of a Model Family
Violence Law for Australia. Such legislation should be inclusive of the forms
of violence as experienced by women with disabilities and encompass the
circumstances and contexts within which women with disabilities experience
family violence;
§
Undertake an immediate review of legislation, policies and processes
currently in place for procedures occurring to girls and women with disabilities
who are deemed ‘incapable of giving informed consent.’
National
Health Policies
The
Australian Government has a responsibility to develop and implement national
health policies that conform to its human rights obligations as set out in the
CESCR, CRPD, CEDAW.
For example,
the Australian Government is currently in the process of developing a new
National Women’s Health Policy (NWHP) [25] in order to: ‘improve the health and wellbeing of all women in Australia, especially
those with the highest risk of poor health; encourage the health system to be
more responsive to the needs of women; actively promote the participation of
women in health decision making and management; and to promote health equity
among women.’[26] WWDA has strongly advocated for the Policy to be
developed in a framework of human rights, giving priority to those women whose
right to health is compromised by social exclusion and discriminatory practices
[27] (including women with disabilities), and prioritising thematic issues of
concern in recognition of the conditions and contexts that deny vulnerable and
marginalised groups of women their right to health [28].
As a
priority, the Australian Government should therefore:
§
Ensure that the principles of gender equity and health equity are
applied to all national policies that address the social determinants of health
[29].
§
Ensure that the new National Women’s Health Policy (NWHP) gives explicit
priority to women with disabilities in recognition of the fact that they
experience direct human rights violations that result in ill-health; experience
significant disadvantage in the social determinants necessary for health; and
remain excluded in the health promotion agenda.
National
Women’s Health Screening Programs
Members of
WWDA have identified access to breast and cervical screening as a priority
issue of concern, in response to their experiences of exclusion from these
health promotion initiatives [30]. In many areas of Australia, breast and
cervical cancer screening services are simply not available to women with
disabilities. Even where screening services are available, many women with
disabilities cannot receive these services because of economic, social,
psychological and cultural barriers that impede or preclude their access to
breast health and cervical screening services [31,32,33].
Currently,
neither the National Breast Cancer Screening Program nor the National Cervical
Cancer Screening Program identify women with disabilities as a target group,
nor do they collect data on the participation rate of women with disabilities
in the screening programs. This exclusion is clearly inconsistent with the need
for targeted measures to enable women with disabilities to realise their right
to health – as articulated in the CESCR, CRPD and CEDAW.
As a
priority, the Australian Government should therefore:
§
Act immediately to ensure that the National Breast Cancer and National
Cervical Cancer Screening Programs are inclusive of women with disabilities,
prioritise women with disabilities as a target group for screening, and collect
data on the participation rate of women with disabilities.
§
Act on recommendations from the CEDAW Monitoring Committee,[34] and
undertake active measures at all levels of Government to ensure development of
the necessary infrastructure to enable women with disabilities to participate
in breast and cervical screening programs and initiatives.
National
Violence Prevention Policies & Programs
A human
rights approach to health recognises that gender-based violence is a priority
public health issue and, more specifically, a form of discrimination against
women [35]. The obligation of Governments to address violence against women
with disabilities is clearly articulated in CEDAW [36] and the CRPD [37]. The
CESCR stipulates that a state’s failure to protect women against violence is a
violation of its obligation to protect the right to health [38].
Compared to
non-disabled women, women with disabilities experience violence at significantly
higher rates, more frequently, for longer, in more ways, and by more
perpetrators, yet programs and services for this group either do not exist or
are extremely limited. In fact, responses to violence against women with
disabilities are characterised by limited recognition by governments and the
service sector of the nature and extent of the problem; inadequate research;
incomplete or partial response structures, and scarce resources to support
advocacy in the area [39]. Clearly, violence against women with disabilities is
not only a serious form of discrimination but also a widespread cause of
ill-health among disabled women and a violation of their right to health.
As a
priority, the Australian Government should therefore:
§
Ensure that the COAG [40] three year National
Plan to Reduce Violence Against Women and their Children gives priority to
addressing the needs of marginalised and excluded groups of women (including
women with disabilities), and to addressing those forms of violence which have
been recognised as under-documented and under-reported [41].
§
Act immediately to commission and fund a national research study on the
incidence and prevalence of violence against women with disabilities, in recognition
of the exclusion of women with disabilities from violence prevention programs
and services, along with the paucity of research, data and statistics
available.
§
Act to ensure that policies, procedures and protocols are developed to aid
in the early identification of violence against women with disabilities
including for example screening and assessment tools.
National
Housing Policies & Programs
The right to
adequate housing [42] is identified as a core obligation under the CESCR,[43]
and includes the right to accessible housing for women with disabilities [44].
The right of women with disabilities to enjoy adequate living conditions,
particularly in relation to housing, is enshrined in CEDAW,[45] and the right
to an adequate standard of housing is also clearly articulated in the CRPD
[46]. Having access to adequate, safe and secure housing substantially
strengthens the likelihood of women with disabilities being able to realise
their right to health. Yet women with disabilities in Australia continue to
experience serious violations of their right to adequate housing,[47] as well
as failures to promote and fulfil this most basic human right.
In Australia,
women with disabilities are over-represented in factors that contribute to
homelessness, which include unemployment, underemployment, poverty, low income,
violence, lack of access to essential services and supports, and lack of access
to affordable, safe, secure housing [48]. Despite this, women with disabilities
remain largely excluded from policy and program responses designed to address
homelessness in Australia [49]. It is well documented that domestic and family
violence is one of the major factors in homelessness in Australia,[50] and
women with disabilities are twice to three times more likely to be victims of
physical and sexual violence than other women [51]. However, the lack of
available services and programs for women with disabilities experiencing
violence, coupled with the almost universal exclusion of women with
disabilities from women’s refuges and other crisis and post-crisis
accommodation services in Australia is a critical issue impacting on the health
of women with disabilities, yet remains largely ignored in violence prevention,
homelessness prevention and health promotion responses at all levels [52].
As a
priority, the Australian Government should therefore:
§
Act immediately to address the exclusion of women with disabilities from
women’s refuges. Inherent in this is the need to undertake a national audit of
crisis accommodation services [53] to determine their levels of accessibility
and safety for women with disabilities and to determine service/agency needs in
meeting relevant anti-discrimination legislation requirements.
§
Ensure that targets developed to reduce homelessness and address the
right to adequate housing are established for people with disabilities as a
population group and include gender specific targets.
Employment
Policies & Programs
The CESCR
identifies the right to work as a one of the key underlying determinants of
health and therefore a critical component of the right to health [54]. The
obligation of Governments to take all appropriate measures to eliminate
discrimination against women in the field of employment is clearly stated in
CEDAW [55]. The right of women with disabilities to work in freely chosen or
accepted employment is also clearly articulated in the CRPD [56].
Employment
and working conditions have powerful effects on health equity. It is widely
recognised that being in paid employment is a key marker of social inclusion
[57] and that unemployment and under-employment are associated with poorer
health status [58]. Paid employment is a critical component in enabling women
with disabilities to support themselves financially, provide financial
security, social status, personal development, social relations and
self-esteem, and achieve social recognition – all necessary for realising the
right to health. Yet in Australia, women with disabilities are less likely to
be in paid work (or looking for work) than other women, men with disabilities
or the population as a whole [59]. In any type of employment women with
disabilities are more likely to be in low paid, part time, short term casual
jobs [60].
As a
priority, the Australian Government should therefore:
§
Act immediately to collect relevant information on workforce
participation of women with disabilities to provide a basis for pay equity
analysis and inform future policy direction.
§
Act to address the disparity in the proportion of men and women with
disabilities who are being assisted by Commonwealth Government funded open
employment services.
§
Act to de-link disability-related supports and services from income support
programs in order to make the supports required by women with disabilities
available to those who could not afford to enter the paid labour market
otherwise.
Service
System Issues
The
socioeconomic and gender-based inequalities that women with disabilities face
are played out in their access to and use of health-care and related services.
Addressing discrimination, inequalities and inequity in access to services and
systems is a critical element of a human rights based approach to health and
fundamental to improving women with disabilities right to health.
The right to
health includes a right to the enjoyment of a variety of facilities, goods,
services and conditions necessary for the realisation of the highest attainable
standard of health [61]. Health services and systems at all levels must
encompass the following inter-related and essential elements if they are to
serve women with disabilities adequately:
§
Available: health and
related facilities, goods, services, and programs must be available in
sufficient quantity to women with disabilities. Available facilities not only
relates to buildings such as hospitals and community health centres, but also
to preventive public health strategies and health promotion as well as well
trained health workers. The adequate resourcing of services that can cater to
women with all types of disabilities is critical.
§
Accessible: health and related facilities, goods,
services, and programs must be accessible to women with disabilities without
discrimination. In the broadest sense accessible services encompass physical,
intellectual, psychiatric, sensory and other disabilities. Accessibility
includes the right to seek, receive and impart information and ideas concerning
health and health-related services, programs and issues in an accessible
format. Affordability is a further element of access.
§
Acceptable: health and related services and programs
that combine sensitivity to both disability issues and to issues of gender are
necessary for women with disabilities to realise their right to health.
§
Quality: The provision
of responsive and suitable health and related services requires skills and
training to enable service providers to recognise and respond appropriately to
the needs and issues of women with disabilities.
As a
priority, the Australian Government should therefore:
§
Act on recommendations from the CEDAW Monitoring Committee [62], and
undertake active measures at all levels of Government to ensure development of
the necessary infrastructure to enable women with disabilities to have access
to all health services.
§
Ensure that the new national Women’s Health Policy (NWHP) and the national
program established to implement the Policy, are based on principles of equity
and freedom from discrimination, in recognition of the fact that these
principles are critical components of the right to health, and are core
obligations of the Australian Governments under the CESCR, CEDAW and the
CRPD.
Participation
and inclusion in health related decision-making
Participation
is a central feature of the right to health. Many international human rights
treaties recognise participation as a human right, and several (including the
CESCR, CEDAW, and CRPD) contain specific articles concerned with ensuring the
participation of marginalised groups in the conduct of public affairs and
policy development.
In the
context of women with disabilities right to health, ‘participation’ is a
process by which they are enabled to become actively and genuinely involved in
defining the issues of concern to them, in making decisions about factors that
affect their lives, in formulating and implementing policies, in planning,
developing, delivering and evaluating services and in taking action to achieve
change [63]. The right to participate in decision-making processes that affect
their health and development is clearly critical for women with disabilities,
however, more often than not, they are excluded and ignored in health and
related policy, service and program development, including information and
education resources. Women with disabilities are not only denied the
opportunity to participate in health and related policy initiatives and service
and program development. Many women with disabilities are excluded from
participating in decisions that affect their lives on a daily basis, including
as active partners in their own health care.
As a
priority, the Australian Government should therefore:
§
Ensure that women with disabilities are represented on the national
advisory structures established to oversee implementation of the National
Women’s Health Policy.
§
Develop the institutional mechanisms to ensure that the participation of
women with disabilities takes place in health policy and planning, including
the planning, management, delivery and evaluation of health and related
services.
Data
Collection and research
In the
context of women with disabilities realising their right to health, the
importance of data collection and research in order to identify and address the
barriers faced by women with disabilities in exercising their rights [64] is
clearly articulated within the CRPD. The CESCR identifies research and data
collection, including disaggregation on the prohibited grounds of
discrimination, as an obligation of Governments in fulfilling the right to
health [65].
The acute
lack of available gender and disability specific data, information and research
in Australia, at all levels of Government and for any issue, has been
identified by WWDA for more than a decade. This neglect has seen Australia
criticised by the CEDAW monitoring Committee, for failing to provide
information on the situation of women with disabilities in its CEDAW
implementation reports [66].
Data,
research and information about women with disabilities and their right to
health is necessary to guide and inform policy, direct funding, and inform
service development [67,68]. It also enables the monitoring of equality of
opportunity and progress towards the achievement of economic, social, political
and cultural rights for women with disabilities. The lack of data, research and
information about women with disabilities and their right to health results in
invisibility and marginalisation in health systems and services and invariably
leads to a critical lack of resources for this group[69].
Members of WWDA
have identified a number of priority areas warranting urgent data collection
and research, including for example the right to reproductive freedom; the
right to found a family, and the right to the highest attainable standard of
health.
As a
priority, the Australian Government should therefore:
§
Act to ensure that health and socio-economic data is disaggregated by
gender and disability, in order to identify and address discrimination and
inequities in health.
§
Fund a national research project on the issues which impact on access
and uptake of breast, cervical and bone-density screening services for women
with disabilities.
§
Fund a full time Project Officer position for Women With Disabilities
Australia (WWDA) for a period of three years to develop and implement a
national research project on the parenting experiences of women with
disabilities.
§
Fund a national project on women with disabilities’ right to
reproductive freedom which:
o
addresses the incidence of forced sterilisation for all women with disabilities;
o
researches the long-term physical and mental health and social effects
of sterilisation;
o
researches the practice of menstrual suppression of girls and women with
disabilities, including those in group homes and other forms of institutional
care.
Public
Health Media Campaigns
The vast
majority of information about disability in the mass media is extremely
negative. Disabling stereotypes which medicalise, patronise, criminalise and
dehumanise women with disabilities abound in books, films, on television, and
in the press. They form the bed-rock on which the attitudes towards,
assumptions and about and expectations of women with disabilities are based.
They are fundamental to the discrimination and exploitation which women with
disabilities encounter daily, and contribute significantly to their systematic
exclusion from mainstream community life [70]. They can, and do, have a
profound effect on the self image of women with disabilities themselves [71].
Despite the
fact that women with disabilities experience direct human rights violations
that result in ill-health; experience significant disadvantage in the social
determinants necessary for health; and remain excluded in the health promotion
agenda, they are rarely included or visible in public health media campaigns.
For example, Australian Government national mass media campaigns around
stopping violence against women have featured images of indigenous women, culturally
and linguistically diverse women, young women and older women but none of women
with disabilities, despite the high incidence of violence perpetrated against
them. It is a similar situation in the national media campaigns around
promoting the uptake of breast and cervical cancer screening.
Despite
increasing appreciation of the heterogeneity of women and the need to address
such factors as race, ethnicity and class in public health campaigns,
disability has not been recognised and it is this exclusion which renders the
experiences of women with disabilities essentially invisible [72].
As a
priority, the Australian Government should therefore:
§
Act to ensure that women with disabilities are represented, on an equal
basis with others, in the development, implementation and evaluation of public
health and health promotion campaigns at national, state and territory levels.
Training of
health workers
The
obligation to fulfil the right to health for women with disabilities requires
the Australian Government to undertake actions that create, maintain and
restore the health of the population. This includes ensuring that health
workers are trained to recognise and respond to the specific needs of
vulnerable or marginalised groups [73], including women with disabilities. The
requirement of Governments to provide education and training for health
personnel on health and human rights is also identified as an obligation under
the CESCR [74] and the CRPD [75].
Health and human
rights education, information and training is therefore essential to sensitise
health and related service providers to the human rights of women with
disabilities, including their right to health.
The lack of
education and training of health and related service providers has been
identified as a major barrier to women with disabilities accessing health and
related services [76]. This lack of education and training is borne out in a
myriad of ways. For example, many service providers lack knowledge of
disability, hold inaccurate perceptions about women with disabilities, and have
a tendency to view women with disabilities solely through the lens of their
impairments [77]. Insufficient time to address the full range of needs is a
common barrier during encounters with health and related service providers, as
is the general lack of sensitivity, responsiveness, courtesy and support shown
to women with disabilities [78]. Health and related service providers can have
a tendency to treat women with disabilities as objects of treatment rather than
rights-holders, and do not always seek their free and informed consent when it
comes to interventions [79].
As a
priority, the Australian Government should therefore:
§
Commission the development of national guidelines for health and related
service providers that describe expectations for compliance with the CESCR,
CEDAW and CRPD.
§
Through
the National Registration and Accreditation Scheme for the Health Professions
(NRAS),[80] act to ensure that accreditation of the training of health
professionals covered under the Health
Practitioner Regulation National Law Act 2009, is contingent on disability
and human rights specific curriculum components.
§
Develop national protocols for health education curriculum (beginning at
primary school level) which incorporate models of diversity that portray
positive images of women with disabilities as sexual beings, including as
parents.
§
Act to ensure that relevant training authorities (such as TAFE) develop
curriculum content which requires demonstration of competencies in knowledge of
human rights of women with disabilities.
The social, economic and
political empowerment of women with disabilities
Women with
disabilities bear a disproportionate burden of poverty and are recognised as
amongst the poorest of all groups in society. Poverty and lack of economic
opportunities are major barriers to them being able to realise their right to
health and are major factors contributing to their entrenched social exclusion.
Poverty and discrimination diminish freedom by depriving women with
disabilities the opportunity to exercise their fundamental human rights. The
denial of human rights can lead to a vicious cycle that entraps women with
disabilities in a life of highly restricted choices. A disabled woman whose
right to education is denied, for example, is more likely to face compromises
to her rights to health.
In order for
women with disabilities to realise their right to health, governments at all
levels should take measures to empower women with disabilities and strengthen
their economic independence. This includes creating the conditions and
structures that improve women with disabilities access to the labour market and
affording them more adequate levels of income support.
Organisations
and groups of women with disabilities play an important role in raising
awareness of, and working to address the violations, denials and infringements
of the right to health. There is recognition that the empowerment of women with
disabilities is achieved principally through women with disabilities coming
together to share their experiences, gaining strength from one another and
providing positive role models. Financial and political support is needed for
the establishment and maintenance of such groups of women with disabilities at
national, regional and local levels.
As a
priority, the Australian Government should therefore:
§
Recognise, support and strengthen the role of women with disabilities
organisations, groups and networks in efforts to fulfil, respect, protect and
promote their human rights, and to support and empower women with disabilities,
both individually and collectively, to claim their rights.
§
Urgently review the adequacy of income support arrangements for those
with a disability across all household types, in recognition of the fact that
the non-optional costs of disability are a significant barrier to the social
inclusion of women with disabilities, and that the setting of income support
payment rates for people with disabilities has failed to take account of these
non-optional, extra costs.
§
Ensure that information on women with disabilities is provided in
relevant human rights treaties Periodic Reports as a matter of course. This
would include information on the situation of women with disabilities under
each right, including their current de-facto and de jure situation, measures
taken to enhance their status, progress made and difficulties and obstacles
encountered.
Conclusion
This paper
has sought to demonstrate that despite Australia’s international commitment to
achieve better health for its citizens, particularly marginalised groups, the
full enjoyment of the right to health still remains a distant goal for women
with disabilities.
Women with
disabilities in Australia not only represent one of the groups with the highest
risk of poor health, but experience many of the now recognised markers of
social exclusion. They experience major inequalities in health status, and
experience significant disadvantage in the social determinants of those
inequalities. The denial and infringement of women with disabilities right to
health can be seen in an array of human rights violations: they experience
violence at higher rates than their non-disabled sisters, experience less
control over what happens to their bodies, have less access to vital health
care services, such as cervical and breast cancer screening and, face
discrimination, societal prejudice and stigma when it comes to determining
their reproductive rights.
The
obligation to respect, protect and fulfil women with disabilities’ right to
health, clearly requires Australian Governments to do much more than merely
abstain from taking measures which might have a negative impact on women with
disabilities. The obligation in the case of women with disabilities is to take
positive action to reduce structural disadvantages and to give appropriate
preferential treatment to women with disabilities in order to ensure that they
enjoy all human rights – including their right to health. This invariably means
that additional resources will need to be made available for this purpose and
that a wide range of specially tailored measures will be required.
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