Integrating Human Rights and Women's Health – an educational approach

Human rights as main focus
Millions of women and children suffer illness or injury every year because their fundamental human rights have been denied. In 2012 we expect that nearly 500,000 women will die in childbirth and 80 per cent of these deaths will be avoidable within the fiscal resources of the societies in which they live – no-one cares enough to ensure that their human rights are protected. Our Committee is developing a generic medical school curriculum that is designed to integrate the teaching of women’s health and human rights, and which will produce a framework that each medical school will be able to adapt to its local and national standards, health policies, laws and conventions. This will help to ensure that every graduate doctor has the necessary clinical and communicative skills and knowledge base to help women protect their sexual and reproductive rights. Doctors educated in this approach are more likely to deliver quality healthcare, advocate effectively for patient rights and participate in the development of healthcare systems that integrate available technologies with quality processes and respect for human rights.

The Committee’s history
The Committee was founded in 2001 under the leadership of Dorothy Shaw. During her FIGO presidential term (2006–2009), Dr Shaw worked tirelessly to raise the profile of reproductive rights and women’s health. When the Committee met in 2008, under the chairmanship of Dr Kamini Rao, FIGO had already agreed to produce a booklet that could be used by medical students to raise awareness of reproductive rights issues and to clarify the terminology in use. Following FIGO’s 2009 Congress, I was invited to chair the Committee in its next developmental stage: the design of the curriculum.

The project in progress
In March 2010 the new Committee working party (four ob/gyn clinicians, a medical educator and a reproductive rights lawyer) met to determine how best to produce the curriculum. An outline document was drafted describing 10 universal human rights and the healthcare competencies that are necessary to ensure them in the course of daily medical practice. Each statement of rights would be accompanied by a case study or exemplar, references to relevant medical, ethical and legal literature and followed by a list of specific discussion questions that would guide the student and teacher to consider local practices, laws and governance. It was recognised that guidelines for the curriculum’s teachers would need to be produced, along with recommendations fordissemination and implementation in medical schools globally.

In May 2011 the list of 10 human rights and healthcare competencies was finalised. A final document was produced alongside plans and a dissemination timetable, and these were presented to the FIGO Executive Board in June 2011, and further approved. Following on, draft outlines for case studies to illustrate the human rights and competencies checklist were proposed by the Committee.

A workshop was held in January 2012 to review and complete the editing for eight of the 10 clinical case studies, which now include the case narrative, questions specific to each and references. We have deliberately weighted the references more heavily towards human rights standards on the assumption that medical teachers and their students have more ready access to texts and references describing the health conditions than they do human rights literature.

There is a common theme to the questions beginning with the medical dilemma and the threat to rights, then progressing to explore the complexities of the relationship of health and rights for the case scenario and for the general healthcare system which is in place locally for that student and teacher. We have now completed the last two cases and reference materials and will start designing the format of the teaching materials guide and curriculum assessment tools. Every opportunity will now be taken to disseminate the project in the form of presentations and interactive workshops.

The way ahead
This transformational project is still evolving, and aims to move women's health and reproductive needs from a marginal position in most curricula to more mainstream thinking. We aim to turn the tables on traditional approaches and ensure that, in the future, sexual and reproductive healthcare teaching and practice has a central focus based on human rights principles. 

Integrated Human Rights and Women’s Health: Checklist to Determine Competencies for Clinical Practice Physicians must be able to apply the principles of human rights to the daily practice of women’s health care.

1. Right to life: Everyone has the right to life.

2. Health: Everyone has the right to the highest attainable standard of physical and mental health.

3. Privacy: Everyone has the right to respect for privacy in the field of health care.

4. Confidentiality: Everyone has the right to confidentiality in relation to information on health care and health status.

5. Autonomy and decision-making: Everyone has the right to autonomous decision-making in matters concerning their health.

6. Information. Everyone has the right to receive and impart information related to their health.

7. Non-discrimination: No one shall be subject to discrimination on any grounds in the course of receiving health care.

8. Right to decide number and spacing of children: Everyone has the right to decide freely and responsibly on the number and spacing of children and to have access to the information, education and means to enable them to exercise these rights.

9. Freedom from inhumane and degrading treatment: Everyone has the right to be free from torture or cruel, inhuman or degrading treatment or punishment in the field of health care.

10. Benefit from scientific progress: Everyone has the right to enjoy the benefits of scientific progress and its applications.