Reproductive Health in a Pluralist Legal World

Reproductive Health in a Pluralist Legal World

Faculty of Law, University of Santiago de Compostela

30^th – 31^st March, 2017

Venue: Meeting Room, 1^st Floor

On March 2016, the UN Committee on Economic, Social and Cultural Rights (ECSCR) adopted its General Comment n. 22 (GC/22) related to Right to Sexual and Reproductive Health. In its legal authoritative views, the Committee recalled that “[r]eproductive health […] concerns the capability to reproduce and the freedom to make informed, free and responsible decisions. It also includes access to a range of reproductive health information, goods, facilities and services to enable individuals to make informed, free and responsible decisions about their reproductive behavior. […]” (para. 5, E/C.12/GC/22). On the basis of this recent legal authoritative opinion, and in the light of recent developments in many national legal orders, the academic community is called to substantively contribute to the enhancement of effective legal solutions to “new” social concerns.

Thursday, 30 March 2017

16.30 – 17.00: Opening Remarks by Conference Coordinator, Prof. Antonietta Elia

 

17.00 – 17.45:                                            Key Note Lecture

 

Law and Science, Perfect Together? Solving Key Challenges to Reproductive Health

Dr. Ilise Feitshans

Former Professor at Columbia School of Law and

 Global Coordinator of the Safety and Health Encyclopedia of the ILO

17.45 – 18.15: Open Debate

 

Friday, 31 March 2017

Chair – Prof. Antonietta Elia, University of Santiago de Compostela, Spain

 

The Impact of Emerging Technologies on Human Right to Health

Prof. Ilise Feitshans, Columbia University, US

 

Reproductive Health in a Comprehensive Framework: the World Health Organisation’s Definition of Infertility as a Disability, between Physical Impairments and Social Determinants of Health

Prof. Daniela Fisichella, University of Catania, Italy

 

The State Positive Obligations Stemming from the Right to Sexual and Reproductive Health: the Prevention of Harmful Practices

Prof. Marcella Ferri, University of Brescia, Italy

 

Critical Analysis of Recent Legislation About ART in Portugal: Access to ART to all Women and Surrogate Motherhood

Prof. André Gonçalo Dias Pereira, University of Coimbra, Portugal

Between National Constraints and International Legal Obligations: A Survey of the Italian Law n. 40/2004 on Medical Assisted Reproduction

Prof. Antonietta Elia

 

Concluding Remarks: Prof. Ilise Feitshans

Prof. Daniela Fisichella

Prof. André Dias Pereira

Prof. Marcella Ferri

Prof. Antonietta Elia

 

++++++++

 

Law and Science, Perfect Together? Solving Key Challenges to

Reproductive Health

Prepared for the conference

Reproductive Health in a Pluralist Legal World

Faculty of Law, University of Santiago de Compostela

 

30^th – 31^st March, 2017

 

Dr. Ilise L Feitshans JD and ScM and DIR

Executive Director The Work Health and Survival Project

Switzerland and USA

917 239 9960   0041 79 836 3965  forecastingnanolaw@gmail.com

 

MS-JD.org Writer in Residence blog “So You want to be An International Lawyer”

Author of the Council of Europe Handbook for the Convention Against Medicrime

Expert on Nanotechnology  and Nanomedicine for the Parliamentary Assembly of the Council of Europe (PACE) ·

Legal Advisor Greek National Platform for Nanomedicine

Presentations at NANOTEXNOLOGY 2012-17 University of Aristotle Thesaloniki Greece and NANOEH 2015 Johannesburg South Africa

Ms.-JD.org SUPERWOMEN JDs Award winner 2016

 

Author, GLOBAL HEALTH IMPACTS OF NANOTECHNOLOGY LAW

This exciting new book is Based on the Award winning Doctorate in International Relations, “Forecasting Nano Law: Risk Management Protecting Public Health Under International Law” Geneva School of Diplomacy

Prize, Best Research 2014 in social medicine and Prevention, University of Lausanne,  Vaud Switzerland and Former Scholar in Law of Health, University of Lausanne

 

The sound of freedom that resonates from civil and political rights rings hollow to a newborn who has low birth weight, because the baby’s mother had no access to a clean workplace, good nutrition or adequate prenatal care.  And, what good are political and civil rights to a different baby, whose Mom died in childbirth or who has lost a parent due to an accident, or whose parents are debilitated by occupational disease, or to the baby who may suffer personal injury due to the effects of a parent’s exposure to toxic substances, or whose father has terminal cancer?

The United Nations International Conference on Population and Development in  Cairo  1994 codifies the definition, “Reproductive health is a state of complete physical, mental and social well_being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes… Reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems…”

Consistent with this legal mandate, in March 2016 the UN Committee on Economic, Social and Cultural Rights (ECSCR) adopted General Comment n. 22 (GC/22) which elaborates upon sexual and reproductive health rights stating “[r]eproductive health …concerns the capability to reproduce and the freedom to make informed, free and responsible decisions. It also includes access to a range of reproductive health information, goods, facilities and services to enable individuals to make informed, free and responsible decisions about their reproductive behavior.” (para. 5 E/C.12/GC/22).

When we care about reproductive health we are protecting Posterity, thereby extending human rights to lives beyond our own. Universal norms, codified in international instruments, outlast lifetimes and reach across geographic borders and ethnicities and national jurisdictions, to enrich all human society. Pregnancy underscores the complex reality that no one is either: self-sufficient or completely dependent on others. Human existence is a confluence of interdependence, which makes even the highest ranking leader dependent on human rights protection. Civil society has not fully replaced human childbearing for human reproduction, and therefore protecting posterity especially during childbirth and pregnancy is a shared health concern of people throughout the world.

Committee in GC22  further stated that “The right to sexual and reproductive health is also indivisible from and interdependent with other human rights. It is intimately linked to civil and political rights underpinning the physical and mental integrity of individuals and their autonomy, such as the right to life; liberty and security of person”. Several key areas challenge implementation of  these beautiful notions about reproductive health and sexual health, without even touching the questions of who should be parents or whether there is a pluralistic social construct for benchmarking the basic standard of living for a “healthy” child.

Acccording to  Louis Henkin, in whose memory the Human Rights clinic at Columbia University School of Law was founded “Human rights is the idea of our time. It asserts that every human being, in every society, is entitled to basic autonomy and freedoms and respected and basic needs satisfied.” ^[1] Without defining autonomy, Henkin further noted that human rights “include freedom from mistreatment and undue governmental intrusion.” This principle applies to ensuring freedom from constraints regarding reproductive health.   Rejecting the notion that there is a trade off between “privacy” and public good” in his seminal article, “Privacy and Autonomy” Henkin^[2] views “privacy” as “freedom from governmental intrusion” and “autonomy” as  a zone “of presumptive immunity to governmental regulation”.^[3] Henkin’s approach of accepting these rights as a part of, rather than in competition to, societal notions of public good, reflects leading codifications of international human rights. Under the United Nation Charter, ^[4] the contracting parties state their aspiration to “promote” economic and social advancement and “better standards of life, including the promotion of human rights protections”, in Article 13. ^[5]

Pretty words. What do we do with all this nice talk?

Our task ahead is to create infrastructure for operationalizing these ideas.

The mission of this conference is to think carefully and with grandeur about giving these words meaning in daily life.  The charge for this conference is “On the basis of this recent legal authoritative opinion, and in the light of recent developments in many national legal orders, this conference calls upon the academic community to substantively contribute to the enhancement of effective legal solutions to “new” social concerns”.

Our conference goal therefore is to review and revise an existing Declaration with Plan of Action for Reproductive health in order to reflect new knowledge about longstanding health disparities and new science that bring a larger constituency to these issues.  The revised Declaration can focus law and science upon a Plan of Action: to meet the Grand Challenge of eliminating health disparities between men and women that impact reproductive health,  with particular emphasis on reducing maternal mortality and infant mortality, and then report these findings to the ESCR and the 2030 Agenda^[6].  Note that although the Declaration from 1998 needs an update, unfortunately, so little has changed in the field regarding unmet needs to protect reproductive health that one can work from this text to craft a strategy that embraces assisted reproductive technologies and the needs of LGBT families, nanotechnologies for preventing cervical cancer and emerging issues in the workforce. The Declaration provides a very useful starting point for a comprehensive reproductive health policy analysis, thereby offering this conference the opportunity to produce a deliverable product

Three key solutions to the major challenges of implementing human rights to sexual and reproductive health are available to promote this effort:  First legal pluralism offers the opportunity to eliminate embedded sexism in the human rights law, which has closeted womens health and reproductive health away from mainstream rights to health. The impact of this inequality presents a second challenge which can be met by good science and sound legal strategy for attacking the problems of reproductive health: empirically documented negative differences in womens health and shockingly high rates of maternal mortality during pregnancy and childbirth, and avoidable infant mortality must be reduced. Inequality embedded under law translates into large health disparities that undermine womens health, especially during pregnancy, in daily life,   as WHO discussed in 2009 « Women and Health: Today’s Evidence , Tomorrow’s Agenda »  d ^[7]. According to WHO, the difference in male versus female health outcomes using their indicators showed better health among men in 5 stages of the life cycle^[8]1. birth to 5 years, 2. adolescence (including implications of adolescent pregnancy) 3. Reproductive years 4. Post-reproductive years (menopause and greater risk for cancer among sex-based target organs) and 5. Advanced ageing (65-80 years).  New technology offers the opportunity to discard skewed methods that have been used in the past,  and thereby reduce health disparaties.

Finally, the third solution to these challenges requires applying good science to achieve realization of human rights to health by creating a clear plan of action, achievable by revising the 1998 Declaration.

Legal pluralism offers the first solution to these challenges. By requiring that parallel systems within our own legal system inform our jurisprudence using those legal systems of indigenous peoples, laws of diverse states within a matrix of federalism and of course the needs of diverse groups of people we expand our constituency for implementing human rights to reproductive health.

Legal pluralism also requires concern for equitably including all groups of people within the same system, such as LGBT and infertile populations using assistive reproductive technologies.  The guidepost for these theories is the soft law of the Universal Declaration of Human Rights (UDHR). UDHR Article 25 offers all men the right “to a standard of living adequate for the health and well-being of himself and his family,” (sic) without a benchmark for that standard and without stating whether his family includes single moms. Legal pluralism answers this challenge posed by a tradition that was previously called ‘the rights of man’.   Although the notion of “man” as opposed to the rights of a deity invested in the Divine Right of  Kings seems appropriate at first, Eleanor Roosevelt  promoted the use of the expression “human rights” in the 1940s when she discovered, through her work drafting the UDHR that the rights of men were not understood everywhere to include the rights of women” ^[9]  In contrast to his rights for his family, international law is rife with references to maternal health or the needs of pregnant women and nursing mothers in a special capacity. UDHR  Article 25.2  states, “Motherhood and childhood are entitled to special care and assistance” but fails to offer special criteria for that care. If new technologies become acceptable rather than experimental, what are the implications for pregnant womens’ right to autonomously choose whether to provide their informed consent for medical care or to accept paying work?

The UN Convention on the Elimination of all forms of discrimination against Women^[10], Part III Article 11.(2)a  prohibits “sanctions, dismissal on the grounds of maternity leave”^[11] For pregnant women and parents who work, these important issues remain unresolved in the jurisprudence of reproductive health. Article 11(2)  is silent regarding prenatal care and  pregnancy during paid employment, despite stating that pregnant women should enjoy “Special Protections”, a term of art which historically has  included laws that kept women out of the workforce^[12]. Is there a legal basis for employing special risk assessments or additional preventive strategies to protect fetal health when pregnant women are exposed to workplace hazards that may contribute to adverse pregnancy outcome(s)?  The international law of reproductive health is silent about this question even as increasingly large percentages of the workforce are female.  It is unclear from the text, what is the standard of proof to make a “special protection” necessary or whether an approach to protection can be considered inappropriate even if it protects, for example, the health of the unborn but undermines maternal autonomy during pregnancy.^[13]

New mandates ensuring reproductive health however, can use the force of old language mandating separation to solve the need to legitimately link these issues to the larger human rights framework. Frozen eggs and a variety of new forms of surrogacy enable women to continue working in a highpowered career without staring squarely at the face of a biological clock. Into this mix too, jurisprudence must reflect upon the meaning of  GC22 “freedom to make informed, free and responsible decisions”. Access to a range of reproductive health information, goods, facilities and services, as promised in GC22, may mean improving prenatal care, preventing cancer of reproductive organs in men as well as women across all age groups, community support for mothers and fathers, maternity leave with pay and paternity leave, a subject of recent interest in the USA, along with use of information when making autonomous decisions about accepting or refusing treatment. HIV testing, ^[15]  has taught the importance of moving the modern paradigm away from examining the physical  “invasiveness” of testing, examining instead the emotional burden that testing places upon individuals.  Civil society’s recent experience with HIV policy provides a useful precedent for determining the scope and parameters of emerging informed consent requirements in highly emotional aspects of reproductive health, such as prenatal gene therapy, medically recommended therapeutic abortion, embryo selection in multiple fetus pregnancy, or fetal surgery.

The impact of these embedded sexisms at the root of special protections under law comes to the fore when measuring health disparities. Will  empirically documented, gender-based health disparities between men and women be reproduced, OR  improved, following the widespread use of new technology?

Second, good science applying new technology may offer solutions to the challenge of  documented health disparities that undermine reproductive health for all.  By expanding universally  the  “Capability to reproduce”, new technologies offer a rare opportunity to uproot embedded errors in our methods of creating and administering health care that concretizes or exacerbates health disparities. For example, the European Union  « Birth Day » Project to Reduce Mortality During Pregnancy and Childbirth seeks to apply new technology to address the problem  that  around the world, hundreds of thousands of women and babies die on the day of birth, and millions more are left with serious illness. WHO estimated that 303 000 women died in 2015 from preventable causes related to pregnancy and childbirth. UNICEF reported that  5.9 million children per year die before their 5th birthday, of which 2.65 million are newborn babies. It is widely agreed that many maternal deaths are due to preventable or treatable conditions (WHO). An excellent starting point to focus the best of science and law protecting reproductive health rights  therefore should face the Grand Challenge of : eliminating or reducing health disparities based on gender or sex, and especially those facets of the disparities that impact infant mortality and maternal mortality.^[14]

Turning to the third and final challenge, this conference has the opportunity to update the   DECLARATION_POSITION STATEMENT AND PROPOSED PLAN OF ACTION  ON WORKERS’  REPRODUCTIVE HEALTH PROTECTION (Adopted by the International Conference _ Medical and Ecological Problems of Workers   Reproductive Health, 9_10 December 1998, To insure optimum reproductive health protection worldwide, the Members of the International conference and Informal meeting of experts believe that there is an urgent need for elaboration of international consensus statements as well as the Plan of Action. This plan of action was written more than a decade before WHO documented the health disparities between men and women, and nearly two decades before nanotechnology holds the promise of preventing cervical cancers. Yet the steps forward in this Plan of action remain remarkably practical today.

            Recognizing then- urgent need for improved primary care, protection of mothers, working parents and their children for the benefit of the family and the urgency attached to the problem of understanding the interaction between workplace exposures, environmental factors and preventing worker exposures that jeopardize familial health and human reproductive health, the Committee of  Experts called upon the Director General of WHO to  foster further understanding, research and international co-operation  to prevent and reduce known or expected hazards to reproductive health.  Priorities in research and for primary health care system and occupational safety and health service include: conceptuses lost prematurely, manifested as sub-fecundity and infertility, spontaneous abortion, congenital defects and childhood cancers.

The Declaration called for research regarding:

_ different susceptibility of the female versus the male organism to exposures of chemical and physical agents in the work environment,

_ Whether there should be different standards and limits of exposure to protect the reproductive health of men and women,

_Monitoring possible reduction in human fertility (and sperm quality) and risk factors involved,

_Impact of stress, shift work, work with new technologies on reproductive health,

The Declaration especially noted that “Particular attention must be paid to the health of working women, a subject that has been neglected in both developed and developing countries”. Such as:

_ Studies in the production sectors which employ predominantly female workers, including both paid and unpaid work in agriculture, domestic labor, garment, textile and food industry, the health care sector, and to consider the double load of women workers who have family.

Concerning the limits of “Special Protection” under law, the Declaration states, “Selective overprotection of women may compromise employment opportunities of women, condemning them to poverty”

            The Declaration also set forth a strategy for “studying reproductive health at work”

Investigation directed to reveal dose_effect and dose_response relationship for proven and/or suspected reproductive and developmental hazards.

Examination of additional and eventually new endpoints for reproductive toxicity.

Studies on contribution of combined exposures.

Exploration of potential reproductive health hazards of new technologies, for newly introduced occupational chemicals and other agents

Development of study protocols and statistical approach to deal with the problem of small numbers of employees in specific occupational settings and being exposed to specific hazards.

Implementation of models for monitoring reproductive health of workers and subsequent use of these data for epidemiological studies. Further refinement of the protocols with inclusion of individual exposure data

Encouraging reporting

The Declaration ends by noting “No single comprehensive international instrument about reproductive health in the workplace addresses these issues directly nor does any such instrument adequately ensure access to information and risk communication for all people who confront reproductive health hazards at work”. Unfortunately this statement remains true even though we have expanded the definition and constituency for “reproductive health”.

Our goal therefore in this conference is to develop a new discourse that will look at all these issues which have been neglected way too long. New developments in assisted reproductive technologies are very useful for expanding the political base with new constituencies who care about reproductive health from the standpoint of childbearing and childrearing. Previously,  the abortion conundrum consumed a disproportionate amount of time and money and emotional energy spent on reproductive health, resources that must be channeled under law to end major health disparities that are inextricably linked to depriving human rights to reproductive health. New technology and new law challenges the traditions of the past, and offers civil society an unprecedented opportunity to protect human rights to reproductive health. Let us accept that challenge. ^[15]

Law and Science, Perfect Together to solve these issues of reproductive health?

Thank you for providing me with an avenue for bringing together these strands.

====== The Santiago=====

DECLARATION

on

Assistive Reproductive Technology,

Public Health and the Worklife Environment  2017

(*** draft***)

 

 (Revising the DECLARATION_POSITION STATEMENT  .AND PROPOSED PLAN OF ACTION FOR PERIOD UP TO 2000 AND IN 21st CENTURY  ON WORKER’S  REPRODUCTIVE HEALTH PROTECTION, originally Adopted by the International Conference _ Medical and Ecological Problems of Workers   Reproductive Health, 9_10 December 1998, Moscow, Russian Federation and refined by the Informal International Consulting Meeting of Experts on Reproductive Health Protection, 11th December 1998, Moscow, Russian Federation and updated by the assembled Experts for the conference Reproductive Health in a Pluralistic Legal World, Santiago Spain March 30 and 31 2017)

 

BY UPDATING THE Declaration and expanding its scope when necessary

1. To reflect technological changes that expand the Capacity to Reproduce for previously infertile individuals, couples and for LGBT families;
2. To thereby include new constituencies  by addressing their unmet needs
3. To reflect the new data that underscores the ongoing crisis in reproductive health care
4. To present a Plan of Action for addressing and reducing long-standing issues of health disparities between men and women that have been documented for the first time by the World Health Organization in the recent decade;
5. To address specific issues of prenatal care, post-reproductive exposures that trigger cancers in reproductive organs, and general concerns for women’s health,
6. To spotlight the need for reproductive health research for men and women with particular emphasis on capacity building for public health awareness and for protection from occupational exposure to toxins;
7. To present a new opportunity to integrate new technologies including but not limited to epigenetics and Nanotechnologies into the general public health framework by offering and publicizing new genetic therapies and Nanomedicines; and
8. To meet the Grand Challenge of eliminating health disparities between men and women that impact reproductive health, with particular emphasis on reducing maternal mortality and infant mortality,
9. To meet the Grand Challenge of on reducing maternal mortality and infant mortality in order to Protect Posterity of Civil Society.

 

To insure optimum reproductive health protection worldwide, the Members of the International conference and Informal meeting of experts Medical and Ecological Problems of Workers   Reproductive Health, 9_10 December 1998, Moscow Russian Federation stated and the Members of the conference Reproductive Health in a Pluralistic Legal World, Santiago Spain  reaffirmed that there is an urgent need for elaboration of international consensus statements as well as the Plan of Action.

 

 MISSION OF THE SANTIAGO DECLARATION

The mission of this conference is to rethink carefully and with grandeur the terms of the previous Declaration from 1998, with a view to giving these words new meaning in a changed daily life in light of new assisted reproductive technologies (“ART”) that enable millions of people to become parents even if they were previously considered to be infertile or were previously unable to marry and be considered lawful parents with their loving partner due to LGBT status, no longer a barrier to the Right to Found A Family under the Universal Declaration of Human Rights (UDHR) and under national laws in many Nations of the World.

 

CHARGE FOR THIS CONFERENCE

On the basis of this recent legal authoritative opinion, and in the light of recent developments in many national legal orders, this conference calls upon the academic community to substantively contribute to the enhancement of effective legal solutions to “new” social concerns.  Our goal therefore in this conference is to develop a new discourse that will look at all these issues which have been neglected way too long. New developments in assisted reproductive technologies are very useful for expanding the political base with new constituencies who care about reproductive health from the standpoint of childbearing and childrearing. Previously,  the abortion conundrum consumed a disproportionate amount of time and money and emotional energy spent on reproductive health, resources that must be channeled under law to end major health disparities that are inextricably linked to depriving human rights to reproductive health. New technology and new law challenges the traditions of the past, and offers civil society an unprecedented opportunity to protect human rights to reproductive health.herefore, review and revise an existing Declaration with Plan of Action for Reproductive health in order to reflect new knowledge about longstanding health disparities and new science that bring a larger constituency to these issues.

 

BACKGROUND INFORMATION: 

The United Nations International Conference on Population and Development in Cairo  1994 codified the definition, “Reproductive health is a state of complete physical, mental and social well_being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes… Reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems…”

The Universal Declaration of Human Rights (UDHR) anticipated this Right to Reproductive health:

Article 16: Right to marriage and family

1. Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.
2. Marriage shall be entered into only with the free and full consent of the intending spouses.
3. The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.

UDHR Article 25 offers all men the right “to a standard of living adequate for the health and well-being of himself and his family,” (sic) without a benchmark for that standard and without stating whether his family includes single moms. Legal pluralism answers this challenge posed by a tradition that was previously called ‘the rights of man’.   Although the notion of “man” as opposed to the rights of a deity invested in the Divine Right of  Kings seems appropriate at first, Eleanor Roosevelt  promoted the use of the expression “human rights” in the 1940s when she discovered, through her work drafting the UDHR that the rights of men were not understood everywhere to include the rights of women” ^[16]  In contrast to his rights for his family, international law is rife with references to maternal health or the needs of pregnant women and nursing mothers in a special capacity. UDHR  Article 25.2  states, “Motherhood childhood are entitled to special care and assistance” but fails to offer special criteria for that care. Consistent with its legal mandate, in March 2016 the UN Committee on Economic, Social and Cultural Rights (ECSCR) adopted General Comment n. 22 (GC/22) which elaborates upon sexual and reproductive health rights stating “[r]eproductive health …concerns the capability to reproduce and the freedom to make informed, free and responsible decisions. It also includes access to a range of reproductive health information, goods, facilities and services to enable individuals to make informed, free and responsible decisions about their reproductive behavior.” (para. 5 E/C.12/GC/22).

Subsequently, new research has revealed that there are major health disparities between men and women from the same age cohort at every stage of the life cycle, and that a Plan of Action is needed  to eliminate embedded sexism in the human rights law, which has closeted women’s health and reproductive health away from mainstream rights to health.  The impact of this inequality presents a second challenge which can be met by good science and sound legal strategy for attacking the problems of reproductive health: empirically documented negative differences in women’s health and shockingly high rates of maternal mortality during pregnancy and childbirth, and avoidable infant mortality must be reduced. Inequality embedded under law translates into large health disparities that undermine womens health, especially during pregnancy, in daily life.

WHO published  in 2009 « Women and Health: Today’s Evidence , Tomorrow’s Agenda » ^[17]. According to WHO, the difference in male versus female health outcomes using their indicators showed better health among men in 5 stages of the life cycle^[18]1. birth to 5 years, 2. adolescence (including implications of adolescent pregnancy) 3. Reproductive years 4. Post-reproductive years (menopause and greater risk for cancer among sex-based target organs) and 5. Advanced ageing (65-80 years).  World Health Organization  (WHO) Women and Health: Today’s Evidence , Tomorrow’s Agenda »  World Health Organization, Geneva Switzerland 2009 ISBN: 9789241563857 : whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf

On March 2016, the UN Committee on Economic, Social and Cultural Rights (ECSCR) adopted its General Comment n. 22 (GC/22) related to Right to Sexual and Reproductive Health. In its legal authoritative views, the Committee recalled that “[r]eproductive health […] concerns the capability to reproduce and the freedom to make informed, free and responsible decisions. It also includes access to a range of reproductive health information, goods, facilities and services to enable individuals to make informed, free and responsible decisions about their reproductive behavior. […]” (para. 5, E/C.12/GC/22). Under the United Nation Charter, ^[19] the contracting parties state their aspiration to “promote” economic and social advancement and “better standards of life, including the promotion of human rights protections”, in Article 13. ^[20]

 

1. INTERDEPENDENCE OF REPRODUCTIVE HEALTH AND ITS INEXTRICABLE LINK TO ALL HUMAN RIGHTS (UN OFFICIAL TEXT)

Achieving Realization of the right to sexual and reproductive health requires that States parties also meet their obligations under other provisions of the  International Covenant on Economic, Social and Cultural Rights (IECSCR)  such as but not limited to:

1. Sexual and reproductive health, combined with the right to non-discrimination and equality between men and women (articles 2.2 and 3), entail a right to education on sexuality and reproduction that is comprehensive, non-discriminatory, evidence-based, scientifically accurate and age appropriate.
2. The right to sexual and reproductive health, combined with the right to work (article 6) and just and favourable working conditions (article 7), as well as the right to non-discrimination and equality between men and women again, requires States to ensure safe and healthful employment that will not undermine the individual’s Right to choose whether or not to Reproduce and will not undermine reproductive Health as defined under International Law and as expanded under the auspices of new Assisted Reproductive Technologies (ART) including but not limited to frozen eggs, IVF, surrogate motherhood, egg donation, gene therapies, alteration of genetic material and donor sperm. .
3. Preserving individual reproductive health is a key component  of  making available work and working conditions that protect Public Health for parents and infants, and requires integration the Worklife Environment for employment with maternity protection and parental leave for workers, and prohibition of discrimination based on pregnancy, childbirth, parenthood,  or sexual orientation, gender identity or intersex status.
4. The right to sexual and reproductive health is also indivisible from and interdependent with other human rights. It is intimately linked to civil and political rights underpinning the physical and mental integrity of individuals and their autonomy, such as the right to life; liberty and security of person and privacy regarding their reproductive choices and sexual orientation which may or may not impact their reproductive decisionmaking.

 

1. PURPOSES OF THE SANTIAGO DECLARATION AND PLAN OF ACTION

RECOGNIZING THAT the sound of freedom that resonates from civil and political rights rings hollow to a newborn who has low birth weight, because the baby’s mother had no access to a clean workplace, good nutrition or adequate prenatal care.  And,  further

 

RECOGNIZING that good are political and civil rights to any different baby who has lost a parent due to an occupational accident, or whose parents are debilitated by occupational disease, or to the baby who may suffer personal injury due to the effects of a parent’s workplace exposure to mutagens or unchecked but foreseeable harms caused by unregulated applications of nanotechnology, at home or in their parents’ workplace and

 

RECOGNIZING  that Pregnancy underscores the complex reality that no one is either: self-sufficient or completely dependent on others and

 

RECOGNIZING  that Civil society has not fully replaced human childbearing for human reproduction, and therefore protecting posterity especially during childbirth and pregnancy is a shared health concern of people throughout the world.

 

RECOGNIZING THAT when public health programs in civil society  care about reproductive health, the true aim and purpose of those programs is  protecting Posterity, and extending human rights to lives beyond those that exist at the time,

 

RECOGNIZING  the ongoing urgent need for improved primary care, protection of mothers, working parents and their children for the benefit of the family and the urgency attached to the problem of understanding the interaction between workplace exposures, environmental factors and preventing worker exposures that jeopardize familial health and human reproductive health, AND

 

NOTING THAT Frozen eggs and a variety of new forms of surrogacy enable women to continue working in a highpowered career without staring squarely at the face of a biological clock. Into this mix too, jurisprudence must reflect upon the meaning of  GC22 “freedom to make informed, free and responsible decisions”. Access to a range of reproductive health information, goods, facilities and services, as promised in GC22, may mean improving prenatal care, preventing cancer of reproductive organs in men as well as women across all age groups, community support for mothers and fathers, maternity leave with pay and paternity leave, a subject of recent interest in the USA, along with use of information when making autonomous decisions about accepting or refusing treatment. HIV testing, ^[15]  has taught the importance of moving the modern paradigm away from examining the physical  “invasiveness” of testing, examining instead the emotional burden that testing places upon individuals AND

THAT   Civil society’s recent experience with HIV policy provides a useful precedent for determining the scope and parameters of emerging informed consent requirements in highly emotional aspects of reproductive health, such as prenatal gene therapy, medically recommended therapeutic abortion, embryo selection in multiple fetus pregnancy, or fetal surgery.

 AND

 

RECOGNIZING THAT many conventions that suggest there is an international need and  obligation to address  these issues, but no single comprehensive internaitonal instrument about reproductive health in the workplace  addresses these issues directly nor does any such instrument adequately ensure access to information and risk communication for all people who confront reproductive health hazards  at work;

 

   

CONSISTENT WITH Principles of United Nations Charter, Universal Declaration of Human Rights, International Convention on the Elimination of All  Forms of Discrimination Against Women, International Convention on Child Rights, UN Conference on Environment and Development (Rio De Janeiro, 1992), on Population and Development (Cairo, 1994), on Women (Beijing, 1995), WHO Constitution,  Alma Ata Declaration (1978) and Health for All 2000″, WHO Global Strategy for Occupational Health for All (1996), WHO revised policy document Health for All in the 21st Century (to be issued later), ILO Conventions and Recommendations on women workers, specifically but not limited to: C.103 AConvention Concerning  Maternity Protectio (1952),  C.165 AConvention Concerning Employment Protection and Protection Against Unemployment;  C. 156 AConvention Concerning Equal Opportunities and Equal Treatment for Men  and Women: Workers With Family Responsibilities”, and C. 155 AConvention Concerning Occupational Safety and Health, Related regional and national directives and recommendations on safety and health of pregnant workers and the mandte to protect male reproductive health and posterity for families across the spectrum of sexual orientation including LGBT heads of households,

 

RECOGNIZING the UN definition, “Reproductive health is a state of complete physical, mental and social well_being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes… reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well_being by preventing and solving reproductive health problems…” (Cairo, 1994).

 

RECALLING the WHO view that health is tied to the prevention of impairments and the ability to participate in all life activities, and that the WHO should endorse a Plan of Action in this Declaration to address this urgent problem

 

This Committee of Experts hereby calls upon the Director_General of WHO and the Chair of the ECSR  AND THE Commission on the Status of Women and the 2030 Agenda for the United Nations  to urge  further understanding, research and international co_operation in the following areas to prevent and reduce known  hazards to reproductive health.

 

• Findings and PLAN OF ACTION

1. FINDINGS

1.Experts in many countries express serious anxiety about unsatisfactory health status of population especially of reproductive health as well as of children’s health due to influence of hazardous occupational and environmental factors (physical, chemical, biological agents, physic loads and nervous stresses). Combined with weak social determinants for health, social and economic problems conspire to create  a critical situation in population reproduction which threatens sustainable development and the health of posterity.

2.New technologies can cure or exacerbate these problems, depending on how the new technologies are used in public health policy.

3. Despite new and emerging technologies that make accessible primary care cheap and portable, many pregnant workers have been denied access to primary care in occupational health services or in the health care delivery systems of the different nations and this grave situation causes further deterioration of maternal and child health and the well_being of all society.

4 The European Union  « Birth Day » Project to Reduce Mortality During Pregnancy and Childbirth seeks to apply new technology to address the problem  that  around the world, hundreds of thousands of women and babies die on the day of birth, and millions more are left with serious illness. WHO estimated that 303 000 women died in 2015 from preventable causes related to pregnancy and childbirth. UNICEF reported that  5.9 million children per year die before their 5th birthday, of which 2.65 million are newborn babies. It is widely agreed that many maternal deaths are due to preventable or treatable conditions (WHO).

5. An excellent starting point to focus the best of science and law protecting reproductive health rights therefore should face the Grand Challenge of : eliminating or reducing health disparities based on gender or sex, and especially those facets of the disparities that impact infant mortality and maternal mortality.^[21]

 

1. PLAN OF ACTION

3.1 Priorities in research and for primary health care system and occupational safety and health service

Notwithstanding the progress in maternal and child health and in reproductive epidemiology, some problems persist, or  are increasing.  A high  proportion  of  conceptuses are lost prematurely, manifested as sub_fecundity and infertility, the rate of spontaneous abortion seems unchanged, congenital defects are a continuous problem, while childhood cancers are increasing. According to some, but not all studies, fertility and sperm quality are decreasing.

Although research efforts have considerably increased in this area in recent years, there are still many open questions. Some examples are the following:

_Is there a differential susceptibility of the female versus the male organism to exposures of chemical and physical agents in the work environment,

_How justifiable are differential standards and limits of exposure for the two genders, are present day work exposure   limits   sufficiently low to protect the reproductive health of men and women,

_Is there a true reduction in human fertility  (and sperm quality), in the industrialized countries, and what may be the risk factors involved,

_How do factors previously neglected such as stress, shift work, work with new technologies, affect reproductive health,

_Are the known reproductive risks under control, and how can this be accomplished ?

Particular attention must be paid to the health of working women, a subject that has been neglected in both developed and developing countries. To fill this gap, it is important that the following steps be undertaken by governments and international organizations:

_ Studies in the production sectors which employ predominantly female workers. These include both paid and unpaid (invisible) work in agriculture, in domestic labor, in garment, textile and food industry, in the health care sector.

_Identify reproductive risks for both men and women in these settings, and prevent exposures of those more vulnerable.

_Take account in studies of the double load of women workers, and of family and other stresses.

_ Most reproductive health  hazards are dangerous to both males and females, whether in utero or as adults. Research should examine both. Selective overprotection of women may compromise employment opportunities of women, condemning them to poverty.

_Document the many forms of exploitation and illicit labor in developing countries, especially
among adolescent girls and child laborers. These phenomena are insufficiently documented, and are too-often tolerated by local authorities.

_Document the deprivation and reproductive risks of migrant workers, who seek employment and survival in western countries. For them too, documentation and intervention programs are deplorably scarce.

 

3.2.Considerations for the need of specific approach in studying reproductive health at work and in the environment in light of new assisted reproduction techologies and new medical technologies inluding nanomedicines epigenetics screenings and nanotechnologies

Several chemicals have a short half_life in the organism and a certain endpoint (nonetheless causing a birth defect) but such harms might arise only after exposure in the respective sensitive period of gestation, the necessity of studying a range of endpoints including sensitive ones and subtle changes as minor birth defects and postnatal functional deficits.

THEREFORE  this Plan of Action recommends

1. Investigation directed to reveal dose_effect and dose_response relationship for proven and/or suspected reproductive and developmental hazards.
2. Examination of additional and eventually new endpoints for reproductive toxicity.
3. Studies on contribution of combined exposures.
4. Exploration of potential reproductive hazards of new technologies, recently introduced chemicals and other agents as well as in branches of commerce which have not been studied.
5. Development of study protocols and statistical approach to deal with the problem of small employers in specific occupational settings and being exposed to specific hazards.
6. Implementation of models for monitoring reproductive health of workers and subsequent use of these data for epidemiological studies. Further refinement of the protocols with inclusion of individual exposure data   relevant for the respective endpoint  period in case_control studies nested in a follow_up cohort.
7. Encouraging occupational health services and national registries for births and national health databases to report clusters of mis_events in reproductive health and with the help of other specialists organizing follow_up studies.

 

3.3 Proposed Action to fill the gaps in existing international and state laws Regarding the role of workplace exposures in shaping reproductive health outcomes:. 

1. The Committee of Experts Notes that there are many conventions that suggest there is an international need and  obligation to address these issues, but No single comprehensive international instrument about reproductive health in the workplace addresses these issues directly nor does any such instrument adequately ensure access to information and risk communication for all people who confront reproductive health hazards at work

THEREFORE An initial survey of international laws demonstrates that many of the treaties and conventions and international human rights instruments that provide jurisdiction for the protection of reproductive health are important but inadequate; they form only a patchwork of indirect efforts  to protect people from reproductive health hazards in their workplace.

 

1. Further international legal research is needed int his area, comparing and harmonizing local, national and internaitonal laws and codes of practices from corporations regarding reproductive health hazards from occupational exposures.

 

1. In addition to further legal research harmonizing international and state laws and analyzing the jurisprudence of pregnancy and of related health laws and laws governing the delivery of primary care at local, national regional and international levels,

 

1. This Committee of Experts strongly urges the development of an international instrument (Such as an ILO Convention, WHO Recommendation, ISO Standard, OECD working Group and Code of Best Practices, treaty or other multilateral document) that will directly address these problems, Combined with a strong campaign for legislative awareness that will educate legislators, members of the international governmental community, regulators, scientists and the general public regarding the urgency and the visible means of preventing foreseeable reproductive health hazards in the workplace and preventing their adverse consequences.

 

4. STRATEGIES FOR CAPACITY BUILDING AND PROPOSED PLAN OF ACTION

4.1. Request for Urgent Priority to this matter from the Director_General of  the WHO and of the OECD, WTO, UNDP, UNFPD, UNHRC ECOSOC CSW,  UN WOMEN ILO and related International Organizations.

 4.2. Implementation of international consensus statements on reproductive health protection 

4.3. Development of agreed terminology on reproductive hazards and reproductive health risks as well as standard definitions for describing and monitoring legislation, policies, services provision and use and reproductive health

4.4. Elaboration of the Guide (or Code of practice) Risk assessment and risk management for pregnant female workers and health monitoring ( possible sponsors include but are nto limited to WHO, UN WOMEN, UNFPD UNDP, external NGOs, UNHRC,  ILO, and OECD).

4.5.  International Co-ordination of efforts and exchange of experience gained between National centers on reproductive health. It is hereby recommended that there be convened an exceptional Committee of Experts via the  WHO Collaborating centers on Occupational Health (coordinating meeting with participation of WHO and ILO) and methodological support of the WHO Safe Motherhood Campaign up to 2000 (WHO Collaborating centers on Occupational Health) regarding risk assessment, management and communication, research regarding the interaction of occupational exposures and environmental factors, and related matters of reproductive health of workers.

 

4.6. Preparation of an International Instrument   (e.g. UNFPA or UNDP or ILO Convention supplemented by WHO/ILO_Joint Committee activity or the specialized branches of WHO; or criteria such other documentation as appropriate) on safe motherhood, reproductive health protection for mothers, using new technologies to protect the right to reproductive health for all including LGBT and people with disabilities,  and to foster research on the role of human rights to reproductive health in the development of emerging nanotechnology, epigenetics and related technologies, and especially including the role of fathers, and the next generation whose reproductive health may be impaired by the harms we study today, but who will not experience the effects of those harms until they also reach reproductive age.

 

IV RECOMMENDATIONS

1.Therefore the Committee of Experts on Reproductive Health and Legal Pluralism  Meeting in Santiago Spain March 31 2017 hereby Declares and recommends that definitions of occupational health, reproductive health and environmental health impacting on the vitality of the family and the next generation include but are not limited to the effects of  dangerous or potentially dangerous exposures to adults in any workplace and shall be considered as a fundamental component of assessing each individual’s health status and well_being regardless of disability of the individuals and regardless of LGBT status.

 

2. Therefore this Committee further Recommends that there shall be an international meeting to follow_up this meeting on regular basis, under the auspices of WHO, United Nations 2030Agenda, UN Women, UNEP, UNDP, UNFPD, ILO and related international governmental organizations, and that the results of such meetings shall be the production and adoption of an International Instrument for the protection of reproductive health of people at work and for the future inclusion of new constituencies and research including LGBT communities.

REFERENCES

Annan K.A. Occupational health: a high priority on the   global, international and national agenda._Asian_Pacific Newsletter on Occupational health and safety _1997; 4(3):59

Brundtland Gro Harle. Speech following election as Director_General of the WHO 13 May 1998. 55th World Healh Assembly.

Implementation of the WHO Global strategy for occupational health for all. Plan of action covering specific period 1996_2001//Int. J. Occup. Med. Environ. Hlth._1997._v. 10, N 2._ P.113_139

UN, Commission on Population and Development, Concise report on world population monitoring, 1996, reproductive rights and reproductive health, E/CN.9/1996/2, 15, January 1996

WHO Global strategy on occupational health for all. The way to health at Work._WHO/OCH/95.1._Geneva: WHO, 1995._ 68 pp.

WHO revised policy document Health for All in 21st Century*  r)

6.B. REFERENCES (scientific)

1.Abeytunga P.K. and Tennassee M. Occupational and environmental exposure data: Information sources and linkage potential to  adverse reproductive outcomes data in Canada, in: Understanding infertility: risk factors affecting fertility. Volume 7 of the Research Studies, Royal Commission on New Reproductive Technologies, Ottawa Canada 1993

2.Feitshans I.L. Occupational health as a human right._In: Encyclopaedia of occupational health and safety._Geneva: ILO, 1998._P.23.21_23.27. Also: BRINGING HEALTH TO WORK, Emalyn Press, Haddonfield USA 1997

3.Effects of occupational health hazards on reproductive functions. Eds. M.A. El Batawi, V. Fomenko, K. Hemminki, M. Sorsa, T. Vergieva. WHO/OCH/87.2. Geneva, WHO, 1987. _ 60 pp.

4.Langard S. Partitioning of causal weights of work  and environment related diseases based on  epidemiologic results ( Norwegian, abstract in English)/Nor. J. Epidemiol._1994._v.4,N 1._P. 26 31

5.Medical and ecological problems of workersÆ reproductive health. û Abstracts of the International Conference, 9_10 December 1998, Moscow. RAMS Institute of Occupational Health, Moscow, 1998. 126 pp.

6.Proposed national strategy for the prevention of disorders of reproduction._ DHHS (NIOSH)

Publication N 89_133, 1988._29 pp.

7.Rantanen J., Fedotov I.A. Standards, principles and approaches in occupational health services. In: Encyclopedia of occupational health and safety. ûGeneva: ILO, 1998. ûP.23.14_23.21.

8.Reproductive toxicity. Volume 1. Summary review of the scientific evidence (for 30 chemicals). û EUR 14991 EN 1993.

9.Sanotsky I.V., Fomenko V.N. Long_term effects of chemicals on the organism. û UNEP, IRPTC, Centre of international projects, GKNT. Moscow, 1986. û 206 pp.

10.Sivochalova O.V., Kozhin A.A. Protecting the reproductive health of the family.//Reproductive Toxicology._1994._Vol. 8, N 1._ P.5_9.

11.Vergieva T. Adverse effects of environmental chemicals on the outcome of human pregnancy. In: Reproductive Toxicology, Ed. M. Richardson, VCH, Weinheim_New York_Basel_Cambridge_Tokyo,1993, 73_97.

12.Women at Work. Proceedings of the International Expert Meeting 10_12 November 1997. û People and work. Research reports 20._Finnish Institute of Occupational Health, Helsinki,1998._214 pp.

 

List of  Participating Experts (RAMS)

Chairpersons of the Meeting:

Izmerov Nikolai F., MD, Dr Sc, Prof, Director, Russian Academy of Medical Science (RAMS) Institute of Occupational Health, Russian Federation and Sivochalova Olga V., MD, Dr Sc, Head, Centre of Medical and Ecological Problems of Workers Reproductive Health, Russian Academy of Medical Science (RAMS) Institute of Occupational Health, Russian Federation

Legal Advisor for Russian Academy of Medical Science

Feitshans, Ilise L. JD and ScM

Cornell University NYS/School of Industrial and Labor Relations

Initiative and editorial group: O. Sivochalova, E. Denisov, I. Figa_Talamanca,

1. Vergieva, I. Feitshans. Updated Santiago Spain 2017

 

NOTE: This text and its supporting research is based presentations for: Health, Law and Human Rights: Exploring the Connections An International Cross-Disciplinary Conference Honoring Jonathan M. Mann www.aslme.org/humanrights2001September 29 to October 1, 2001 USA;  the Conference: Medical and Ecological Problems of Workers: Reproductive Health, Scientific Council,  Reproductive health of Workers, (RAMS)  WHO Collaborating Centre,  Moscow, Russian Federation 1998;  Lectures at Yale University School of Medicine: Rethinking Reproductive Health at Work  1999;  Work Health and Survival, 2000; Genetic Destiny: Emerging Issues in Genetic Testing in The Workplace, 2000; Legislating to Preserve Women’s Autonomy During Pregnancy INTERNATIONAL JOURNAL OF MEDICINE AND LAW Vol 14 No 5/6 1995; Texas Journal of Women and the Law Article, IS THERE A Human Right to Reproductive Health? and  Keynote Address for the conference Reclaiming Our Birthright: Reproductive Health Hazards in the Workplace Toronto Canada,  1999.

[1]    Louis Henkin, Editor The International Bill of Rights Columbia University Press, 1981. (introduction)

[2]    Louis Henkin, 74 Columbia Law Review 1410 (1974)

[3]    Henkin “Privacy and Autonomy” 74 Columbia Law Review 1410 (1974) at 1419.

[4]    United Nations Charter, (henceforth UN Charter) Signed 26 June, 1945, Entered into Force 24 October 1945. Center for the Study of Human Rights, Twenty Five Human Rights Documents Columbia University 1994. The Preamble elludes to subsequent economic and social rights protections, by resolving “to promote social progress and better standards of life in larger freedom…. to employ international machinery for the promotion of economic and social advancement of all peoples.”

[5]   UN Charter, Chapter I, Article 13: “1. The General Assembly shall initiate studies and make recommendations for the purpose of: (b) promoting international cooperation in economic, social,… and health fields, and assisting in the realization of human rights and fundamental freedoms for all”.

[6] insertcite BioOpenaccesJournal nanotechnologySept 2016.

 

[7]Ilise Feitshans, Invited Presentation “Beauty, Babies And Dieting: The Impact Of Nanotechnology Law On Reproductive Health  and Women’s Occupational Health Disparities”  IDA background briefing for use by OSTP,  Washington D C December 2013

[8]World Health Organization  (WHO) Women and Health: Today’s Evidence , Tomorrow’s Agenda »  World Health Organization, Geneva Switzerland 2009 ISBN: 9789241563857 : http://whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf

[9]    Maurice Cranston, Daedalus Journal of the American Academy of Arts and Sciences Fall 1983, citing D.D. Raphael, Politcal Theory and The Rights of Man London Macmillan, 1967 p.54.

[10]    Convention on the Elimination of ALl Forms of Discrimination Against Women. Adopted and Opened for Signature, ratification and accession by United Nations General Assembly resolution 34/180 on 18 December 1979. Entered into Force on 3 September 1981 in accordance with Article 27 (1) Reprinted in Center for the Study of Human Rights, Twenty Five Human Rights Documents  supra note ____ at 48-56.N.B.:The potential effects of the terms of this Convention on the abse nce of gender neutral language in UN treaties in general and even in leading human rights documents raises the interesting question whether there the is an identical same legal regime for men and women under international law?

[11]    See: Feitshans, Ilise Levy, “Job Security for Pregnant Employees: The Model Employment Termination Act” 536 Annals of the Amer Academy of Political and Social Sciences 119 (Nov. 1994)

[12]    In the USA, U.S. Supreme Court cases in this area span from a concern for limiting the hours of womens’ work because of their need to be home raising families, upheld in  Muller v. the State of Oregon,  208 U.S. 412 (1908) to the recent decision banning forced sterilizations of women who are exposed to reproductive health hazards in the workplace in IUAW v. Johnson Controls   499 U.S. 187 (1991). See: Feitshans, Ilise Levy, “Job Security for Pregnant Employees”  supra note ___ at 122 “Muller v. Oregon and the Protectionist Era”. See also: Becker, Mary, “Reproductive Hazards After Johnson Controls” 31 Houston Law Rev. 43 (1994).

[13]    See discussion of IUAW v. Johnson Controls and OCAW v. American Cyanamid supra note ___ above. In those cases, women were compelled by their employers to be sterilized in order to obtain or retain employment in an arguably fetotoxic work environment. The Convention on the Elimination of All Forms of Discrimination Against Women remains silent, however, regarding whether its notion of “Special Protections” would be satisfied or limited by the so-called “protections” offered in such extreme cases

[14]ilise Feitshans, “Public Comment On The Draft Strategy 2016 For OSTP and NNI: A New Grand Challenge: The Mom Project Eliminating Or Reducing Womens Health Disparities Impacting Infant Mortality And Maternal Mortality During Pregnancy”,  The Work Health And Survival Project  Haddonfield NJ USA  September 23 2016. Posted on Researchgate October 2016

[15]World Health Organization “World Report on Disability” World Health Organization, Geneva Switzerland 2010.

[16]    Maurice Cranston, Daedalus Journal of the American Academy of Arts and Sciences Fall 1983, citing D.D. Raphael, Politcal Theory and The Rights of Man London Macmillan, 1967 p.54.

[17]Ilise Feitshans, Invited Presentation “Beauty, Babies And Dieting: The Impact Of Nanotechnology Law On Reproductive Health  and Women’s Occupational Health Disparities”  IDA background briefing for use by OSTP,  Washington D C December 2013

[18]World Health Organization  (WHO) Women and Health: Today’s Evidence , Tomorrow’s Agenda »  World Health Organization, Geneva Switzerland 2009 ISBN: 9789241563857 : http://whqlibdoc.who.int/publications/2009/9789241563857_eng.pdf

[19]    United Nations Charter, (henceforth UN Charter) Signed 26 June, 1945, Entered into Force 24 October 1945. Center for the Study of Human Rights, Twenty Five Human Rights Documents Columbia University 1994. The Preamble elludes to subsequent economic and social rights protections, by resolving “to promote social progress and better standards of life in larger freedom…. to employ international machinery for the promotion of economic and social advancement of all peoples.”

[20]    UN Charter, Chapter I, Article 13: “1. The General Assembly shall intiate studies and make recommendations for the purpose of: (b) promoting international cooperation in economic, social,… and health fields, and assisting in the realization of human rights and fundamental freedoms for all”.

[21]Ilise Feitshans, “Public Comment On The Draft Strategy 2016 For OSTP and NNI: A New Grand Challenge: The Mom Project Eliminating Or Reducing Womens Health Disparities Impacting Infant Mortality And Maternal Mortality During Pregnancy”,  The Work Health And Survival Project  Haddonfield NJ USA  September 23 2016. Posted on Researchgate October 2016 and reprinted in BAOJ Nanotechnology September 2016