Under a huge baobab tree in Sudan’s Nuba mountains, I met Sebila, a 27-year-old mother of three. In March last year, her village had been attacked by Sudanese ground troops and bombed by government war planes. The assault forced Sebila and many other villagers to flee deeper into rebel-held territory.

She was just back in the village for the day with her children, two toddlers in tow and carrying a baby, to dig up sorghum she had buried. Sebila said food here is scarcer than it has been for years, because of poor rains and conflict fighting. “It’s exhausting, trying to feed them all [my family],” Sebila said of her children.

Aid obstruction in the rebel-held territories of Sudan’s South Kordofan and Blue Nile has been in force for nearly six years, and has had a devastating impact on the communities here. For Sebila – and all the women living across these territories – it has meant no access to contraception. “Every year, I give birth,” she told me. “It would be better if I could space it [out].” But Sebila cannot space her babies out, or have any control of her body. Like all women living in rebel-held territory here, she has zero access to contraception.

 In the Nuba Mountains, South Kordofan, access to family planning and maternal healthcare is severely limited by blocks on humanitarian supplies.

© Goran Tomasevic/Reuters

It has also meant a severe lack of maternal healthcare. There is no local midwife, and Sebila lives five hours’ drive from a hospital, in a region where cars are a rare luxury. Women told me of waiting hours for transport while in obstructed labour, or being held propped up, bleeding and falling in and out of consciousness, between two men on the back of a motorcycle to reach a hospital. Multiple and closely-spaced births can carry serious health risks for both mother and infant, and can be life-threatening without proper treatment.

Yet there is no coordinated international aid effort under way in the Nuba mountains. Funds are in place, but both the government and the rebel group are preventing supplies getting in. The conflict has left already-stretched health services in the region in a pitiful state. Most facilities are little more than a table with some basic medicines, and there are only five doctors and one blood bank for perhaps close to a million people.

Despite many rounds of peace talks since fighting began in 2011, the Sudanese government and the Sudan People’s Liberation Army-North have failed to agree on how to allow aid – needs-based and impartially delivered – into the affected areas. Instead they are still arguing about whether aid can come through a third country, or, as the government insists, only from inside Sudan. Some aid groups have found ways to provide occasional help, unauthorised by the government but supported by the rebels, but this is no substitute for the large-scale effort needed. 

This has very serious consequences for reproductive health. None of the women I met in the Nuba mountains had any access to family planning. One clinic provides a three-month injectable contraception, but local rebel regulations require women to get their husband’s permission first. Despite evidence that gonorrhoea and syphilis are on the rise and hepatitis B common, condoms are scarce. Most of the women I met had never seen a condom, let alone any other form of contraception.

It is also feared that the number of women and girls dying in childbirth in the rebel-held areas of Southern Kordofan – already much higher than other states in Sudan – is rising yet further. And two major aid efforts, including a UN polio vaccination campaign for children, have failed.

Sudan has a long history of aid obstruction going back to the start of the conflict: denying travel permits; rejecting visas; blocking work permits; and expelling aid workers. Meanwhile, citing mistrust of the government, the rebels have still not agreed to an offer by the US to provide aid via Khartoum, and have instead called for yet more negotiations. 

Although aid saves lives, and warring parties in conflict have an obligation to allow the delivery of humanitarian assistance to civilians, preventing it from reaching people is rarely punished. The UN security council briefly threatened punitive action against Sudan in 2012, but never acted. The health crisis unfolding in the Nuba mountains should prompt a change of tack. The UN security council, the African Union and the EU should investigate and consider travel bans and asset freezes on rebel and government leaders found to have deliberately blocked such deliveries. 

International aid is often a lifeline to civilians trapped in conflict. And it would help women like Sebila to access contraception, avoid risky childbirth, and feed their children.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Sarah Jamal Ahmed, a 24-year-old sociologist who was one of the activists during the 2011 uprising in Sanaa, stands by posters of dead protesters posted in the streets.

© 2012 Panos/Abbie Trayler-Smith

The revolution made us proud to be there on the front line and men were forced to accept us. But now there are some who think it is time for women to go home.

—Salwa Bughaighis, lawyer and human rights activist, Benghazi, Libya, July 2012[i]

In 2011, women were at the forefront as the Arab Spring erupted in Libya, organizing and demanding their rights to have a voice in their country’s future. The ensuing civil war resulted in the former Libyan leader Muammar Gaddafi being toppled.  In the transitional period following that armed conflict women organized as voters and candidates in preparation for elections, documented human rights abuses, and worked to ensure any new constitution would enshrine women’s rights.

The revolution made us proud to be there on the front line and men were forced to accept us. But now there are some who think it is time for women to go home.

Salwa Bughaighis

Lawyer and human rights activist, Benghazi, Libya, July 2012

Iman and Salwa Bughaighis—sisters and human rights activists—were among the key organizers of the first demonstrations against Gaddafi in Benghazi in February 2011. “The revolution was an earthquake to the cultural status of women in Libya,” Iman told Human Rights Watch.

But the space for women’s political participation soon began to shrink. As the wrangling intensified over power and the future of Libya, women found themselves facing significant obstacles to their full participation in the country’s transitional processes, and even targeted for violence. On June 25, 2014, following threats, unidentified gunmen murdered Salwa Bughaighis in her home in Benghazi. One month later, on July 17, unidentified assailants shot dead Fariha al-Barkawi, a former lawmaker, in the eastern city of Derna.[ii] Both crimes are among hundreds of apparently politically motivated killings in post-Gaddafi Libya that remain uninvestigated and unprosecuted.

On the eve of Libya’s first democratic national election, Haja Nowara held a vigil in the square outside the courthouse in Benghazi, where she had spent many evenings supporting the revolution since early 2011. “I have waited my whole life for tomorrow, which will be a new day for Libya,” said Nowara, who would be voting for the first time in her life. “We sacrificed a lot to get here.”

© 2012 Samer Muscati/Human Rights Watch

In its treatment of women and girls in wartime and in the post-war transition, Libya is sadly unexceptional.  Throughout history, women and girls have often been targeted in wartime for violence, especially sexual violence.  And they have also been denied the ability to participate in conflict prevention and post-conflict resolution efforts. Governments and non-state armed groups did not pay attention to the use of rape as a weapon of war, nor to the exclusion of women from crucial decision-making on conflict resolution and prevention, until women themselves mobilized for recognition and action.

This document sets out the commitments that the international community has since made to women and girls affected by armed conflict and outlines the major disappointments and gaps in implementation in three distinct but interconnected areas: participation; protection and assistance; and accountability. It also makes recommendations to governments, to all parties to armed conflicts, and to the UN on how to turn the promises made to women and girls in these three areas into reality.

Security Council Resolution 1325

After sustained advocacy efforts from women’s civil society organizations, the United Nations Security Council, in 2000, adopted Resolution 1325 on women, peace and security.[iii] It was the Security Council’s first dedicated resolution that recognized the specific risks to and experiences of women in armed conflict and women’s central role in maintaining international peace and security. Resolution 1325 elucidated states’ obligations to women and girls in situations of armed conflict, including ensuring that women are involved in all aspects of conflict prevention, conflict resolution, and post-conflict rebuilding. As broadly understood, the women, peace and security agenda acknowledges the linkages between participation, protection and assistance, and accountability, and the centrality of these issues to broader human rights concerns.

Angelina, 20, from Koch county, was spared in May when members of government aligned militia abducted three women and a teenage girl who she was hiding with. “When I fled [my village], I felt very tired and I sometimes would fall and have to use my arms to pull myself forward on the ground,” said the 20-year-old who has a physical disability. “I arrived [at the UNMI SS camp] three weeks after the attack. My whole body was swollen.” 

© 2015 Samer Muscati/Human Rights Watch

This groundbreaking resolution and the subsequent resolutions on women, peace and security elaborate the responsibilities of all parties to ensure the meaningful “participation of women in all levels of decision-making” in institutions and mechanisms for the prevention, management, and resolution of armed conflict, calling on all actors in peace talks to increase women’s participation in negotiations, and to ensure women’s rights are addressed in peace agreements.[iv] The resolutions remind all parties to armed conflicts of their obligations under international law, particularly civilian protection in armed conflicts, and call for states to end impunity for crimes of gender-based violence in armed conflicts. They urge the UN and governments to take steps to increase the number of women throughout the justice sector, and in armed forces. In these resolutions, the Security Council also states its intention to ensure it incorporates women, peace and security in its own work, including through consulting with civil society.

The resolution has given women around the world increased attention and legitimacy in their work in areas of armed conflict. Since the resolution’s adoption in 2000, many governments have begun to recognize that women’s roles in peace processes are not negotiable add-ons, but fundamental to sustainable and implementable peace accords. Security Council resolutions and commitments by UN member states have recognized conflict-related sexual violence as a tactic often ruthlessly deployed in war, and have expanded international prevention and response efforts. Governments and international bodies have introduced new policy frameworks, including additional Security Council resolutions, on women, peace and security at the national, regional, and multilateral levels. The UN is starting to collect data on a range of protection and participation aspects—from sexual violence in armed conflicts to women in peace talks—allowing policymakers and program implementers to begin to track where there has been success and where problems persist.

Much Work Remains

The remaining challenges are many. There is a lack of concerted, high-level leadership willing to spend political capital at key policy moments, such as in Security Council negotiations and in peace talks. There is insufficient and irregular funding, particularly for grassroots organizations working on women’s local-level peacebuilding and service provision.[v] Despite the improvement in data collection, there remains a lack of timely and disaggregated information for policymakers on women and girls in crisis situations, accompanied by a lack of analysis and recommendations for policymakers on appropriate action to take.[vi] Despite the heightened risk of violence faced by lesbian, gay, bisexual, and transgender (LGBT) individuals and women with disabilities in situations of armed conflict, specific measures for them are rarely incorporated into policy and programming, often leaving these populations out of decision-making processes and unable to access services.

Sexual violence during Nepal’s 10 year conflict between Maoists and government forces has remained largely undisclosed. 

©2014 Arantxa Cedillo for Human Rights Watch

The UN Security Council, despite six subsequent resolutions on women, peace and security, often fails to bring these issues into its work on crisis situations. Despite the Security Council members’ meeting with women civil society representatives on its 2013 visit to the Great Lakes region, the subsequent report on the mission contained no substantive analysis or recommendations on women’s rights and concerns.[vii] Briefings from senior UN officials often lack specific information on women’s rights violations, on the inclusion of women in peacemaking efforts, and on the levels of women’s participation in security reform. Use of sanctions and other tools at the Security Council’s disposal are similarly haphazardly applied with respect to women, peace and security.[viii]  The Security Council rarely takes advantage of information on perpetrators to hold them to account and prevent future violations. For example, despite evidence of widespread crimes of sexual violence committed by Sudanese forces in Tabit in Darfur in 2014, the Security Council has not adopted a strong response.[ix] 

With women’s rights high on their rhetorical agenda, practical support among donor countries lags. It is rare, for example, that donors make women’s rights and women’s participation in decision-making a priority in political engagement with conflict-affected countries. Too often, including in countries such as Afghanistan and Somalia, officials assert it is not the right time to push for women’s rights, that security is somehow a prerequisite for women’s rights rather than inextricably linked with them, or that they do not have the leverage to act.[x]

For women and girls living in situations of armed conflict, participation, protection and assistance, and accountability for gender-based crimes remain a distant promise. As detailed in the following sections, it will take strong action backed by persistent political will for the potential of the women, peace and security agenda to be realized.

Nigerian girls in a refugee camp near Lake Chad in Chad. 

© 2015 Samer Muscati/Human Rights Watch

Participation

When Afghan women were asked their definition of security, we used the word “amnyat wa masuniat,” by which we mean a comprehensive feeling of safety when engaged in daily public and social life. The success of peace agreements must be gauged by real, measurable security improvements for women and for all members of the community, not just that a peace agreement has been signed. Excellencies, peace is a process, not an event. We look to you as Member States, including members of the Security Council, to ensure that women are consistently appointed as mediators and negotiators, and that our rights are fundamental to peace processes and outcomes.

—Statement by Orzala Ashraf Nemat, Afghan civil society representative and women’s rights advocate, delivered in the UN Security Council on behalf of the NGO Working Group on Women, Peace and Security, New York, October 28, 2011[xi]

Despite years of rhetoric on the importance of women’s participation in Afghanistan peace processes, no women have been included in over 20 known rounds of informal talks between the international community and the Taliban. In talks between the Afghanistan government and the Taliban, women were present on two occasions.[xii] In most situations of armed conflict and post-conflict, women have few channels and face formidable obstacles to participating in conflict prevention, conflict-resolution, and political processes such as elections and constitutional reform.

The success of peace agreements must be gauged by real, measurable security improvements for women and for all members of the community, not just that a peace agreement has been signed. Excellencies, peace is a process, not an event. We look to you as Member States, including members of the Security Council, to ensure that women are consistently appointed as mediators and negotiators, and that our rights are fundamental to peace processes and outcomes.

Statement by Orzala Ashraf Nemat

Afghan civil society representative and women’s rights advocate, delivered in the UN Security Council on behalf of the NGO Working Group on Women, Peace and Security, New York, October 28, 2011

Women have little representation in formal peace talks. Available UN and academic data show that women are rarely present in these negotiations, and specific rights and concerns of women and girls are rarely reflected in peace agreements. One study of peace processes from 1992-2011 shows that only 4 percent of signatories to peace agreements have been women, and only 18 out of 300 peace agreements signed between 1998 and 2008 addressed any aspect of women’s rights and concerns.[xiii] Women struggle to have their voices heard, but examples of greater women’s involvement are gradually increasing. In Colombia, for example, women are present as permanent members of the negotiation delegation, and a sub-committee on gender in the negotiations was established in 2014, and women’s rights are discussed in the substantive talks. This happened after concerted pressure from civil society organizations, supported by UN Women.[xiv] Despite these gains, however, women’s civil society organizations have not been afforded a formal role in the Colombia negotiations.

Those facilitating formal peace talks often fail to recognize women’s work in community-level peace efforts.  When the opportunity to engage in formal peace talks arose in the 2014 Geneva II talks, Syrian women mobilized. With support from international nongovernmental organizations, UN member states, and the UN, women met behind closed doors with the Security Council, held consultative meetings to draft consolidated demands, and worked with women peacemakers from Ireland, Guatemala, and Bosnia-Herzegovina on strategies for engaging in the peace process.[xv] But when they met with the UN special envoy to Syria, Lakdhar Brahimi, he did not stay to hear their concerns and recommendations. “Mr. Brahimi, we are already building peace in Syria,” the women said, although Brahimi, effectively the chief mediator of Syria’s peace process, had already left the meeting. “We can help you if you let us.”[xvi]  Brahimi’s successor, Staffan de Mistura, has consulted with Syrian women’s groups, despite the stalling of the formal peace process.

Two activists working with the Association for Crisis Assistance and Development Co-operation (WADI), a German-Iraqi human rights group supporting Yezidi women and girls who escaped ISIS. WADI has three mobile units that visit women and girls in camps and settlements. It is seeking funds to build a center for training courses and social activities.

©2015 Samer Muscati/Human Rights Watch

Women should have seats at all decision-making tables, and women’s rights and concerns should be included in the outcomes of conflict negotiations. For example, women's rights should be reflected in humanitarian access agreements, human rights agreements, ceasefires, ceasefire monitoring, and in disarmament, demobilization, and reintegration (DDR) efforts agreed to by parties to a conflict. They should also be integrated throughout security sector reforms, including the vetting of armed and security forces, justice, reparations, and in relief and recovery programs.[xvii] Women’s participation is also the key to ensuring their protection and minimizing risks in displacement settings. This includes in the design of refugee and internally displaced person (IDP) camps so that women and girls are not placed at further risk in those settings.[xviii] Targeted efforts need to be made to ensure that the diversity of women’s perspectives is reflected in all aspects of conflict resolution and peacebuilding. For example, women with disabilities face unique challenges and can share their problem-solving approaches in conflict resolution and peacebuilding efforts.

Women human rights defenders often face risks, particularly in times of armed conflict. Even when women can legally conduct their work, they may face physical assault, sexual violence, and threats far greater than their male counterparts. Human Rights Watch has documented physical attacks, death threats, threatening phone calls, sexual harassment and assault, rape, and threats against children of activists in armed conflicts, all of which can create a chilling environment in an effort to silence these women.[xix] In the 2015 Sudan elections, for example, National Intelligence and Security Service officers arrested Dr. Sandra Kadouda, a prominent political and human rights activist, on April 12 as she drove to an anti-elections event at the National Umma Party headquarters in Omdurman. The authorities held her for three days at an unknown location, and then freed her on April 15, visibly bruised and with injuries to her shoulder, credible sources reported.[xx]

Women should also have the opportunity to participate in security forces without facing discrimination or harassment.  Women often are subject to hostile work environments that dissuade them from staying in or even joining police and military services. In Afghanistan, for example, despite efforts to increase their numbers, women have remained about 1 percent of the Afghan police over the last several years.[xxi] In addition to a lack of the most basic toilet and changing room facilities, women in the Afghan police face abuse and sometimes assault, including sexual assault, by male colleagues. Despite multiple reports of such incidents, these crimes often go unpunished, and government officials, including the minister of interior, have denied that abuses against women officers are a problem.[xxii]

Recommendations to Governments, Parties to Armed Conflict, UN agencies, and the UN Secretariat

  1. Implement national-level policies, including National Action Plans, on UN Security Council Resolution 1325, to ensure the full and meaningful participation of women in all peace and security discussions, including in all peace processes and transitional justice mechanisms. All parties involved in peace negotiations, including mediators and facilitators, should act to ensure women’s rights and concerns are a priority in negotiations and are integrated throughout any agreement. All discussions should benefit from the full engagement of civil society organizations, including women’s rights groups, women from marginalized populations, such as ethnic and religious minorities, and women with disabilities.
     
  2. Safeguard women’s security and support women’s participation in post-conflict elections, referendums and constitutional drafting, and reform processes. This includes promotion and protection of women candidates, voters, election workers, and women’s human rights defenders.
     
  3. Protect women’s human rights defenders. Governments should monitor threats and attacks against women's human rights defenders and provide protection as requested in a manner that allows them to continue their work.
     
  4. Strengthen recruitment and retention strategies for women in the security sector, including by addressing cultural and practical barriers that women face, by providing specific training and facilities, and ensuring women have equal opportunities for responsibility and advancement.
  5. Ensure women’s leadership and protection in displacement settings. Encourage and facilitate women’s representation in the leadership of camps and centers for the internally displaced and refugees. UN agencies should consult with women and girls, including those with disabilities, to ensure camp designs are accessible, safe, disability-inclusive, and provide equal access to food distributions, sanitation facilities, health—as well as reproductive health—services, education, and vocational training for women and girls.

A female election worker helps an elderly voter at a polling station in Benghazi. The electoral law rightly allowed people with “special needs” to bring assistants. However, barriers remain to ensure the right to political participation for women and men with disabilities.

© 2012 Samer Muscati/Human Rights Watch

Protection and Assistance

The government should give us proper shelter with a fence and an entrance. Police should secure the camp and manage who comes and goes. The worst thing is that the rapes push us into poverty because afterward we cannot do the same work or carry heavy loads. We need money for our kids to live. The government should do something or kids will die of hunger.

—Farxiyo, who was raped in an IDP camp, Mogadishu, Somalia, August 2013[xxiii]

No one has offered me one-on-one counselling of any kind. I’d be interested in receiving professional counseling to help me process my experiences if it was available.… I have trouble sleeping at night, and only sleep a few hours at a time. When I sleep, I often see my parents and siblings in front of my eyes, especially the image of my brothers being forced to kneel on the road, and my mother’s face.

—Narin (pseudonym), 20-year-old woman from Sinjar who escaped captivity and sexual abuse by ISIS fighters, Dohuk, Iraq, January 2015[xxiv]

In armed conflicts around the globe, combatants frequently target women and girls for abuse. National armies and non-state armed groups use sexual violence as a tactic in war in violation of international law.  Conflict-related sexual violence can include rape, abduction, forced prostitution, forced marriage, sexual slavery, and forced pregnancy. 

Women and girls face multiple abuses in war, in addition to conflict-related sexual violence, including: forced displacement; the targeting and punishment of women because of their own activism or activism by male relatives; the drive towards early, forced, and child marriages because of instability and a lack of security for girls and younger women; an increase in domestic violence and sexual violence committed by civilians; lack of access to food, shelter, and health care; the interruption of education; and sexual exploitation and trafficking, to name but a few.

The government should give us proper shelter with a fence and an entrance. Police should secure the camp and manage who comes and goes. The worst thing is that the rapes push us into poverty because afterward we cannot do the same work or carry heavy loads. We need money for our kids to live. The government should do something or kids will die of hunger.

Farxiyo, who was raped in an IDP camp, Mogadishu, Somalia, August 2013

For example, Human Rights Watch has documented the abuse faced by Syrian women activists and other civilians.[xxv] Some of these women have long histories of activism while others began participating politically only after the beginning of uprisings against the Syrian government. Some were targeted or arbitrarily detained for their work, such as Jelnar, who used her pharmaceutical credentials to smuggle medications between neighborhoods. Several of them experienced torture, sexual assault, physical abuse, or harassment as a direct result of their activism, like Layal, who was detained by government forces for assisting the internally displaced. Others became household heads following their husbands’ detention or death, such as Zeinab, who lost her husband and son in separate incidents at the hands of government forces.

In Sudan’s ongoing armed conflicts, Sudanese government forces and allied militias have committed rape and other sexual violence against women and girls on numerous instances. For example, Sudanese military forces engaged in the mass rape of more than 200 women and girls in the town of Tabit, Darfur, in late 2014, restricted access to the town for UN and international investigators, peacekeepers, and humanitarian agencies, and threatened residents with reprisals if they spoke about their ordeals. Government authorities fostered a climate of fear in Tabit that deterred many women and girls from seeking medical care at clinics and hospitals.[xxvi]  

Adequate protection measures are vital to ensuring the safety of women and girls, but when attacks do happen, service provision is vital for survivors. In Nigeria, numerous victims and witnesses interviewed by Human Rights Watch expressed concern about the lack of security force presence in areas particularly vulnerable to attack by Boko Haram, notably in towns and villages in Borno State. Victims, witnesses, community leaders, and analysts told Human Rights Watch that government security services could have done more to prevent attacks by ensuring the adequate presence and arming of military personnel, and by responding more quickly and effectively to reports of attacks once in progress. Survivors of Boko Haram attacks received virtually no necessary psychosocial and medical services, and none of the rape survivors interviewed by Human Rights Watch had any information about how and where to access post-rape care.[xxvii]

Manal Ameer, 33, pictured here with her two daughters, was among the first to vote in Benghazi. She said she had learned about the election process through television advertising and had researched candidates via the Internet.

© 2012 Samer Muscati/Human Rights Watch

In northern Iraq, the extremist group Islamic State (also known as ISIS) has carried out systematic rape and other sexual violence against Yezidi women and girls since August 2014. Human Rights Watch documented a system of mass abduction, organized rape and sexual assault, sexual slavery, and forced marriage by ISIS forces.[xxviii] Many of the women and girls remain missing, but survivors who escaped to the Kurdish Region of Iraq need psychosocial support and basic humanitarian assistance. These survivors require specialized and expert psychosocial services in their present locations to aid their recovery and their reintegration into their communities. Few have received these.

Women and girls in displaced populations are at increased risk of sexual and gender-based violence, and of becoming victims of sex and labor trafficking.[xxix] Humanitarian crises often mean that women and girls are placed at greater risk of violence, with specific measures such as camp design and humanitarian relief necessary. Human Rights Watch research has found that women and girls with disabilities were frequently abandoned or left behind in crises, condemning them to face isolation, neglect, and abuse in post-conflict settings.[xxx] Despite commitments from governments and the UN, prevention efforts, access to services, and holding perpetrators accountable all remain extremely weak, and in some cases, non-existent.

Women displaced by armed conflict often find it difficult to access necessary long-term protection and humanitarian assistance. In Colombia, in an example that highlights the complexity of long-term access to assistance, Lucia fled her community in Antioquia with her husband and six children when an armed group threatened her son for refusing to join their ranks in 2010. Lucia’s husband had physically abused her and this became worse after the family fled to Medellín. Despite trying to access humanitarian assistance for herself and her children directly, the government agency never responded to her case. [xxxi]

No one has offered me one-on-one counselling of any kind. I’d be interested in receiving professional counseling to help me process my experiences if it was available.… I have trouble sleeping at night, and only sleep a few hours at a time. When I sleep, I often see my parents and siblings in front of my eyes, especially the image of my brothers being forced to kneel on the road, and my mother’s face.

Narin (pseudonym)

20-year-old woman from Sinjar who escaped captivity and sexual abuse by ISIS fighters, Dohuk, Iraq, January 2015

Women with disabilities in displacement settings also face discrimination on the basis of gender, disability, and poverty, and thus need particular measures to address protection concerns.[xxxii] Lack of mobility and communication barriers, for example, mean women with disabilities are at particular risk of sexual violence. This discrimination, as well as more general social stigma, prevents them from realizing their rights to accessible information, and accessing health care and other government services. In a displacement camp in Northern Uganda, Charity, a woman with a physical disability, recounted her experience: “People told me I should just die so others can eat the food: ‘You are useless. You are a waste of food.’”[xxxiii]

In line with their obligations under international humanitarian law—the laws of war—parties to armed conflicts should take all feasible measures to protect civilians under their control from attack, including protecting women and girls from sexual and other gender-based violence.[xxxiv]  International human rights law also applies during armed conflict, and provides protections to women and girls against sexual violence and other abuses, including domestic violence.[xxxv] States have obligations to investigate credible allegations of war crimes and other serious human rights abuses and prosecute those responsible.

International humanitarian and human rights law prohibit acts of sexual violence. International humanitarian law sets out protections for civilians and other non-combatants during both international and non-international armed conflicts.[xxxvi] It implicitly and explicitly prohibits both state armed forces and non-state armed groups from committing rape and other forms of sexual violence.[xxxvii]

International human rights law also contains protections from rape and other forms of sexual abuse through its prohibitions on torture and other ill-treatment, slavery, forced prostitution, and discrimination based on sex.[xxxviii]  The Convention on the Rights of the Child contains additional protections for children.[xxxix]

Recommendations to Governments, Parties to Armed Conflicts, UN agencies, and the UN Secretariat

  1. Comply with international humanitarian law and human rights law prohibitions of rape and other forms of sexual violence, sexual slavery, cruel treatment, and other abuses. All parties to armed conflicts should issue clear, public orders to all forces under their control to end and appropriately punish all abuses, including crimes of sexual and gender-based violence.
     
  2. Governments providing military and other security assistance should ensure that such support does not encourage or facilitate abuses against women, and that it provides a basis for promoting greater respect for women’s rights.  Compliance with international human rights standards should be a factor in evaluating the continuation of such support. Governments should vet recipients of this assistance to exclude units or individuals when there is credible information they have been involved in serious violations of human rights.
     
  3. Ensure that survivors of sexual violence and other gender-based violence have access to essential medical and psychological care, as well as available economic and social support. Humanitarian aid should include access to the full range of sexual and reproductive health services that respect the confidentiality and rights of survivors, including for pregnancy, termination of pregnancy, and injuries resulting from sexual violence, with specific measures taken to ensure these services are accessible for women with disabilities.
     
  4. Make women’s and girls’ protection and access to assistance a priority in displacement settings, including through consultation, promoting women’s leadership, camp and shelter design, registration and distribution systems, security measures, and recruitment and training of female security staff.
     
  5. Ensure all parties to armed conflicts grant UN agencies and independent humanitarian organizations unfettered access to civilians and communities in need of assistance. The media and human rights groups should also be provided access to conflict areas.
     
  6. Governments and the UN should highlight women’s participation, protection, and assistance concerns at the highest levels, including by conducting high-level visits to areas where serious abuses have been reported and raising the issues with senior government officials, donor governments, and regional and international bodies. Security Council members should press all parties to armed conflicts to meet all international law obligations.
     
  7. The UN Security Council and concerned governments should impose arms embargoes on state armed forces and non-state armed groups implicated in widespread or systematic serious human rights abuses, including those targeting women and girls. The Security Council should require states to suspend all military sales and assistance, including technical training and services, to these abusive actors until meaningful steps are taken to end such violations and appropriately punish those responsible. Travel bans and asset freezes should also be imposed on individuals responsible for serious abuses, with appropriate due process protections.

“For three months, I had a feeling that one of us was going to die,” said Maha, 28 (left), of the young activists group in which she participated. In November, 2012, she and fellow members of the group had just finished a peaceful protest outside a mosque in Aleppo, when government shelling struck the site, killing her husband of only a few weeks. Her sister Nuha, 23 (right), also an activist, was kidnapped by pro-government militia while on her way to work in Damascus in August 2012 and held for 23 days. 

©2014 Samer Muscati/Human Rights Watch

Accountability

We want these people punished. We just don’t have the reach or the power. If I did, we would have dealt with it a long time ago. We need support.

—Husband of Nandita (pseudonym), who was raped in 2001 because her husband was a Maoist combatant, Nepal, April 2014[xl]

Perpetrators of abuses in armed conflicts rarely face justice and, by all accounts, are even less likely to when responsible for sexual violence against women and girls. In November 2012, in Minova, Democratic Republic of Congo, Congolese army soldiers raped at least 76 women and girls when nearby Goma fell to the M23 rebel group.[xli] The crimes created an outcry at the national and international level. Strong international pressure was brought on the Congolese authorities to pursue justice. The UN threatened to suspend support by the peacekeeping mission MONUSCO to the Congolese army unless those responsible were brought to justice. The UN Security Council and donor governments raised the need for accountability for the crimes in Minova in multiple statements and in meetings with Congolese authorities. High-profile visits to the area by the Congolese minister of justice, the wife of President Joseph Kabila, UK Foreign Minister William Hague, and UN refugee agency special envoy Angelina Jolie, raised attention to the issue.

Three years after the attacks, accountability, services, and security are still insufficient. Despite considerable efforts by Congolese authorities and international partners to ensure judicial proceedings in the case, including by providing for the participation of numerous victims and effective protection of victims and witnesses, the verdict did little to achieve justice. Out of 39 soldiers and officers brought to trial, only 2 rank-and-file soldiers were convicted of rape.  All mid-ranking officers present in Minova at the time of the crimes and brought to trial were completely acquitted. No high-level officers were even charged.[xlii] 

The Minova case illustrates the difficulties of ensuring accountability for conflict-related sexual violence. Congolese authorities and international partners have made considerable efforts to increase accountability for sexual violence in Congo over the past several years, resulting in a few trials involving charges of rape as a war crime or a crime against humanity, and dozens of proceedings and convictions for rape as an ordinary crime. Investigating and proving sexual violence in judicial proceedings remains a complex matter and further efforts are needed.

We want these people punished. We just don’t have the reach or the power. If I did, we would have dealt with it a long time ago. We need support.

Husband of Nandita (pseudonym), who was raped in 2001 because her husband was a Maoist combatant, Nepal, April 2014

Women and girls who suffer rights abuses in armed conflicts, including sexual violence, face tremendous barriers in obtaining redress. Regular police and court functions may be in disarray. They may not wish to seek avenues for justice out of fear of retaliation or marginalization in their communities and homes. They may lack the financial or logistical means to access courts and legal assistance. National judicial systems often lack expertise in handling vulnerable victims of sexual violence during investigations and prosecutions. Physical protection and psychological assistance may be lacking. There may be strong resistance to or lack of resources for reforming the security apparatus in the immediate and long-term aftermath of an armed conflict. Disarmament, demobilization, and reintegration programs often neglect to address female combatants and women euphemistically called “bush wives,” or women who are associated with armed groups, often forcibly. Women with disabilities have particular difficulty accessing redress or justice mechanisms, including physical barriers in entering police stations and courtrooms, communication barriers, or questioning of the credibility of their testimony if they have a psychosocial or intellectual disability.

Even when international peacekeeping forces are in place to bring stability to conflict-riven regions, they are sometimes perpetrators themselves. Although the UN has a “zero tolerance” policy on sexual exploitation and abuse, accountability for these crimes remains a concern.[xliii] For example, in the past decade, there have been allegations of sexual exploitation and abuse in peacekeeping missions in the Central African Republic, Haiti, Somalia, and the Democratic Republic of Congo. The persistent lack of transparency on these cases makes it very difficult to help victims seek justice. With the UN historically providing few specifics on allegations of abuse, and few countries that contribute troops and police to UN operations providing information on investigations and prosecutions, the scope of the problem is unclear. In one of the few cases in which public information is available on accountability for UN peacekeepers, a Pakistani peacekeeper charged with sexually assaulting a Haitian boy was convicted, and faced a one-year sentence upon conviction.[xliv]

A woman prisoner looks out a window in Parwan prison north of Kabul, Afghanistan, in February 2011.The woman was convicted of moral crimes after a man from her neighborhood raped her. She later gave birth in prison.

© 2011 Farzana Wahidy

When crimes of sexual violence are committed as part of armed conflict, they can be prosecuted as war crimes. States have an obligation to investigate alleged war crimes committed by members of the armed forces and other nationals, and prosecute those responsible.[xlv] Non-state armed groups also have an obligation to prevent war crimes and should investigate and appropriately punish perpetrators.[xlvi] Those acts of sexual violence committed as part of a widespread or systematic attack against a civilian population may amount to crimes against humanity. The Rome Statute of the International Criminal Court (ICC) specifies that acts of rape, sexual slavery, enforced prostitution, forced pregnancy, enforced sterilization, or any other form of sexual violence of comparable gravity can constitute war crimes or crimes against humanity.[xlvii]

Aside from their direct criminal responsibility for crimes committed, for instance, by issuing orders that subordinates carry out, commanders and other superiors may be criminally liable for failing to prevent or punish crimes committed by their subordinates.[xlviii]

International human rights law also enshrines the right to an effective remedy, which obligates the state to prevent, investigate, and punish serious human rights violations.[xlix] State should also provide reparations to victims of human rights violations, such as compensation for damages.[l] The UN has reaffirmed these principles specifically in relation to eliminating violence against women.[li]

Recommendations to Governments, UN agencies, and the UN Secretariat

  1. Ensure comprehensive, credible, and impartial investigations into sexual and gender-based violence and appropriately and fairly prosecute those responsible. This should include independent investigations into all allegations against members of armed forces, including peacekeepers, that respect the confidentiality and rights of survivors.
     
  2. Ensure accessible judicial processes that adhere to international fair trial standards for grave international crimes, including sexual and gender-based violence. This should include providing specialized training to investigators, prosecutors, and judges on the proper handling of such cases.  Adequate protection measures and psychological support should be available, before, during, and after trials, including, but not limited to, relocation measures for victims and their households. Judicial mechanisms should also be accessible for women with disabilities, including by facilitating access to police stations and courts, ensuring access to documentation, and relevant training for law enforcement and the judiciary.
     
  3. Strengthen independent institutions capable of responding to sexual and gender-based violence and supporting survivors. Governments should create accessible and safe channels to report rape, assault, and other abuses and issue clear, public orders to all security forces to end any harassment, intimidation, and arbitrary arrests of those who speak out or seek to enforce their rights. Reporting mechanisms should be fully inclusive and provide specific accommodations for women and girls with disabilities. Governments should ensure proper and timely investigations and prosecutions that respect the rights of the survivor.
     
  4. Enact security sector reform to provide vetting of police and other security personnel, ensure recruitment, hiring, and training of female security personnel, and provide training for prosecutors, as well as judges and defense lawyers, on respecting women’s rights in the justice system, including handling crimes of sexual violence. Identify and exclude individuals from the security forces who are under investigation, have charges pending against them, or have been subjected to disciplinary measures or criminal convictions for sexual violence or other serious abuses.
     
  5. Press for accountability and justice, including through the UN Security Council, General Assembly, and Human Rights Council. When national level efforts fail or are inadequate, pursue alternative paths to justice, such as independent commissions of inquiry, the use of universal jurisdiction, and when applicable, referrals to the ICC. In accordance with the ICC prosecutor’s newly adopted Policy Paper on Sexual and Gender-Based Crimes, the ICC should continue to ensure that these crimes are the focus of special attention in ICC proceedings.[lii]
     
  6. Ensure reparations programs meet international standards and include specific consideration for women and girls. Consult with local women’s rights groups and women from communities affected by armed conflict in determining and distributing reparation packages.
     
  7. Protect women’s rights in national laws and ensure they meet international standards. This includes ratifying the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) with no reservations, or removing any existing reservations to CEDAW. National laws should guarantee equality before the law, protection from violence, and freedom from discrimination, including on the basis of sex, gender, pregnancy, disability, and marital status. Consistent with international standards, sexual violence and other gender-based violence crimes should be included in the criminal code. Ensure accountability when these laws are violated.
     
  8. Institute measures to ensure accountability, including by raising public concern and urging relevant actors, including troop-contributing countries, to carry out immediate investigations when there are substantial grounds to believe that peacekeepers have committed serious human rights abuses or war crimes, including sexual exploitation and abuse.
 

[i] Human Rights Watch, A Revolution for All: Women’s Rights in the New Libya, May 2013,  https://www.hrw.org/report/2013/05/27/revolution-all/womens-rights-new-libya, p. 11.

[ii] “Libya: Extremists Terrorizing Derna Residents,” Human Rights Watch news release, November 27, 2014,  https://www.hrw.org/news/2014/11/27/libya-extremists-terrorizing-derna-residents.

[iii] United Nations Security Council, Resolution 1325 (2000), S/RES/1325 (2000) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/1325(2000) (accessed July 21, 2015).

[iv] United Nations Security Council, Resolution 1820 (2008), S/RES/1820 (2008) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/1820(2008) (accessed  July 21, 2015); United Nations Security Council, Resolution 1888 (2009), S/RES/1888 (2009) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/1888(2009) (accessed July 21, 2015); United Nations Security Council, Resolution 1889 (2009), S/RES/1889 (2009) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/1889(2009) (accessed July 21, 2015); United Nations Security Council, Resolution 1960 (2010), S/RES/1960 (2010) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/1960(2010) (accessed July 21, 2015); United Nations Security Council, Resolution 2106 (2013), S/RES/2106 (2013) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/2106(2013) (accessed July 21, 2015); United Nations Security Council, Resolution 2122 (2013), S/RES/2122 (2013) http://www.un.org/en/ga/search/view_doc.asp?symbol=S/RES/2122(2013) (accessed July 21, 2015).

[v] According to the 2014 Secretary-General’s report on women, peace and security, data compiled by the Organization for Economic Cooperation and Development shows that “only 0.35 per cent of aid allocated to conflict, peace and security activities [was] marked as having a gender focus.” United Nations Security Council, Report of the Secretary-General on women and peace and security,  S/2014/693, September 2014, http://www.securitycouncilreport.org/atf/cf/%7B65BFCF9B-6D27-4E9C-8CD3-CF6E4FF96FF9%7D/s_2014_693.pdf (accessed July 17, 2015).

[vi] Based on data from: NGO Working Group on Women, Peace and Security, “Mapping Women, Peace and Security in the UN Security Council: 2012-2013,” December 2013, http://womenpeacesecurity.org/media/pdf-2012-13_MAP_Report.pdf  (accessed July 8, 2015); and Women’s International League for Peace and Freedom, PeaceWomen, “Report Watch,” undated, http://www.peacewomen.org/security-council/report-watch (accessed July 8, 2015).

[vii] United Nations Security Council, Sixty-eighth year, 7045th meeting, October 21, 2013, http://www.un.org/ga/search/view_doc.asp?symbol=S/PV.7045 (accessed July 8, 2015).

 [viii] Based on data from: NGO Working Group on Women, Peace and Security, “Mapping Women, Peace and Security in the UN Security Council: 2012-2013”; Women’s International League for Peace and Freedom, PeaceWomen, “Report Watch”; and Security Council Report, “Cross Cutting Report: Women, Peace and Security,” April 2014,   http://www.securitycouncilreport.org/atf/cf/%7B65BFCF9B-6D27-4E9C-8CD3-CF6E4FF96FF9%7D/cross_cutting_report_2_women_peace_security_2014.pdf  (accessed July 8, 2015).

[ix] Human Rights Watch, Mass Rape in North Darfur: Sudanese Army Attacks against Civilians in Tabit, February 2015, https://www.hrw.org/report/2015/02/11/mass-rape-north-darfur/sudanese-army-attacks-against-civilians-tabit.

[x] Heather Barr, “A seat at the table in Afghanistan,” Washington Post, May 1, 2015, http://www.washingtonpost.com/opinions/a-seat-at-the-table-in-afghanistan/2015/05/01/fd930e26-ef41-11e4-8abc-d6aa3bad79dd_story.html (accessed July 16, 2015).

[xi] Statement by Orzala Ashraf Nemat at the UN Security Council Open Debate on Women, Peace and Security, October 28, 2011, http://womenpeacesecurity.org/media/pdf-Statement_OpenDebate_Oct2011.pdf (accessed July 16, 2015).

[xii] Oxfam “Behind Closed Doors: The risk of denying women a voice in determining Afghanistan’s future,” November 24, 2014, https://www.oxfam.org/sites/www.oxfam.org/files/file_attachments/bp200-behind-doors-afghan-women-rights-241114-en.pdf (accessed July 16, 2015).

[xiii] See UN Women, “Women’s Participation in Peace Negotiations: Connections between Presence and Influence,”  October 2012, http://www.unwomen.org/~/media/headquarters/attachments/sections/library/publications/2012/10/wpssourcebook-03a-womenpeacenegotiations-en.pdf (accessed July 20, 2015); and United Nations Security Council, Report of the Secretary-General on Women and Peace and Security, S/2011/598, September 29, 2011, http://www.un.org/en/ga/search/view_doc.asp?symbol=S/2011/598 (accessed July 27, 2015); S/2012/732, October 2, 2012, http://www.un.org/en/ga/search/view_doc.asp?symbol=S/2012/732 (accessed July 27, 2015); S/2013/525, September 4, 2013, http://www.un.org/en/ga/search/view_doc.asp?symbol=S/2013/525 (accessed July 27, 2015); and S/2014/693, September 23, 2014, http://www.un.org/en/ga/search/view_doc.asp?symbol=S/2014/693 (accessed July 27, 2015). See also, Christine Bell and Catherine O’Rourke, Women and Peace Agreements 1325 Dataset, Distributed by University of Ulster, Transitional Justice Institute, 2010 http://www.transitionaljustice.ulster.ac.uk/tji_database.html (accessed July 20, 2015).

[xiv] “Women take the reins to build peace in Colombia”, UN Women press release, May 28, 2015, http://www.unwomen.org/en/news/stories/2015/5/women-build-peace-in-colombia (accessed July 16, 2015).

[xv] Women’s International League for Peace and Freedom, “Innovative WILPF Conference Gathers Syrian And Bosnian Women’s Rights Activists,” February 21, 2014,  http://www.wilpfinternational.org/innovative-wilpf-conference-gathers-syrian-and-bosnian-womens-rights-activists-2/ (accessed July 16, 205); Cynthia Enloe, “Day I of the Syrian Women’s Peace Talks in Geneva: Prelude to the Official Syrian Peace Talks,” Women’s Action for New Directions,  January 20, 2014, http://www.wandactioncenter.org/2014/01/30/guest-author-cynthia-enloes-report-from-the-syrian-peace-talks/ (accessed July 16, 2015).

[xvi] “He Left Before Syria’s Women Could Speak,” Human Rights Watch Dispatch, December 19, 2013, https://www.hrw.org/news/2013/12/19/dispatches-he-left-syria-s-women-could-speak (accessed July 16, 2015).

[xvii] UNSCR 1888, Operative Paragraph 17; UNSCR 1820, Operative Paragraph 10; United Nations Disarmament, Demobilization and Reintegration Resource Centre (UNDDR), Integrated Disarmament, Demobilization and Reintegration Standard, “5:10, Women, Gender and DDR,” August 2006, http://unddr.org/uploads/documents/IDDRS%205.10%20Women,%20Gender%20and%20DDR.pdf (accessed 21 July 2015).

[xviii] United Nations Security Council, Resolution 1325, Operative Paragraph 12.

[xix] “UN Human Rights Council: Call to Recognize the Status of Women's Human Rights Defenders,” Human Rights Watch Oral Statement during the Annual Day of Discussion on Women's Human Rights, June 26, 2012, https://www.hrw.org/news/2012/06/26/un-human-rights-council-call-recognize-status-womens-human-rights-defenders.

[xx] “Sudan: Surge in Detention, Beatings, Around Elections,” Human Rights Watch news release, April 28, 2015, https://www.hrw.org/news/2015/04/28/sudan-surge-detention-beatings-around-elections.

[xxi] “Afghanistan: Urgent Need for Safe Facilities for Female Police,” Human Rights Watch news release, April 25, 2013, https://www.hrw.org/news/2013/04/25/afghanistan-urgent-need-safe-facilities-female-police.

[xxii] “Afghanistan: Surge in Women Jailed for ‘Moral Crimes,’” Human Rights Watch news release, May 21, 2015, https://www.hrw.org/news/2013/05/21/afghanistan-surge-women-jailed-moral-crimes.

[xxiii] Human Rights Watch, “Here, Rape is Normal”: A Five-Point Plan to Curtail Sexual Violence in Somalia, February 2014, https://www.hrw.org/report/2014/02/13/here-rape-normal/five-point-plan-curtail-sexual-violence-somalia.

[xxiv] “Iraq: ISIS Escapees Describe Systematic Rape,” Human Rights Watch news release, April 14, 2015, https://www.hrw.org/news/2015/04/14/iraq-isis-escapees-describe-systematic-rape.

[xxv] Human Rights Watch, “We are Still Here”: Women on the Front Lines of Syria's Conflict, July 2014, https://www.hrw.org/report/2014/07/02/we-are-still-here/women-front-lines-syrias-conflict.

[xxvi] “Sudan: Soldiers, Militias Killing, Raping Civilians,” Human Rights Watch news release, December 14, 2014, https://www.hrw.org/news/2014/12/14/sudan-soldiers-militias-killing-raping-civilians; “Sudan: Mass Rape by Army in Darfur,” Human Rights Watch news release, February 11, 2015, https://www.hrw.org/news/2015/02/11/sudan-mass-rape-army-darfur.

[xxvii] Human Rights Watch, “Those Terrible Weeks in their Camp”: Boko Haram Violence against Women and Girls in Northeast Nigeria, October 2014, https://www.hrw.org/report/2014/10/27/those-terrible-weeks-their-camp/boko-haram-violence-against-women-and-girls.

[xxviii] “Iraq: ISIS Escapees Describe Systematic Rape,” Human Rights Watch news release, April 14, 2015, https://www.hrw.org/news/2015/04/14/iraq-isis-escapees-describe-systematic-rape.

29 United Nations Security Council, Report of the Secretary-General on women and peace and security,  S/2014/693, p. 19.

[xxx] Human Rights Watch, “As if We Weren’t Human”: Discrimination and Violence against Women with Disabilities in Northern Uganda, August 2010, https://www.hrw.org/report/2010/08/26/if-we-werent-human/discrimination-and-violence-against-women-disabilities-northern.

[xxxi] Human Rights Watch, Rights Out of Reach: Obstacles to Health, Justice, and Protection for Displaced Victims of Gender-Based Violence in Colombia, November 2012, https://www.hrw.org/report/2012/11/14/rights-out-reach/obstacles-health-justice-and-protection-displaced-victims-gender, p. 5.

[xxxii] World Bank and World Health Organization, “World Report on Disability,” 2011, http://whqlibdoc.who.int/publications/2011/9789240685215_eng.pdf (accessed July 21, 2015), p. 8.

[xxxiii] Human Rights Watch, “As if We Weren’t Human.”

[xxxiv] See International Committee of the Red Cross (ICRC), Customary International Humanitarian Law (Cambridge, UK: Cambridge University Press, 2005), rule 22, citing Protocol I, art. 58(c) and rule 93 (prohibiting rape and other forms of sexual violence).

[xxxv] The International Covenant on Civil and Political Rights (ICCPR) prohibits torture and other cruel, inhuman, or degrading treatment (art. 7) and protects women’s right to be free from discrimination based on sex (arts. 2(1) and 26). ICCPR, adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, entered into force March 23, 1976; Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted December 10, 1984, G.A. res. 39/46, annex, 39 U.N. GAOR Supp. (No. 51) at 197, U.N. Doc. A/39/51 (1984), entered into force June 26, 1987, arts. 2 and 16; Rome Statute, arts. 7 and 8. The UN Human Rights Committee has stated that governments violate their treaty obligations not only when state actors are responsible for the action, but also when the state fails to take necessary steps to prevent violations caused by private actors. The committee’s General Recommendation No. 31 to the ICCPR notes that governments must “take appropriate measures or … exercise due diligence to prevent, punish, investigate or redress the harm caused by such acts by private persons or entities.” The Committee against Torture requires governments to prevent and protect victims from gender-based violence and rape by exercising due diligence in investigating, prosecuting, and punishing perpetrators—even private actors—of rape and sexual assault.

[xxxvi] See four Geneva Conventions of 1949 and their two Protocols Additional of 1977. Other sources of international humanitarian law are the 1907 Hague Convention and Regulations, decisions of international tribunals, and customary law.

[xxxvii] Article 3 common to the four Geneva Conventions of 1949.

[xxxviii] The International Covenant on Civil and Political Rights; Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment; Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted December 18, 1979, G.A. res. 34/180, 34 U.N. GAOR Supp. (No. 46) at 193, U.N. Doc. A/34/46, entered into force September 3, 1981.

[xxxix] Convention on the Rights of the Child, G.A. res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989), entered into force Sept. 2, 1990, arts. 2, 34, 37, 43.

[xl] Human Rights Watch, Silenced and Forgotten: Survivors of Nepal’s Conflict-Era Sexual Violence, September 2014, https://www.hrw.org/report/2014/09/23/silenced-and-forgotten/survivors-nepals-conflict-era-sexual-violence.

[xli] The United Nations has documented at least 135 victims in this case. The United Nations Organization Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) and Office of the High Commissioner for Human Rights (OHCHR), “Report of the United Nations Joint Human Rights Office on Human Rights Violations Perpetrated by Soldiers of the Congolese Armed Forces and Combatants of the M23 in Goma and Sake, North Kivu Province, and In and Around Minova, South Kivu Province, From 15 November to 2 December 2012,” May 2013, p. 4,  http://www.ohchr.org/Documents/Countries/CD/UNJHROMay2013_en.pdf (accessed July 8, 2015).

[xlii] “DR Congo: War Crimes by M23, Congolese Army,” Human Rights Watch news release, February 5, 2013, https://www.hrw.org/news/2013/02/05/dr-congo-war-crimes-m23-congolese-army; “Revealed: how the world turned its back on rape victims of Congo,” The Guardian, undated, http://www.theguardian.com/world/2015/jun/13/rape-victims-congo-world-turned-away (accessed July 8, 2015).

[xliii] United Nations General Assembly, “Fifty-ninth session, Agenda item 77, Comprehensive review of the whole question of peacekeeping operations in all their aspects,” March 24, 2005 http://www.un.org/en/ga/search/view_doc.asp?symbol=A/59/710 (accessed July 8, 2015); United Nations Secretariat, Secretary-General’s Bulletin, “Special measures for protection from sexual exploitation and sexual abuse,” October 9, 2003, https://cdu.unlb.org/Portals/0/PdfFiles/PolicyDocC.pdf (accessed July 8, 2015); Office of Internal Oversight Services (OIOS), “Evaluation Report: Evaluation of the Enforcement and Remedial Assistance Efforts for Sexual Exploitation and Abuse by the United Nations and Related Personnel in Peacekeeping Operations,” May 2015, https://oios.un.org/page?slug=evaluation-report (accessed July 23, 2015).

[xliv] Somini Sengupta, “Allegations Against French Peacekeepers Highlight Obstacles in Addressing Abuse,” New York Times, May 25, 2015, (accessed July 8, 2015), http://www.nytimes.com/2015/05/26/world/europe/allegations-against-french-peacekeepers-highlight-obstacles-in-addressing-abuse.html.

[xlv] The obligation of states to prosecute grave breaches of international humanitarian law is outlined in each of the Geneva Conventions.

[xlvi] ICRC, Customary International Humanitarian Law, pp. 591-93, 607-10.

[xlvii] Rome Statute of the International Criminal Court (Rome Statute), U.N. Doc. A/CONF.183/9, July 17, 1998, entered into force July 1, 2002. The Rome Statute is the treaty creating the ICC. Command responsibility is an established principle of customary international humanitarian law and has been incorporated into the Rome Statute.

[xlviii] Rome Statute, art. 28.

[xlix] See UN Human Rights Committee, General Comment 31, Nature of the General Legal Obligation on States Parties to the Covenant, U.N. Doc. CCPR/C/21/Rev.1/Add.13 (2004) , para. 15. See also, Updated Set of Principles for the Protection and Promotion of Human Rights through Action to Combat Impunity (“Impunity Principles”), U.N. Doc. E/CN.4/2005/102/Add.1, February 8, 2005, adopted by the UN Commission on Human Rights in Resolution E/CN.4/2005/81, April 15, 2005, principle I; Basic Principles and Guidelines on the Right to a Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of International Humanitarian Law, adopted December 16, 2005, G.A. res. 60/147, U.N. Doc. A/RES/60/147 (2005), principle 11.

[l] UN Human Rights Committee, General Comment 31, para. 16.

[li] UN Declaration on the Elimination of Violence Against Women, December 20, 1993, G.A. res. 48/104, 48 U.N. GAOR Supp. (No. 49) at 217, U.N. Doc. A/48/49 (1993).

[lii] International Criminal Court, Office of the Prosecutor, Policy Paper on Sexual and Gender-Based Crimes, June 2014, http://www.icc-cpi.int/iccdocs/otp/OTP-Policy-Paper-on-Sexual-and-Gender-Based-Crimes--June-2014.pdf (accessed July 8, 2015).

Posted: January 1, 1970, 12:00 am

Liesl Gerntholtz is the executive director of the women's rights division. She is an expert on women's rights in Africa and has worked and written extensively on violence against women and HIV/AIDS in Southern Africa. Her work at Human Rights Watch has included documenting access to safe and legal abortion in Ireland and sexual and gender-based violence in Haiti in the aftermath of the earthquake.

Before joining Human Rights Watch, Liesl worked for some of the key constitutional institutions promoting human rights and democracy in a post-apartheid South Africa, including the South African Human Rights Commission and the Commission on Gender Equality.  A lawyer by training, she was involved in high-profile, strategic human rights litigation to promote women and children's rights, including a case that changed the definition of rape in South Africa.

NPR Interview - Women's Rights In The Age Of The Arab Spring

Posted: January 1, 1970, 12:00 am

Indonesia said it will stop administering “virginity tests” to female aspiring civil servants as part of its admission process. The country’s Home Affairs Minister Tjahjo Kumolo announced this change—which will affect women working in government offices—on the heels of Human Rights Watch research that documented this degrading practice in the admission process for another branch of the Indonesian government, the National Police force.

Human Rights Watch found that the testing included the invasive “two-finger test” to determine whether female applicants’ hymens are intact. Minister Kumolo said that it was “illogical” to recruit a student based on her virginity and noted that a woman’s hymen could be torn due to sports, exercise, or other accidents. 

Rumors about these tests have circulated for decades, but Human Rights Watch brought the issue into the national spotlight by gathering concrete testimony from eight  current and former police women and applicants as well as police doctors, a police recruitment evaluator, a National Police Commission member, and several prominent women’s rights activists. The women we interviewed described the examination as frightening, humiliating, and extremely painful.  

Virginity tests are a form of gender-based violence, cannot be administered to men, and are inherently degrading and discriminatory. Moreover, these tests have been widely discredited by the scientific community and the World Health Organization. For years, Human Rights Watch has been pushing for an end to this practice and documenting cases of abusive testing in Indonesia and several other countries including Egypt, India, and Afghanistan

Ending virginity tests for Institute of Public Administration applicants is an important step forward, but much remains to be done.  Recently, the municipal government of Indonesia’s city of Jember in east Java proposed forcing female high school students to pass a virginity test before they could receive their diploma. This time, however, officials quickly back-pedaled from the proposal.

Indonesia’s National Police and the Indonesian Armed Forces have yet to follow the Institute of Public Administration’s lead. Despite Human Rights Watch’s findings, police officials continue to deny administering virginity tests, claiming that the female recruits are simply undergoing a required “medical examination.” Human Rights Watch’s research has also revealed that the military—the air force, the army, and the navy—has for decades also extended the “virginity test” requirement to female recruits as well as the fiancées of military officers prior to marriage.

Indonesia's police and military need to abolish virginity testing and make sure their recruiting stations across the country stop using it as well.

 

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

So, all abortion is banned in the Dominican Republic?

Yes. Even in instances where a woman or girl is pregnant from rape or incest, if her life is in danger, or if the fetus won’t survive outside the womb. But the ban, in effect since 1884, doesn’t stop abortions — it just forces women to have clandestine abortions.

Women who have money and information can travel abroad or find safe clandestine providers. But if you’re from a rural area, you’re young or poor, or you don’t have information on abortion or people to help, you’re likely to turn to less safe methods.

And women die from unsafe abortions. Around eight percent of maternal deaths in the country are attributed to complications from abortion or miscarriage, but it’s likely higher.

What are these less safe methods?

Clandestine abortion has become safer because there is now medication to induce abortion. A lot of women and girls take misoprostol, which is used to induce labor and treat stomach ulcers. Many still turn to more locally traditional methods to end pregnancy, though – herbs, teas, and beverages that can carry risks and lead to life-threatening complications. Some pregnant women try to harm their health in hopes of causing miscarriage, depriving themselves of rest, water, or food. Some take medication like sleeping pills that are harmful to pregnancy. One woman I spoke with beat her stomach with a concrete block.

What complications arise when women do this?

They can experience heavy bleeding and intense pain. Sometimes the pregnancy ends, but there’s still tissue in the uterus. If the tissue isn’t removed it can lead to severe infections or even death.

Why are women so desperate that they resort to this?

If a woman doesn’t want to continue a pregnancy, it’s for a reason. Most women I spoke with wanted an abortion because of economic difficulties. Maybe they or their partner weren’t working. Some couldn’t afford to care for another child. Some had a violent or abusive partner, or the relationship wasn’t stable. When women or girls become pregnant from rape, when a pregnancy endangers their health, or if the fetus won’t survive outside the womb, being forced to continue a pregnancy can feel like torture.  

I interviewed a health educator at a clinic who, a few days earlier, spoke with an 11-year-old girl who was pregnant because her stepfather raped her. She had no idea what had happened to her, and there was nothing the provider could do but refer her to pre-natal care.

This is what banning abortion looks like.

Video

Dominican Republic: What happens when abortion is totally banned?

The Dominican Republic’s total ban on abortion threatens women's health and lives and violates their rights. Abortion is illegal in the Dominican Republic in all circumstances, even when a pregnancy is life-threatening, unviable, or the result of rape. 

I’m assuming doctors could be imprisoned for performing an abortion?

Yes, up to 20 years for providers who perform abortions and up to 2 years for women who have abortions. That said, the Dominican Republic isn’t like El Salvador, where more than two dozen women alleged to have had abortions are in prison for manslaughter, homicide, or aggravated homicide. Arrests and prosecutions in the Dominican Republic are rare. But the law creates fear and drives the whole process underground, keeping it less safe.

It also stops doctors from acting in the best interest of their patients. Some doctors do perform abortions secretly to help their patients, but at great risk to them and their careers. Imagine looking these women in the eye and saying, “You could die from this pregnancy but I can’t help you.”

Which women that you spoke with stood out to you?

There were so many. One was a young professional. She was educated, lived in a city, had a good income. But her contraception failed. When she learned she was pregnant she thought, “My life is over.” She talked to a friend of a friend who went to a secret abortion clinic, and she went there too. The clinic was filthy, she said, with no running water or sheets on the bed. Afterward the provider told her to get a heavy course of antibiotics and a tetanus shot, which tells you something about the conditions.

Thankfully she didn’t develop any infections. While she has no regrets about her decision, she said, “I could have died.” Today, she’s an activist for making abortion safe and legal.

Many women and girls I interviewed attempted abortion alone or only with one other person. It’s a lonely process. They made a quiet decision, found some pills at a pharmacy, took them with the tea. Then they’d wait. And if the pain or bleeding became too much they planned to seek care at a health center.

How are women treated at health centers?

Some women are so scared of mistreatment, or of being reported to authorities, that they don’t seek treatment. Those who do are often left waiting for a long time, or not given any pain relief if doctors need to remove tissue from their uterus—seemingly as “punishment” for ending a pregnancy. Sometimes, the staff threaten the women, calling them horrible names, like “murderer.” Some who went to health centers after miscarriages said they were treated poorly because staff suspected they had induced an abortion.

I spoke with one woman from a rural area who already had four kids, and knew she couldn’t have another. She drank a tea — a home remedy – and had a lot of pain, but not a lot of bleeding. She knew something had gone wrong, so she went to a health center. The doctor didn’t even examine her, or give her pain medication, just gave her misoprostol to remove tissue from the uterus and sent her away. She felt judged and neglected. So she takes the medication, has intense pain, but doesn’t want to go back, so she suffers through it alone.

Weeks later she’s still in pain, and when she gets checked out is told she has an infection. When I spoke with her, she’d been in pain for months.

What surprised you during your research?

How openly women and girls were willing to speak with me about abortion even though it’s illegal. As one long-time advocate explained, women in the Dominican Republic have always defied the abortion law and ended pregnancies that they couldn’t continue.

Can you easily access birth control in the Dominican Republic?

Everyone we interviewed had at least some information about contraceptives. The public health system offers a range of options which are either free or low cost. But sometimes they’d go for their injection or a refill and the hospital didn’t have it. Some women say birth control makes them sick, or causes their bodies to change, so they stop.

Sometimes, contraception fails. We spoke with one woman who learned she was pregnant at 17, three months before finishing high school, even though she was using injections to prevent pregnancy. She considered an abortion but was scared. When her private school’s director found out, she was kicked out. The director told her she couldn’t be pregnant in school.

Getting kicked out of school is a particular consequence for girls. Are there other ways that girls are affected differently than women?

First, adolescent girls have less access to information about sexual and reproductive health than adults. Girls often find out they are pregnant later because they don’t know the signs. At that point, it’s risky or impossible to have a clandestine abortion. But because having a baby is more likely to derail their plans – they could get kicked out of school or be pressured into marriage – they’re actually more likely to try riskier abortion methods. We found their experiences so compelling that we’re doing a separate report based on their accounts.

What do you want to happen?

The government should decriminalize abortion.

The Dominican Republic has been in the process of reforming its penal code for more than two decades. One of the contentious issues has been the articles dealing with abortion. Some members of Congress and the president support abortion in cases of rape or incest, when the mother’s life is in danger, or when the fetus won’t survive. But Congress hasn’t enacted this. The president twice vetoed versions of the penal code were sent to him without these changes.

There is a really vibrant civil society effort to legalize abortion in these instances. A huge coalition of groups came together and had a big march in July, filling the streets. At the end of October they delivered a petition, signed by 10,000 people, urging Congress to decriminalize abortion. One advocate I spoke with said, “I’m 63 and I’ve been doing this fight for more than 40 years, and I want them to know, I’m not going to give up. I’m not going to back down.” And that’s really inspiring.

Author: Human Rights Watch, Human Rights Watch
Posted: January 1, 1970, 12:00 am

 

Summary

Abortion is illegal in the Dominican Republic in all circumstances, even when the life of the pregnant woman or girl is in danger. The country’s total abortion ban has devastating consequences. Women and girls facing unplanned or unwanted pregnancies—including those resulting from rape or incest, or when the fetus will not survive—are forced to choose between clandestine abortion or continuing their pregnancies, even if they do not want to and even if they face serious health risks, including death. Some women and girls can afford to travel to another country where abortion is legal or find safe providers to help them to end a pregnancy, but many, especially those from poor and rural communities risk their health and lives to have clandestine abortions, often without any guidance from trained providers. Some suffer serious health complications, and even death, from unsafe abortion.

Melina, 26, told Human Rights Watch she had an unwanted pregnancy in 2017 when her contraceptive method failed. Already a mother of four young children, she was deeply distressed when she learned she was pregnant. She tried to end the pregnancy by drinking a tea made from herbs and plants—one of many home remedies women use to try to end pregnancies clandestinely. She began bleeding and felt intense pain in her back and abdomen. Melina felt something had gone wrong but delayed seeking medical attention because she feared being reported to authorities, or facing abuse by medical providers, for having an illegal abortion. When the pain became unbearable, she went to a public hospital and explained that she made a tea to try to end a pregnancy. The abortion was incomplete: the pregnancy had ended, but tissue remained in her uterus, putting her at risk of serious complications. The provider prescribed a medication that helps the body expel tissue from the uterus and sent her away without examining her or giving her anything to manage the pain. Melina took the medication, but the pain persisted for ten days, and she developed an infection. “I started thinking I was not going to survive it.” When she spoke with Human Rights Watch, six months later, she still suffered chronic pain and other health effects from the ordeal. “It was really intense. I suffered a lot,” she said.

The criminal code in the Dominican Republic imposes prison sentences of up to two years on women and girls who induce abortions and up to 20 years for medical professionals who provide them. Although criminal actions against women and girls who seek abortions, and those who help them, are relatively rare, the law has created pervasive fear that drives women and girls to desperate measures to end unwanted pregnancies, and leaves healthcare providers unable to protect the health and lives of their patients.

For more than two decades, legislators in the Dominican Republic have debated a new penal code. President Danilo Medina has urged legislators to decriminalize abortion in three circumstances: when the life of the woman or girl is in danger, when the pregnancy resulted from rape or incest, or when the fetus has serious complications incompatible with life outside of the womb. He twice vetoed penal code reforms that maintained the total abortion ban without exceptions. As of October 2018, the National Congress had not enacted any changes to the country’s criminal code on this issue, and the total criminalization of abortion in all circumstances remained in effect.

Key government officials recognize that there is a problem. Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, told Human Rights Watch,

Abortion is a phenomenon that’s penalized by law in all its forms, with no exceptions. But we’ve always recognized that unsafe abortion is an important health problem because women have to appeal to clandestine methods to find an answer to their situation [an unwanted pregnancy]. And that creates the phenomenon of unsafe abortion.

Recent research by the Guttmacher Institute showed that restrictive laws and criminal penalties do not reduce the incidence or rate of abortions, but they make them less safe. Human Rights Watch conducted research in the Dominican Republic in early 2018 to investigate the human rights impacts of the total abortion ban. We spoke with 167 people, including women and girls, healthcare providers, and experts across four provinces. Their accounts reveal the brutal consequences of the country’s harsh abortion law.

Survey data from the Ministry of Public Health suggest that nearly half of pregnancies in the Dominican Republic are either unplanned or unwanted. For this report, Human Rights Watch sought to interview women and girls of reproductive age who had had unplanned or unwanted pregnancies. We interviewed 50 women and girls of reproductive age, 47 of whom said they had experienced an unplanned or unwanted pregnancy. Interviewees reported a variety of reasons for such pregnancies, including barriers accessing contraceptive methods, contraceptive failures, and sexual violence.

Overwhelmingly, women and girls described experiencing distress upon learning of an unplanned pregnancy, saying they felt “depressed,” “terrified,” “desperate,” or “trapped, with no future.” Some women chose to continue unplanned pregnancies that were also unwanted, either due to their personal beliefs about abortion, or because they feared clandestine abortion. More than half of the women and girls interviewed, however, attempted to have clandestine abortions and described these experiences to Human Rights Watch.

Some women and girls interviewed for this report might have been eligible for a safe and legal abortion if authorities in the Dominican Republic had decriminalized abortion in the three circumstances discussed above—when the life of a woman is in danger, when the pregnancy resulted from rape or incest, or when the fetus will not survive outside the womb. Most interviewees, however, said they wanted to end a pregnancy due to socioeconomic difficulties, instability or violence in their relationships, or because they already had other children and felt unable to care for any more.

Women and girls interviewed for this report described using a variety of methods to try to end pregnancies, including taking or inserting pills (most commonly misoprostol, often called by the brand name Cytotec); using teas, beverages, and other home remedies; trying to induce poor health, for example by denying themselves food or water; taking prescription medications contraindicated during pregnancy; or trying to induce physical trauma that ends the pregnancy (for example, one woman described beating her belly with a concrete block).

Several women said the methods they used to try to terminate pregnancies clandestinely failed, forcing them to continue pregnancies against their wishes. A few reported experiencing post-partum depression after they had been unsuccessful at terminating unwanted pregnancies.

Some clandestine abortions present more serious health risks to the woman or girl than others. The off-label use of misoprostol—a medication used to induce labor and to treat stomach ulcers—for medical abortion has reduced the risk of abortion-related complications in countries where legal access is restricted. Even with misoprostol, however, women and girls can experience complications related to clandestine abortion if they lack reliable information from trained providers on the correct dosage for safe and effective use.

According to the World Health Organization, complications from unsafe abortion include: “incomplete abortion (failure to remove or expel all of the pregnancy tissue from the uterus); haemorrhage (heavy bleeding); infection; uterine perforation (caused when the uterus is pierced by a sharp object); [and] damage to the genital tract and internal organs.”

An estimated 25,000 women and girls are treated for complications from miscarriage or abortion in the public health system in the Dominican Republic each year. One obstetrician-gynecologist at a public hospital in Santo Domingo estimated that 10 to 12 patients arrived at the hospital each day with incomplete abortions: “They come with pain, bleeding. Once we see them in the emergency room, then we do the procedure [to remove tissue from the uterus].” Failure to treat incomplete abortion can lead to serious infections and even sepsis and death.

Severe, untreated complications from unsafe abortion can be life-threatening. In the Dominican Republic, complications from abortion or miscarriage account for at least eight percent of maternal deaths, according to the Ministry of Public Health. Women and girls, healthcare and social service providers, and advocates interviewed for this report described deaths from unsafe abortion. Recent reports published by the Center for Gender Studies (Centro de Estudios de Género, CEG-INTEC) and Women’s Link Worldwide have also documented deaths from unsafe abortion.

Dominican authorities have pledged to eliminate preventable maternal death and have set a goal of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. The country’s 2014 maternal mortality ratio was 96.8 deaths per 100,000 live births. Research has shown that expanding legal grounds for abortion can lead to significant reductions in maternal mortality.

In the Dominican Republic, 35 percent of women and girls ages 15 to 49, who were ever married or in a union, have experienced some form of domestic violence, including physical, emotional, or sexual violence by an intimate partner, according to the government’s 2013 demographic and health survey (ENDESA-2013). In addition, approximately one in ten women and girls in the Dominican Republic has experienced sexual violence in her lifetime. The Dominican Republic has laws addressing domestic and sexual violence, as well as policies and protocols to implement those laws, but these protections are undermined by the blanket prohibition on abortion.

Human Rights Watch documented some cases of women and girls who became pregnant from rape and incest and did not have the option to safely and legally terminate their pregnancies. For example, one healthcare provider told Human Rights Watch that she had recently counseled a pregnant 11-year-old girl who had been raped by her stepfather. The girl was already 15 weeks pregnant and had pelvic pain. “She’s just a little girl,” the provider said. “She doesn’t know what’s going on in her life or in her body.” Because abortion is illegal, the provider had no options aside from referring the girl to prenatal care. International experts have stated that denial of safe abortion for survivors of rape and incest may amount to torture or cruel, inhuman, or degrading treatment. In some cases, survivors of violence had clandestine abortions, but the secrecy around abortion due to the country’s total ban kept them isolated from supportive and professional services, leaving them without a channel for reporting abuse. In one case, a provider said she felt unable to refer a patient she suspected was suffering abuse to appropriate services, because she encountered the patient in the context of a clandestine abortion and did not have formal avenues for follow-up.

We also documented several cases in which the law prevented pregnant women and girls from accessing a safe abortion, despite their pregnancies presenting serious risks to their health or lives. Medical providers explained that criminal penalties for abortion made it difficult for them to exercise their best judgment and provide the best standard of care when their pregnant patients faced serious health risks. Human Rights Watch asked one provider whether he could use his discretion to end pregnancy in such a circumstance: “In our country, the law doesn’t allow it.” He explained, “Sometimes you have your hands tied. You don’t know what to do. You have the law telling you that you can’t do it [perform an abortion], that pregnancy has to be preserved from conception to delivery…. But it doesn’t work like that. The pregnancy can put a woman’s life at risk.” A recent report published by the Coalition for the Rights and Life of Women (Coalición por los Derechos y la Vida de las Mujeres) documented the experiences of five women and girls in the Dominican Republic who had clandestine abortions either because the pregnancy threatened their lives, they were pregnant from rape or incest, or they learned the fetus would not survive outside of the womb.

Some women and girls interviewed for this report said that they faced negligence, mistreatment, or abusive behavior by health personnel when they sought medical attention for urgent sexual and reproductive health concerns, including being turned away from medical facilities; facing unreasonable delays in receiving care, sometimes to the extent that their lives were in danger; and being treated without anesthesia or pain management, causing severe pain and suffering. In some cases, women said that they experienced or witnessed abusive behavior following miscarriages or clandestine abortions. Two women said they experienced reproductive health emergencies unrelated to pregnancy, but health workers assumed they had attempted abortion and mistreated them. In one case, a woman described being left waiting for hours while she bled heavily, to the point that her life was in danger. In the other case, a woman had a painful medical procedure with no anesthesia. Some interviewees told Human Rights Watch that criminal penalties for abortion in the Dominican Republic, as well as reports of abuse by health care professionals, led them to delay or go without seeking care following complications from clandestine abortions or during miscarriages.

In countries where abortion is safe, legal, and accessible, women and girls facing unplanned pregnancies can freely seek confidential, professional medical advice and counseling about their options. Pre-abortion counseling can uncover undue pressure or coercion women may be experiencing from partners, parents, or other sources to terminate pregnancies, allowing providers to help patients to delay decision-making or receive additional counseling or referrals, as needed. When abortion is criminalized, pregnant women and girls often cannot access factual, unbiased, and confidential information from qualified professionals about a full range of options, leaving them more susceptible to pressure, coercion, or even abuse from partners or others who may want to control their reproductive health.

Human Rights Watch interviewed some women and girls who said they were pressured, abused, or misled by their partners, family members, or neighbors to terminate unplanned pregnancies they wanted to continue. While women and girls may face coercion around pregnancy decisions even in settings where abortion is legal and accessible, criminalization denies women and the girls access to standardized, reliable, and confidential reproductive health counseling that can help them make the best decisions for their health and lives.

The criminalization of abortion is incompatible with the Dominican Republic’s international human rights obligations. Denying women and girls access to abortion is a form of discrimination that jeopardizes human rights including the rights to life; health; freedom from cruel, inhuman and degrading treatment; nondiscrimination and equality; privacy; information; and freedom to decide the number and spacing of children. Human rights treaty bodies and other authorities now consistently urge states to decriminalize abortion in all cases, and the bare minimum to at least ensure safe and legal access when the life or health of the pregnant woman is threatened, and for pregnancies resulting from rape or incest, or involving severe fetal impairment.

Decriminalizing abortion is an urgent public health and human rights imperative. Authorities should act swiftly to protect the health, human rights, dignity, and lives of women and girls in the Dominican Republic.

Many countries around the world have eased abortion restrictions in recent years. The Guttmacher Institute reported that 27 countries around the world reformed their abortion laws to expand legal access to abortion between 2000 and 2017. The Dominican Republic should join this global trend.

 

Recommendations

To the National Congress

  • Decriminalize abortion as a matter of urgency, by removing all criminal penalties for abortion from the penal code.
  • At a minimum, reform the penal code to provide women and girls with access to safe and legal abortion services when the pregnancy poses a risk to the life or health of the woman or girl, when the fetus has a serious condition incompatible with life outside the womb, or when the pregnancy resulted from any form of sexual violence.
  • Enact the proposed Sexual and Reproductive Health Law to expand legal protections for women’s and girls’ sexual and reproductive health and rights.

To President Danilo Medina

  • Continue to urge Congress to reform the penal code to make it consistent with the Dominican Republic’s international human rights obligations by decriminalizing abortion in all circumstances and ensuring safe and legal access to abortion, at a minimum, when the pregnancy poses a risk to the life or health of the woman or girl, when the fetus has a serious condition incompatible with life outside the womb, or when the pregnancy resulted from any form of sexual violence.
  • Veto any version of the penal code that maintains full criminalization of abortion in all circumstances.

 

To the Supreme Court of the Dominican Republic

  • Give appropriate consideration to all of the Dominican Republic’s obligations under international and regional human rights treaties when ruling on any petitions related to the constitutionality of the country’s laws on abortion.

 

To the Ministry of Public Health

  • Ensure that all national sexual and reproductive health protocols include the following:
    • A screening process to determine whether pregnant women and girls planned and want their pregnancies, and a discussion of their options and referrals for psychosocial support, in the event that the pregnancy is unwanted;
    • Harm reduction counseling on the safety and risk of different measures used to induce abortion and information on when and how to access post-abortion care for women and girls who may wish to terminate pregnancies clandestinely;
    • Guidelines for attending to patients with incomplete abortions or post-abortion complications in a prompt, neutral, professional, rights-respecting, and non-discriminatory manner, including a specific requirement that patients not be denied pain management as “punishment;”
    • Routine post-delivery and post-abortion contraceptive counseling to ensure all women and girls have comprehensive and accurate information about how to prevent pregnancy;
    • Referrals to psychosocial support services for pregnant adolescent girls.
  • Develop and implement an extensive training program to ensure all health care providers competently and consistently implement sexual and reproductive health protocols, including the provisions listed above.
  • Develop or strengthen measures to inform patients of their rights, including the right to prompt, professional, and respectful post-abortion care. Strengthen complaint mechanisms for patients, the friends and family members accompanying them, and medical personnel to report neglectful or abusive treatment of women and girls seeking, or believed to be seeking, post-abortion care. Inform patients about how to file complaints, and investigate all complaints of mistreatment promptly, thoroughly, and fairly. Sanction staff found to have engaged in neglectful or abusive behavior.
  • Conduct research on the sexual and reproductive health needs of women and adolescent girls, to identify factors contributing to unintended and early pregnancies. Investigate barriers in access to, and consistent use of, the contraceptive methods provided by the National Health System, including long-acting reversible contraceptives (such as intrauterine devices) and voluntary sterilization. Modify national health policies as needed to expand contraceptive options and address these barriers.
  • Ensure health centers do not stigmatize adolescents who are sexually active, and that they are staffed with medical personnel qualified to provide confidential and comprehensive adolescent health services.
  • Strengthen measures to reach out to adolescents to raise their awareness about access to contraception and reassure them of the availability and confidentiality of adolescent-friendly, non-judgmental services.
  • Implement public information and awareness-raising campaigns that address the stigma around adolescent sexuality and promote healthy adolescent sexual practices. Ensure such campaigns make clear that adolescent children do not need an adult’s authorization to access sexual and reproductive health information and services.
  • Strengthen services for women and girls facing sexual violence, domestic violence, and other forms of abuse. Ensure links between services for survivors of violence and medical providers, so that survivors of abuse can easily access specialized medical care. Ensure that medical providers consistently refer patients they know, or suspect, are experiencing abuse to comprehensive, supportive services.
  • Work with the Ministry of Education to implement a mandatory comprehensive sexuality education curriculum nationwide.

To the Ministry of Education

  • Implement a mandatory comprehensive sexuality education curriculum in primary and secondary schools that complies with international standards and is scientifically accurate, rights-based, and age-appropriate. Ensure the curriculum reaches students from an early age and builds incrementally to equip them with developmentally relevant information about their health and wellbeing. As part of the curriculum, provide children with practical information about how to use contraceptive methods and where they can obtain contraceptive supplies.
  • Train educators to teach the curriculum impartially.

To the Ministry of Women

  • Work with the Ministry of Public Health and the Ministry of Education to implement the recommendations detailed above.

To Donors and United Nations Agencies

  • Advocate for the Dominican Republic to remove all criminal penalties for abortion and to ensure that women and girls have safe and legal access to abortion.
  • Encourage states to fulfill their obligations under international law regarding sexual and reproductive rights and eliminate restrictions on overseas development assistance that serve to limit the exercise of those rights.
  • Advocate for the government of the Dominican Republic to implement the recommendations above and support it in doing so.

To the Inter-American Commission on Human Rights

  • Hold a thematic hearing on access to comprehensive sexual and reproductive health services and information, including access to safe and legal abortion, in Latin American and the Caribbean. Ensure that the rights and needs of adolescent children and young adults are included.
  • Consider appropriate steps to prioritize the petition filed by Rosa Hernández, with support from Colectiva Mujer y Salud and Women’s Link Worldwide, regarding the death of her 16-year-old daughter Rosaura Almonte Hernández (known as “Esperancita”).
  • Consider the findings and recommendations of this report during the deliberations of the Working Group on Implementation of Human Rights Policies in the Dominican Republic. Ensure that the Working Group’s final report includes a detailed discussion on the public health and human rights impacts of the criminalization of abortion in the country.

 

Methodology

Human Rights Watch conducted research for this report in February and April 2018 in four provinces of the Dominican Republic: Santo Domingo, Santiago, San Cristóbal, and Monte Plata. Most interviews were carried out in the country’s two largest cities: Santo Domingo and Santiago de los Caballeros.

Human Rights Watch identified interviewees with the assistance of nongovernmental organizations (NGOs), advocates, researchers, and service providers. We sought to interview women and girls who had experienced unplanned or unwanted pregnancies, including some from specific populations that may be particularly vulnerable to harm from the criminalization of abortion, such as adolescent girls and young women, Dominicans of Haitian descent, Haitian immigrants, women or girls involved in sex work, survivors of violence, and those living in poor communities.

We interviewed 50 women and girls of reproductive age, ages 15 to 43, who had been pregnant at least once in their lives. Among them, 47 had an unplanned or unwanted pregnancy, and 29 attempted abortion. In addition, we spoke with 21 healthcare and social service providers, including psychologists, obstetrician-gynecologists, case workers, and health outreach workers; and 33 other experts, such as academic researchers, lawyers, and representatives of NGOs. For additional contextual information, Human Rights Watch interviewed six children and young adults ages 17 to 24 and one older woman, and held focus group discussions with 54 other individuals, including adolescent children, health outreach workers, and members of a community-based organization. Human Rights Watch also interviewed representatives of the Ministry of Public Health and the Ministry of Education. In total, Human Rights Watch spoke with 167 people for this report.

Most interviews were conducted in Spanish through an interpreter. A few interviews were conducted in Haitian Kreyòl with the help of an additional interpreter. In most cases, Human Rights Watch held interviews individually and in private, though in a few cases, interviewees preferred to have another person present. Interviews were primarily held in private areas in community spaces or the offices of local organizations.

Human Rights Watch informed all interviewees of the purpose of the interview, its voluntary nature, and the ways in which the information would be collected and used. Interviewers assured participants that they could end the interview at any time or decline to answer any questions, without any negative consequences. All interviewees provided verbal informed consent to participate.

Interviews were semi-structured and covered topics related to sexual and reproductive health and rights, as well as access to information and services. Most interviews lasted 45 to 60 minutes, and all interviews took place in person. Care was taken with victims of trauma to minimize the risk that recounting their experiences could further traumatize them. Where appropriate, Human Rights Watch provided contact information for organizations offering legal, counseling, health, or social services. Human Rights Watch did not provide anyone with compensation or other incentives for participating.

All interviewees were already connected in some way to local organizations or service providers. We did not seek to access those outside of these networks, due in part to a commitment to ensure interviewees had access to support following their participation in the research. As a result, the accounts in this report do not reflect the experiences of some of the most vulnerable and isolated women and girls in the Dominican Republic—women and girls with no connection to services.

Human Rights Watch also analyzed relevant laws and policies and conducted a review of secondary sources, including epidemiological data, public health studies, reports from the World Health Organization and the Ministry of Public Health, and other sources.

Human Rights Watch met with government officials in Santo Domingo in April and September 2018, including representatives of the Ministry of Public Health and the Ministry of Education.

The names of the women and girls interviewed, as well as service providers, have been changed to protect their privacy and safety. The names of other experts have not been changed. In a few cases, Human Rights Watch withheld the date and location of an interview for security reasons.

Terminology

In this report, the word “child” refers to anyone under the age of 18, with “girl” referring to a female child.[1]

The term “adolescent” is used to describe children and young adults ages 10 to 19, consistent with the definition used by the World Health Organization (WHO).[2]

 

I. Background: Abortion in the Dominican Republic

Abortion is criminalized in the Dominican Republic in all circumstances, even when the life of the pregnant woman or girl is in danger. The Dominican Republic is one of only six countries in Latin America and the Caribbean to maintain a total abortion ban; the others are El Salvador, Haiti, Honduras, Nicaragua, and Suriname.[3] For many years, women’s rights groups have fought for access to safe and legal abortion.

Legal Framework

The criminal code in the Dominican Republic penalizes women and girls who induce abortions and anyone who assists them.[4] Under article 317 of the criminal code, doctors, surgeons, midwives, nurses, pharmacists, and “other medical professionals” who provide abortions face prison terms of five to 20 years.[5] Pregnant women who induce or consent to abortions, and any individuals who relay information to pregnant women about obtaining an abortion, if the abortion occurs, face six months to two years in prison.[6]

There are no exceptions provided in the language of criminal code, or any other laws or regulations, to allow for legal abortion in any circumstance. According to the Center for Reproductive Rights, criminal laws like those in the Dominican Republic, when challenged in court, “are normally interpreted to permit life-saving abortions on the grounds of the general criminal law defense of ‘necessity,’” suggesting that a provider could be exempt from criminal liability if she or he performed an abortion to save a pregnant patient’s life.[7] Advocates told Human Rights Watch that they had not seen this type of challenge to the law reach the justice system in the Dominican Republic.[8]

In 2010, lawmakers in the Dominican Republic reformed the constitution to establish a right to life from conception. Article 37 of the constitution states, “The right to life is inviolable from conception until death.”[9]

Women’s rights experts told Human Rights Watch that arrests and prosecutions for abortion-related crimes in the Dominican Republic are rare, despite the strict criminal laws.[10] “Even though abortion is illegal under the framework, there are not prosecutions,” one doctor explained.[11] Dr. José De Lancer, an obstetrician-gynecologist who worked in the public health system for many years, told Human Rights Watch, “It’s not like El Salvador. We don’t throw doctors and women in jail. We’re far from that.”[12]

In early 2018, however, a court ordered a 20-year-old woman in San José de Ocoa to serve three months of “preventive detention” while authorities investigated whether she had an illegal abortion. The woman maintained that she fell down and that her partner gave her a medication, claiming it would help with the pain. She said she did not realize until afterward that it was a medication that could induce abortion. After experiencing pain, she sought medical attention at a hospital for a miscarriage, and her medical provider reported her to authorities for inducing an abortion.[13] At the time of writing, she was at home awaiting trial.

According to advocates, the woman’s arrest and sentence for abortion-related crimes were highly unusual in the country.[14] “We’ve never seen them put someone in jail for an abortion,” said Fátima Lorenzo, director of the nongovernmental organization Ciudad Alternativa.[15] Some advocates said they feared the 2018 case could signal a move toward greater enforcement of criminal penalties for abortion.[16]

Abortion Incidence and Safety

Research from around the world shows that restrictive laws and criminal penalties do not reduce the incidence or rate of abortions, but they make them less safe. A recent study by the Guttmacher Institute found little difference between the rate of abortion in countries that restricted access and countries that did not:

Women living under the most restrictive laws (i.e., where abortion is prohibited altogether or allowed only to save a woman’s life) have abortions at about the same rate as those living where the procedure is available without restriction as to reason (37 and 34 abortions per 1,000, respectively).[17]

It is difficult to obtain reliable data on the incidence or rate of abortion in countries where it is criminalized, such as the Dominican Republic. According to the Guttmacher Institute, 97 percent of women in Latin America and the Caribbean live in countries with restrictive abortion laws.[18] Despite restrictions, Latin America and the Caribbean also has the highest estimated abortion rate: 44 abortions per 1,000 women and girls ages 15 to 44, compared to an estimated global rate of 35 per 1,000. The estimated abortion rate in the Caribbean is 59 abortions per 1,000 women and girls.[19]

Human Rights Watch could not locate any recent, comprehensive, country-specific estimates of the abortion rate in the Dominican Republic.[20] A survey of 2,436 university students by the organization Profamilia found that more than two-thirds of participants said they knew someone who had had an abortion, though only 126 (about 5.2 percent) reported having had an abortion themselves. According to Profamilia, a 2013 demographic and health survey (ENDESA-2013) found 9.8 percent of women and girls ages 15 to 49 reported having had an abortion or a miscarriage in their lifetime, though it did not distinguish between spontaneous and induced terminations.[21]

Under the legal framework described above, all abortions occurring in the Dominican Republic are considered illegal, and therefore, performed clandestinely. Some clandestine abortions present more serious health risks than others. In a 2017 study published in The Lancet, researchers with the World Health Organization (WHO) presented a three-tiered classification of abortion as safe, less safe, and least safe. By their definitions, abortions are classified as safe if they are provided by trained healthcare workers using methods recommended by WHO such as medical abortion or vacuum aspiration (a procedure using suction to remove tissue from the uterus) appropriate for the stage of the pregnancy. Less safe abortions are those done by trained providers using outdated or less safe methods (such as curettage, a procedure to remove tissue from the uterus by scraping with a sharp tool), or abortions done with safe methods (such as misoprostol, a medication that can induce abortion), but “without adequate information or support from a trained individual.” Least safe abortions are those done by untrained people using dangerous or invasive methods, “such as ingestion of caustic substances, insertion of foreign bodies, or use of traditional concoctions.”[22]

The vast majority of abortions in Latin America and the Caribbean—more than three-quarters—are unsafe (less safe or least safe, according to the model above). Nearly five million unsafe abortions occur in the region each year, and more than one million of those are considered “least safe” under the criteria described above.[23]

Unsafe abortion can cause serious health complications, including death. According to the WHO, complications from unsafe abortion include “incomplete abortion (failure to remove or expel all of the pregnancy tissue from the uterus); haemorrhage (heavy bleeding); infection; uterine perforation (caused when the uterus is pierced by a sharp object); damage to the genital tract and internal organs by inserting dangerous objects such as sticks, knitting needles, or broken glass into the vagina or anus.”[24]

In Latin America and the Caribbean, unsafe abortion is the cause of at least 10 percent of maternal deaths, and more than 760,000 women are treated for abortion-related complications in the region each year.[25] The Pan American Health Organization estimates an average of 68 maternal deaths per 100,000 live births in Latin America and the Caribbean.[26]

The Dominican Republic has a higher maternal death ratio than the regional average. According to a 2015 report from the Ministry of Public Health, the maternal mortality ratio in the Dominican Republic was 96.8 per 100,000 live births in 2014.[27] At least eight percent of maternal deaths in the country are attributed to complications from miscarriage or abortion.[28] At least 96 women died from such complications between 2010 and 2015, though this number is likely an undercounting, excluding women whose abortion-related deaths were registered under other causes.[29] According to the Ministry of Public Health, there are an estimated 25,000 hospitalizations for abortion or miscarriage in the public health system each year, many of which are women needing care after a clandestine abortion.[30]

The off-label use of misoprostol—a medication used to induce labor and to treat stomach ulcers—for medical abortion has reduced the risk of abortion-related complications in countries where legal access to abortion is restricted.[31] The WHO recommends the use of misoprostol in combination with mifepristone, another drug used in medical abortion.[32] Misoprostol is much more widely available and accessible, and research has shown that it can be safe and effective when used alone to terminate pregnancies.[33]

Misoprostol is included in the Dominican Republic’s essential medicines list, the national list of medicines that satisfy the priority healthcare needs of the population, and should be available and accessible through the health system.[34] A 2005 study published in the International Journal of Obstetrics and Gynaecology found a 75 percent decline in serious abortion-related complications at one of the largest maternity hospitals in Santo Domingo between 1986—the year the misoprostol was introduced in the country—and 2001.[35]

Public Opinion on Abortion

Though a majority of the population in the Dominican Republic is Roman Catholic, and conservative religious authorities have opposed public policies that would advance sexual and reproductive rights, new public opinion research shows a clear majority of the population favors easing restrictions on abortion. A 2018 public opinion study involving more than 2,000 people in the Dominican Republic found that 79 percent of respondents believe abortion should not be criminalized when the life or health of the woman is at risk, 76 percent when the pregnancy is not viable, and 67 percent when the pregnancy resulted from rape or incest.[36]

Proposals for Reform

For more than two decades, legislators in the Dominican Republic have debated a new penal code, incorporating a number of reforms, which would replace the current criminal code. In recent years, conflict between the president and some legislators over whether to ease restrictions on abortion has arisen in the context of the penal code reform process and has become an obstacle to the new code being adopted.

In 2014, the Chamber of Deputies—the lower house of the country’s bicameral National Congress—approved a version of the new code that maintained the criminalization of abortion in all circumstances. President Danilo Medina vetoed it and sent it back to Congress, requesting changes to the articles regarding abortion.[37] In a letter to the president of the Chamber of Deputies explaining his veto (“observation”[38]), President Medina argued that the penal code should decriminalize abortion in three circumstances: when the life of the woman or girl is in danger, when the pregnancy resulted from rape or incest, or when the fetus has serious complications incompatible with life outside of the womb. He stated that such a policy was “the most just, balanced, and consistent with the spirit of protection of rights and humanity that should govern the State.”[39] A diverse coalition of women’s rights groups, the Coalition for the Rights and Life of Women (Coalición por los Derechos y la Vida de las Mujeres), has for several years urged authorities to decriminalize abortion in those three circumstances (tres causales).[40]

The Chamber of Deputies responded to President Medina by passing a revised version of new penal code that decriminalized abortion when the life of the woman was in danger, and said the other two circumstances (unviable pregnancies, and those resulting from sexual violence) should be determined by a special law. But this version of the code was not sent to the Senate for a vote. This opened the door to several religious and socially conservative organizations challenging the constitutionality of the new criminal code in court, denouncing procedural irregularities in the approval process, and arguing that the new code was incompatible with the constitutional protection for the right to life from conception.

In late 2015, just before the new penal code was set to take effect, the Constitutional Court ruled that it was unconstitutional due to procedural irregularities in the approval process, reinstating the old criminal code.[41] The court did not rule on the question of whether this easing of restrictions on abortion could be reconciled with the constitutional protection for the right to life from conception.[42]

In 2016, the Senate approved a version of the penal code leaving in place the criminalization of abortion in all circumstances. President Medina again vetoed the proposed penal code and issued another “observation” objecting to the total abortion ban.[43] In a letter to the president of the Senate, President Medina argued again for decriminalization in the same three circumstances, stating that they were “extreme circumstances, terrible, but that occur in daily life, and which we as legitimate representatives of the people, should give responses in accordance with the Constitution and with our own values.”[44] Due to this disagreement, the penal code reform failed to pass in 2016.

In 2017, the Senate again approved a penal code with total criminalization of abortion, rejecting the changes requested in President Medina’s 2016 observation. The Senate sent the proposed penal code to the Chamber of Deputies, where it was voted down. As of October 2018, the penal code’s criminalization of abortion in all circumstances remained in effect.

Aside from the ongoing penal code reform process, another bill currently pending in the Chamber of Deputies, the Proposed Law on Sexual and Reproductive Health (Proyecto de ley de salud sexual y reproductiva), could help to ease restrictions on abortion. The stated purpose of the bill is “to establish the legal framework for the guarantee and full exercise of sexual rights and reproductive rights, through the regulation of public policies aimed at the prevention and care of sexual and reproductive health, as well as to the establishment of sanctions for their violation.” It outlines roles and responsibilities for various government entities and establishes a process for legal abortion in the first 12 weeks of gestation if there is a “grave risk” to the life or health of the pregnant woman, if the fetus has complications incompatible with life, or if the pregnancy resulted from sexual violence.[45] The bill would also formalize and institutionalize rights-based sexual and reproductive health information and services, such as adolescent-friendly health services, and comprehensive care for survivors of violence. At the time of writing, the Proposed Law on Sexual and Reproductive Health had not been brought for a vote.

 

II. Findings: Unplanned Pregnancies and the Impacts of the Total Abortion Ban

Almost half of pregnancies in the Dominican Republic are either unplanned or unwanted. Human Rights Watch found that that women and girls experience significant distress around unplanned pregnancies, but criminal laws prohibiting abortion in all circumstances force them to turn to clandestine, and often unsafe, methods to terminate pregnancies. Many women and girls experience health complications from clandestine and unsafe abortion, and some die. Some face abuse, neglect or mistreatment by healthcare providers when they seek medical attention for reproductive healthcare emergencies. Even women or girls who become pregnant from sexual violence, or who face serious health risks during their pregnancies, do not have the option to access safe and legal abortion. The Dominican Republic’s abortion ban denies women and girls their reproductive rights and endangers their health and lives.

Unplanned Pregnancies

The national health system in the Dominican Republic offers women and girls a range of free or low-cost contraceptive methods, including oral contraceptive pills, implants, injections, and the intrauterine device (IUD).[46] According to a 2013 demographic and health survey (ENDESA-2013), 68.6 percent of women and girls ages 15 to 49 who were married or in unions (living with their partners in the same household), and 63.4 percent of those who were sexually active but not in unions, said they used a modern contraceptive method.[47] Emergency contraception (often called the “morning after pill”) is included on the essential medicines list and available at pharmacies without a prescription, and condoms are widely available at health centers, pharmacies, and convenience stores.[48]

Despite this, survey data suggest that nearly half of pregnancies in the Dominican Republic are either unplanned or unwanted.[49] Though only 11 percent of women and girls ages 15 to 49 who are married or in unions have an unmet need for contraception (meaning they wish to delay or prevent pregnancy but are not using any method of contraception), adolescent girls and younger women are disproportionately affected. More than one-quarter (27 percent) of adolescent girls and young women ages 15 to 19, and more than one-fifth (21 percent) of women ages 20 to 24 have an unmet need for contraception.[50] The women and girls of reproductive age interviewed for this report who had had unplanned or unwanted pregnancies cited a variety of reasons for such pregnancies, including barriers to accessing contraceptive methods, contraceptive failures, and sexual violence.

Though most interviewees had information about contraception and knew where to go for services, some encountered barriers in accessing their preferred family planning methods, including supply shortages.[51] For example, Madelyn, 28, said she started using an oral contraceptive pill to prevent pregnancy after she gave birth to her second child. “I went to the public hospital for pills every month. When I went one time, there were none.” She said she did not have the money to buy contraceptive pills at the pharmacy: “We were in a very difficult economic situation.” It took two days for the pills to become available in the public health system, but even a short interruption in oral contraceptive use can dramatically reduce effectiveness at preventing pregnancy. A few weeks later Madelyn learned she was pregnant.[52]

Daralis, a 24-year-old mother of two, tried using an implant to prevent pregnancy, but she said it caused complications in one of her ovaries. After two years, she had the implant removed. “When I took the implant out, I started taking [oral contraceptive] pills, but they didn’t work, and I got pregnant.” After giving birth to her second child, she tried to get injections to prevent pregnancy at the public maternity hospital near her home. “Every time I go, they don’t have it,” she said.[53]

A few interviewees said they got pregnant when they missed doses of their daily oral contraceptive pills.[54] Others became pregnant while switching from one contraceptive method to another.[55] Some women and girls said their methods failed to prevent pregnancy for reasons they did not understand.[56] Samantha, 18, said she started getting injections when she turned 17 to prevent pregnancy. She had to submit a pregnancy test as part of a medical examination for a new job. When she learned she was five months pregnant, she was shocked. “I was one of those people that unfortunately the injection doesn’t work properly for,” she said. “I believed that I was protected. I thought this couldn’t happen to me.”[57]

Lisbeth, a 16-year-old girl who was three months pregnant when she met with Human Rights Watch, said she got an implant to prevent pregnancy after she gave birth at age 14. After a year, she got the implant removed because it interfered with her period, and she switched to an oral contraceptive pill. She became pregnant while taking an oral contraceptive pill.[58]

Many women said they found it difficult or impossible to use family planning methods due to health conditions, such as hypertension, or unpleasant side effects, including changes in weight, irregular periods, cysts or myomas, or other sicknesses.[59]

A few women said they tried to access tubal ligation but were told they were too young, including one woman who had been advised that she should not have any more children because she has hypertension and nearly died in childbirth.[60] While there is evidence that younger women have a higher risk of a failed tubal ligation (that is, a pregnancy occurs),[61] providers often deny young women tubal ligations because they believe they will regret having the procedure, as it is difficult, or impossible, to reverse.

Some adolescent girls and young women said they did not seek family planning information or services prior to becoming pregnant, either because they felt uncomfortable, or they did not have adequate information.[62] “I started having sex at 14,” said Lucely, an 18-year-old woman with a 2-year-old daughter. “I didn’t want to [ask for family planning options]. They say, ‘Oh, you’re so young. You’re already doing it?’”[63]

In addition, some women and girls interviewed for this report became pregnant from rape or incest. Their accounts are detailed below (under the section on “Lack of Access to Legal Abortion Even in Cases of Rape, Incest, and Serious Health Risks”).

Regardless of the circumstances, overwhelmingly women and girls experienced distress upon learning of an unplanned pregnancy, saying they felt “depressed,” “terrified,” “desperate,” or “trapped, with no future.”[64] “I couldn’t leave the house. I was crying, and crying, and crying,” said Melina, 26, describing how she felt when she learned she was pregnant three months after giving birth to her third child.[65] Nayely, 29, told Human Rights Watch she “wanted to die,” when at age 18, she learned she was pregnant for the second time. She had recently separated from her partner. “Imagine, with a two-year-old and pregnant.”[66]

“When the doctor told me I was pregnant, my world crumbled,” said Camila, 24, describing learning of an unplanned pregnancy at age 22. Her family kicked her out of the house for having a pregnancy while she was unmarried. “It almost made me crazy.”[67]

One psychologist interviewed by Human Rights Watch counseled women coping with the news of unplanned pregnancies. She said women often exhibited, “despair, depression about their economic situation, fear of facing a pregnancy. I had a case in 2016 of one girl who wanted to kill herself when she became pregnant because she was underage, and her parents didn’t accept her when she got pregnant. She was 16.”[68] One 22-year-old woman interviewed for this report explained it simply: “When you don’t want to have a baby, you feel bad.”[69]

Some women chose to continue unplanned pregnancies that were also unwanted, either due to their personal beliefs about abortion, or because they feared clandestine abortion. Daralis, 24, told Human Rights Watch, “If you attempt to stop a pregnancy, you can end up dead.”[70] Adelyn, 20, said she considered having a clandestine abortion, but decided not to try to interrupt the pregnancy, “because I thought of myself too. Because you can die.”[71] More than half of the women and girls interviewed for this report who had unplanned or unwanted pregnancies, however, said they had had or tried to have clandestine abortions.

Clandestine and Unsafe Abortions

Despite the criminalization of abortion, women and girls in the Dominican Republic seek to terminate unwanted pregnancies, and because of the ban on abortion are often forced to risk their health and lives doing so clandestinely. “In the Dominican Republic, women have always defied this denial of their rights,” said Sergia Galván, a leading women’s rights advocate in Santo Domingo.[72]

Human Rights Watch interviewed women and girls who reported attempting abortion in various ways, including taking or inserting pills (most commonly misoprostol, often called by the brand name Cytotec); using teas, beverages, and other home remedies; trying to induce poor health, for example by denying themselves food, water, or sufficient rest; taking prescription medications contraindicated during pregnancy; or trying to induce physical trauma that ends the pregnancy.

Liliana Dolis, general coordinator of the Movimiento de Mujeres Dominico-Haitianas (MUDHA), told Human Rights Watch that women and girls spoke openly about clandestine abortion at events her organization hosted: “Many of our women know what to do, but they put their lives in danger…. In the workshops, they talk about all the methods they use: teas, letting yourself fall down, beating the belly, squeezing the uterus, taking aspirin, inserting other things.”[73]

Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, told Human Rights Watch:

Abortion is a phenomenon that’s penalized by law in all its forms, with no exceptions. But we’ve always recognized that unsafe abortion is an important health problem because women have to appeal to clandestine methods to find an answer to their situation [an unwanted pregnancy]. And that creates the phenomenon of unsafe abortion.[74]

Some women and girls interviewed for this report might have been eligible for safe and legal abortion if authorities in the Dominican Republic had decriminalized abortion in the three circumstances (“tres causales”) discussed above—when the life of a woman is in danger, when the pregnancy resulted from rape or incest, or when the fetus will not survive outside the womb. Most interviewees, however, said they wanted to end pregnancies due to socioeconomic difficulties, instability or violence in their relationships, or because they already had other children and felt unable to care for any more. “If women don’t want to have it [a child], it’s for a reason,” explained Camila, 24, who ended a pregnancy at age 22 when her son was 1 year old. “Everyone has a reason.”[75]

The experience of Juliana, a 16-year-old mother of two, was typical among the women and girls interviewed for this report. “I have a hard economic situation. Sometimes I don’t even know what we’ll have for dinner.” She became pregnant unexpectedly in early 2018, when her children were 3 and 1: “I was terrified. I was going crazy, thinking if I can’t even find food for these two babies [I already have], how will I feed a third?” She took pills and a tea that she believed would induce abortion, and experienced “a lot of pain.” When she went to the doctor, she was told that the abortion was incomplete, but her cervix had closed, and she was referred for additional testing. When she met with Human Rights Watch, she had not received further treatment and was still experiencing pain and dizziness, which she believed could have been related to the clandestine abortion she underwent four weeks prior.[76]

Gabriela, 27, had a similar experience. She told Human Rights Watch she had a clandestine abortion three years ago, when her second child was only a few months old. “I was using [contraceptive] pills, but they failed,” she said. “I didn’t want to have a baby. My husband was not working, and there was nothing in the house to eat, and I wasn’t working. I [already] had the baby girl [my second child].” She took pills that someone bought for her at a pharmacy and terminated the pregnancy, without telling anyone except her husband and the person who bought the medication.[77]

Some interviewees said they feared criminal penalties, even though abortion-related arrests and prosecutions in the Dominican Republic are rare. Isamar, 31, became pregnant unexpectedly in early 2018. As a single mother of four children, with the youngest only 10 months old, she felt unable to care for another child.

I decided to go to the pharmacy to buy a pill to abort [the pregnancy]. I asked the pharmacist for the pill to get an abortion. They didn’t want to sell it to me. They said they couldn’t sell pills for that, so I sent someone else to get them for me … and I bought a malt drink. I heated it with cinnamon and nutmeg on the stove, and I took it at night … with the pills. At dawn, I felt a strong pain, and I started bleeding. By the next day, the bleeding had stopped, but the pain continued. I decided to go to the doctor.

 

At the hospital, she received medical attention for an incomplete abortion and said she was treated well. “I was really afraid,” she said, explaining that she knew there were criminal penalties for abortion. She did not tell anyone what she went through: “Not my family, not anyone. Because my family would criticize me a lot for the situation I’m going through. I did what I did. I didn’t even tell my family I went to the hospital.” She said she felt very alone, “especially when I came out of surgery.”[78]

Human Rights Watch asked one clandestine abortion provider whether she feared criminal prosecution for helping patients terminate unwanted or risky pregnancies. “Every single day,” she said. “It’s always a risk.… But we are willing to exchange [information and services], willing to hope that at some point we will be able to look backwards [at the time when abortion was criminalized] and say, ‘Do you remember when we had to do this under the table?’”[79]

 

Stephany’s Story

Though most women and girls interviewed for this report used medication or home remedies to end pregnancies, one woman had a traumatic experience getting a surgical abortion at a clandestine clinic. Stephany, 24, told Human Rights Watch she had an unwanted pregnancy at 21. When she found out she was pregnant, she said it felt like “the world was tumbling down,” and she immediately sought a way to end the pregnancy. “I didn’t know how to end it, where to go, where to ask for help. I didn’t want to tell other friends, for fear they would judge me. I didn’t know anyone who had gone through it.”

Stephany learned about a clandestine abortion provider from her partner’s friend. “Everything was wrong with the health facility,” she said. “It was not clean at all. It was an old house. It was very big. It was dark. Everything was old. The chairs were old, the television was from the 1990s, the bathroom was a mess. But I was desperate.” She paid over RD$10,000 pesos (US$200) to have an abortion at the clinic. “The house had two levels. We went to the second level. The papers [on the wall] were so old, they were yellow.… It was dirty and dusty. There were two seats, and we waited in the dark. It was really dark. There was no natural light. It was a like a horror movie in every sense…. I was desperate, totally anxious, shaking, sitting there doing nothing.… He took me to a room at the back. It was a room with a toilet and a sink. There was no running water. He told me to go to the bathroom and put on a robe, so I took off my clothes. He asked me to sit on the metal table, without any sheets or pillows.”

Stephany said the provider administered local anesthesia, and the procedure lasted only five to seven minutes. She recounted it in vivid detail: “I was seeing lights. I could hear a radio. I was conscious, but I didn’t feel pain. I could feel the edge of the table on my lower back. I felt everything. It was a spatula [tool] scraping the uterus. I was screaming. He did the curettage and then put a hose with water inside my uterus. I was screaming the whole time. I was very uncomfortable.”

She had no complications and recovered physically from the procedure, but she wished she had more information about her options when she became pregnant. “At that time, I didn’t know anything. I didn’t want to ask.” Stephany had no regret about ending the pregnancy: “I regret the way I did it. I don’t regret doing it,” she said. “I was relieved because it was over…. It was a relief, even though the process was so horrific.… The circumstances were bad, but it was the right decision.”

Afterward, she spoke with a friend who had information about safer options for ending pregnancies clandestinely. “She told me, ‘You didn’t have to go through that.’ … That’s when I started to talk more about it. I want people not to have shame.… I don’t want other women feeling like I did.” Now Stephany speaks openly with friends about her experience and provides information about safer options for ending pregnancies clandestinely.[80]

Legal restrictions on access to abortion disproportionately harm women and girls from poor communities, and those with less access to accurate information and support to terminate unwanted pregnancies safely.[81] Many experts interviewed for this report described a double standard, or doble moral, around abortion in the Dominican Republic, due to criminalization: women with resources can safely terminate pregnancies with trained and competent clandestine providers, or by traveling abroad, while poor women must resort to less safe methods, without support from reliably qualified providers. “If you are poor, you are lost,” explained one doctor interviewed for this report. “If you have money, you can do it [have a safe abortion] anyplace. The problem is poor women go to any doctors, unknown doctors, and they are not adequate.”[82] Another doctor had a similar observation: “For very rich women, it’s not a problem [to have a safe abortion]. The problem is with poor women.”[83]

Human Rights Watch interviewed two women who had safe—though clandestine and illegal—abortions.[84] Both women had medical abortions under the care and supervision of trained providers.[85] One woman, Nicole, had private insurance, a high level of education, and a stable job, and she was able to find a safe and reliable provider to help her terminate the pregnancy. “I had the privilege of networks. I knew people and reached out to them. I had a medical abortion. It went well. I had no problems, not even getting the pills. The provider gave them to me and gave me all the information about how to use the pills.” Describing the interaction with her provider, she said, “It calmed me to see her.… She told me what to expect. She said, ‘If these things happen, it’s a sign you should get medical attention.’… To know you’re with someone who will give you time and information, it gives you a lot of confidence and reassurance.” Nicole said the experience solidified her belief in the importance of access to safe and legal abortion: “All women should have the same process. For me, [this experience] was fundamental to understand the importance of the fight for safe abortion.”[86]

Camila, the other woman, had a medical abortion under the care of a trusted provider. She contrasted her experience with that of a friend who experienced complications after a clandestine abortion and had to seek post-abortion care in the public health system. “They treated me well because, in reality, it was a clinic I could pay for…. But she [my friend] didn’t have money,” Camila said, explaining how her friend took pills and drank a beverage to end a pregnancy alone, without support from a medical provider. She later had to seek emergency attention in the public health system for post-abortion complications. “She was admitted [to the hospital] for a week.… It was a really painful process.”[87]

Post-Abortion Complications

Though the use of misoprostol has made clandestine abortion safer than it was in the past, criminalization still prevents women from accessing the information, services, and support they need to terminate pregnancies safely.

“Complications from unsafe abortion haven’t disappeared, but they’ve reduced dramatically,” said Dr. José De Lancer, an obstetrician-gynecologist in Santo Domingo who worked in the public health system for many years.[88] An obstetrician-gynecologist in Santiago de los Caballeros had a similar observation: “Back when I was a student at the hospital in the 1980s, in my specialty [obstetrics and gynecology], we saw perforations [of the uterus], infections. The use of technology has helped people. Misoprostol has avoided a lot of complications.”[89]

Even with the availability of misoprostol, however, many women and girls attempt abortion using less safe means and experience complications as a result. Those who use misoprostol also often face risks when they lack reliable information from medical providers on correct dosage for safe and effective use. An estimated 25,000 patients are treated for complications from miscarriage or abortion in the public health system each year. One obstetrician-gynecologist at a public hospital in Santo Domingo estimated that 10 to 12 patients arrived at the hospital each day with incomplete abortions: “They come with pain, bleeding. Once we see them in the emergency room, then we do the procedure [to remove tissue from the uterus].”[90]

Many people interviewed for this report experienced or witnessed complications from unsafe abortion. For example, Melina, a 26-year-old woman with four young children, said she had become pregnant unexpectedly six months earlier when her contraceptive method failed. She was very upset when she learned she was pregnant. “I felt bad. All I could think about was getting an abortion.” She tried to end the pregnancy by drinking a tea made from herbs and plants and suffered intense pain. “I had a lot of pain in the front [abdomen] and back. I couldn’t sleep, and I was bleeding only a little. I endured the pain at home alone because I didn’t want to seek [medical] attention because I had taken home [abortion] remedies.” Melina said she feared being reported to authorities, or facing abuse by medical providers, for having an illegal abortion. When the pain became unbearable, she went to a public hospital and explained that she made a tea to try to end a pregnancy. Melina said the doctor prescribed her misoprostol and sent her home without examining her or providing anything for the pain. Melina took the pills as instructed, but the pain persisted for ten days. “I started thinking I was not going to survive it.” She went to see a doctor again and was told she had an infection. When she spoke with Human Rights Watch, six months later, she still suffered chronic pain and other health effects from the ordeal. “It was really intense. I suffered a lot,” she said.[91]

Alejandro, a 24-year-old man, told Human Rights Watch that he brought a 28-year-old friend to the hospital with post-abortion complications in 2017 after she drank a beverage she thought would induce abortion. “When I went to see her, she had a fever, and she was shaking. She drank it [the beverage], and she was supposed to expel everything [from her uterus], but everything didn’t come out. I remember it was horrible. There were blood clots in the bathroom.” After five days, Alejandro said his friend agreed to go to a hospital, even though they both feared criminal penalties for seeking medical care.

She was afraid, but she couldn’t endure the pain. She was afraid to say she had an abortion…. When we went to the doctor, I stayed outside.… I dropped her off and left. And I went back for her. But I didn’t stay because it’s illegal, and I didn’t know if there could be consequences.

Alejandro’s friend received medical attention and recovered.[92]

Kendra, a health outreach worker with a health center in Santo Domingo, told Human Rights Watch about a woman she visited who had serious complications from unsafe abortion. The woman decided to end a pregnancy after finding out that her partner was already married. “She used a home remedy [to induce abortion],” Kendra explained. The woman developed a serious infection, but delayed seeking care: “After 15 days of being silent, alone, she started to have a fever and a lot of pain… I accompanied her to the maternity [hospital], and after the extraction she was hospitalized for 10 days receiving antibiotics [to treat the infection].”[93] She recovered.

Paola, 31, told Human Rights Watch that her younger sister is unable to have children after an unsafe abortion a year ago. “She made a tea and took pills.” Paola was with her afterward, and said her sister experienced heavy bleeding and infection. One week later, she had to have emergency surgery and is no longer able to have children.[94]  

Alicia, 17, told Human Rights Watch that a 16-year-old friend had serious complications after taking pills and a tea made from herbs to try to terminate a pregnancy.

She was on the verge of death because of near gangrene [tissue death due to serious infection]…. I wasn’t there at the time [that she took the pills], but when I came back, she was vomiting, pale, feeling weak. She had to go to the hospital for the cleaning. She was afraid they were going to put her in prison, because it’s illegal. She thought they’d ask about what happened.[95]

In some countries with restrictions on legal access to abortion, programs exist to provide pregnant women and girls with access to accurate information about safer options for clandestine abortion, in order to reduce morbidity and mortality associated with unsafe abortion.[96] Authorities in the Dominican Republic should implement a risk reduction program nationwide to provide women and girls with information on the safety and risk of different measures used to induce abortion clandestinely.

Abusive Behavior by Health Care Providers Following Clandestine Abortion

Some women and girls interviewed for this report faced obstetric violence—negligence, mistreatment, or abuse by health personnel—when they sought medical attention for urgent reproductive and sexual health needs, including following miscarriages or clandestine abortions.[97] In two cases, women experienced reproductive health emergencies unrelated to pregnancy, but health workers assumed they had abortions and mistreated them. Interviewees reported the following types of abuse in the health sector: extreme delays in medical attention, or discharging or dismissing women and girls without sufficient examination, sometimes to the extent that their lives were in danger; inadequate or non-provision of anesthesia or pain relief, specifically while performing dilatation and curettage to remove tissue from the uterus,[98] causing severe pain and suffering; and hostile, threatening, or disrespectful questions or comments.

The Ministry of Public Health has detailed protocols for the provision obstetric and gynecological care, including treatment for miscarriages or incomplete abortions. The protocol instructs all health personnel to “offer the client dignified, respectful and sensitive treatment, with a neutral attitude, and free from discrimination of any kind,” and specifies that providers should take a clinical history, do a detailed examination, administer care appropriate for the duration of the pregnancy, treat any post-abortion complications, and refer patients for counseling about contraceptive methods.[99]

Human Rights Watch research, as well as research by other organizations, suggest a discrepancy between the protocol and the treatment women and girls receive in some health facilities. The Center for Gender Studies (Centro de Estudios de Género, CEG-INTEC) and Women’s Link Worldwide have documented obstetric violence in the context of post-abortion care in the Dominican Republic.[100]

Several women and girls said that they were not attended to promptly or were not given adequate anesthesia or pain management when they had miscarriages. Lidia Ferrer Paredes and Vanessa Rodriguez from Confederación Nacional de Mujeres Campesinas (CONAMUCA), a nongovernmental organization that represents rural women, explained this abuse: “We suffer a lot of violence when we go to the hospitals. Even when women go to hospitals with miscarriages, they [hospital staff] say it was induced [abortion], and they do procedures to clean the uterus in cold blood [without anesthesia].”[101]

Rayneli, 15, told Human Rights Watch she had a miscarriage at age 13 after she was in a motorcycle accident: “I fell, and I was having pain. That’s how I learned I was pregnant.” She went to the hospital for the pain, and learned that she had been three months pregnant, but had miscarried, and that the tissue inside her uterus had caused infection. “I went to the hospital and they did a curettage. I didn’t know I was pregnant…. They didn’t provide care right away. It lasted a while. And they did it without anesthesia, because they thought it was [a] provoked [abortion]…. It was very painful.”[102]

Bianca, a 30-year-old mother of three, found out she was pregnant after missing a dose of her daily contraceptive pill. Three weeks into the pregnancy, she had a sonogram, and her health provider told her that she had a high risk of miscarriage. Two months into the pregnancy, she miscarried.

I started bleeding, and I went to the doctor.… They didn’t give me a cleaning right away. They tried to protect themselves on suspicion that it was provoked. I was at the hospital for three days…. I was in pain and bleeding. I think they didn’t care for me because they always say when they receive cases like that it’s the woman who provoked it.

After three days, she left and went to a private clinic, where they attended to her immediately.[103]

One young woman said she was questioned and threatened with criminal penalties while under anesthesia. Adelyn, 20, became pregnant for the first time at age 15. She did not know she was pregnant until she miscarried. She went to the hospital bleeding and in pain. “When I was under anesthesia, they asked me how I had the abortion, how I had provoked it. They asked a lot of questions…They told me, ‘Be careful. If you did it on purpose, we can put you in jail.’” Adelyn believed the doctors had no choice but to interrogate her. “They have to ask because that [abortion] is a crime,” she said simply.[104]

Human Rights Watch also documented cases of women and girls who were mistreated when seeking post-abortion care. Four years ago, Camila, 24, accompanied a 20-year-old friend who had a clandestine abortion in the second trimester of pregnancy. The woman took pills and drank a beverage (“botella”) to try to terminate the pregnancy: “She’d done it at home, and she got to my house saying, ‘I feel terrible.’” Camila helped her friend into bed and saw that she was bleeding heavily. “My bed was completely soaked with liquid. We had to go to the emergency room.” Camila said her friend was treated poorly by the medical personnel when she got to the hospital. “The lady doing the cleaning [removal of tissue] told her she was an abuser who killed her son [by inducing the abortion], and said, ‘They should kill you too.’ She yelled at her and treated her harshly, without anesthesia. The treatment shouldn’t be like that. Everyone has to make their decision.”[105]

Madelyn, 28, said she had a friend who suffered severe complications after being turned away from a maternity hospital when she sought post-abortion care.

She started bleeding and went to the hospital in a lot of pain. They told her to go back home. They told her, “We don’t have beds. When you start bleeding more, come back.” They sent her away. She couldn’t stand the pain, and at midnight she was in a lot of pain and started bleeding nonstop, it didn’t stop. She wouldn’t stop bleeding. She called a taxi and had to take a cloth between her legs [to absorb the blood]. When she arrived at the hospital, she wouldn’t stop bleeding. She was hemorrhaging, and she was dizzy. They [the hospital staff] were running all over the place because they knew they could lose her…. They were scared because she had been there earlier and hadn’t received care.

Her friend had to stay overnight in the hospital to recover from the blood loss.[106]

Aury recounted the experience of a close friend who had an abortion three years earlier at age 19, after she became pregnant from rape. She had a clandestine abortion and sought medical treatment when she experienced complications. Aury said the medical professional she saw mistreated her and threatened to report her to the authorities for having an abortion: “They left her in pain, bleeding, they didn’t pay attention to her. The one who did the cleaning was rough with her.” Aury said her friend was kept at the hospital for three days, essentially so that she could be detained while the health providers decided whether to report her to police. In the end, they let her leave. Aury said the trauma of the rape and clandestine abortion were compounded by her treatment at the medical facility: “She was depressed because she was raped. And everything was mixed together in her head. She wanted to kill herself. They treated her like a dog. Worse than a dog.”[107]

Mayerlin, 38, told Human Rights Watch that she was neglected and mistreated at a hospital when she experienced irregular bleeding that was not related to her period or a pregnancy.

I wasn’t pregnant, but I was bleeding. I went to the hospital, and … they assumed I took something to start the period…. I said, “I’m in pain, and I’m bleeding,” and they asked if I was pregnant and got an abortion, and I said, “No.” I was waiting and waiting, and they were leaving me there…. They left me waiting until the next day.

Mayerlin eventually gave up and went home, still in pain and bleeding, but hours later, she returned to the emergency department. “The pain was unbearable,” she said. When she was finally examined, the doctor determined that she had torn a cyst. “For them, I’d had an abortion, and I had to accept the consequences.” By the time she received care, she had lost so much blood that her life was in danger. “I almost lost my life because of medical negligence,” she said.[108]

Elizabeth Velez with Catholics for Choice, a reproductive rights advocacy group, explained how the criminalization of abortion fuels abuse by health providers: “Health personnel know they can question, mistreat, and judge patients [with post-abortion complications], especially adolescents.”[109]

Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, acknowledged the discrepancy between official protocols and practices in the health system: “There are important gaps in implementation [of the protocol],” he said, adding that some providers may not provide adequate counseling, or may use methods that are outdated and pose greater risks to patients (for example, curettage instead of aspiration to remove tissue from the uterus).[110]

Reluctance to Seek Medical Care

In countries where abortion is treated as a crime, women and girls may delay seeking post-abortion care for fear of being reported to authorities. They may also delay or go without care due to the reasonable fear of judgmental or abusive behavior by medical professionals.[111]  

Delaying treatment following a miscarriage or an abortion can significantly increase the risk of serious and life-threatening complications.[112] In a 2018 report, the Guttmacher Institute summarized the consequences of delaying treatment for post-abortion complications:

Delays in seeking treatment can have life-threatening consequences, given that the sever­ity of complications and the related risk of death rise the longer a woman goes without care. And should a woman suffer discriminatory treatment, sometimes in the form of excessive wait times, her prognosis can worsen further.[113]

Some women and girls told Human Rights Watch that fear of prosecution, as well as fear of obstetric violence, led them to delay or refrain from seeking care following clandestine abortions or miscarriages. For example, Carolina, 30, told Human Rights Watch that she had a clandestine abortion two years earlier using pills she bought at a pharmacy. “I felt weak, like I was going to fall. I had a bad taste in my throat. I fell asleep for a while, then the pain woke me up. It was like menstrual cramps at the beginning. I was bleeding a little bit. After a couple of hours, the pain got stronger.” She said the next day she experienced “very strong” pain, but she remained at home, and took more pills, rather than seeking help from a medical professional, because she feared abuse. “I’ve seen and heard about mistreatment when women go to the hospital with an abortion.”

Nine years ago, Carolina was in a hospital delivering one of her children, when she said she overheard an interaction between a doctor and another patient—a young woman who arrived at the hospital in great pain and said she had miscarried. Carolina said the provider accused the young woman of inducing an abortion: “The doctor told her, ‘That blood color doesn’t look like you fell this morning.’… They neglected her and left her in pain. She was screaming.” A few years later, Carolina accompanied a friend to the hospital who had serious complications from an unsafe abortion. “I was with her. I thought she was going to die…. I went with her to the hospital. They didn’t want to give her attention because she had problems from an induced abortion.” Carolina said her friend was not given any kind of anesthesia: “She told me she felt everything they were doing to her body.” Having witnessed these two experiences, Carolina was unwilling to seek medical care when she had a clandestine abortion. “I thought of going to the doctor, but I didn’t want to, because of the mistreatment.”[114]

Yamaira, 39, told Human Rights Watch she had an unwanted pregnancy 17 years earlier, when she was a young woman. She already had two children: “I was depressed, really worried about providing for three kids. I got desperate. A friend gave me pills—Cytotec—and a horrible tea.… I bled but I didn’t want to go to the doctor because I was afraid. I was afraid I’d go to jail because they noticed when you did an abortion.” She continued bleeding, but she did not seek medical attention. She remained pregnant.[115]

The fear of mistreatment by medical professionals following induced abortion is so pervasive that it deters some women and girls from seeking care when they are carrying one of the estimated 10 to 20 percent of known pregnancies that results in miscarriage.[116]

Aury, a 24-year-old mother of two, told Human Rights Watch she had two miscarriages in the span of three months when she was around 20. She experienced tremendous pain and heavy bleeding in the second miscarriage, but she refused to seek medical care in the public health system:

I was in so much pain, bleeding, depressed…. I was in pain for three days. My mom was with me. I was bleeding a lot, and I was really afraid. I thought I was going to die. But I know in the public hospital they do the abortion [post-abortion care] without anesthesia. My mom wanted to take me there, but I said no.

Instead she drank tea and tried to endure the pain at home. Eventually, Aury’s mother convinced her to go to a private clinic where she received medical attention.[117]

Failed Abortions

Several women and girls interviewed for this report tried to terminate unwanted pregnancies, but the methods they used did not work. A few reported experiencing post-partum depression after failed abortions, and all lived with the consequences of having a child against their wishes.[118]

Rebeca, 26, gave birth to her first child at age 17. When the baby was 18 months old, she learned she was pregnant again. “I felt depressed because I was not prepared for the pregnancy,” she said. One month into the pregnancy, she tried to end it: “I tried to abort, but all the methods I tried failed. I prepared a tea. I bought pills. I sent the man who got me pregnant to get pills at the pharmacy. The more I tried, the more it failed.” She never sought medical advice on terminating her pregnancy, because she knew it was illegal. “I was afraid,” she said. “That’s why I didn’t want to confide in anyone, so they would not denounce me [to the authorities].”[119]

Larissa, 22, told Human Rights Watch she married at age 12, and by age 18, she already had two children and was pregnant for a third time.[120] “I didn’t want to have it,” she said. She attempted to end the pregnancy: “I took pills, and teas, and I bled various times, but it didn’t work.” She had very little information and thought that taking the placebo pills from her oral contraceptive pack—the pills that women and girls take while they are menstruating—would induce abortion. “I didn’t have any support. A friend of mine knew, but she didn’t agree with what I was doing. I’d heard people saying things about mango tea and such…. I was afraid. I thought something would happen to me, attempting the abortion. Sometimes things get complicated.”[121]

Mayerlin, 38, told Human Rights Watch that she attempted to terminate an unwanted pregnancy at age 20. “I tried various methods: teas, pills. I would beat my belly with concrete blocks. I spent long periods of time without eating or drinking water to make myself weak. They said Cytotec [misoprostol] was the best. I got it, and drank some, inserted others into my vagina.” She found a doctor who could perform an abortion, but she could not afford to pay him. “He was asking for RD$20,000 [approximately US$400]…. If I’d had the facility to go to a clinic, I would have gotten it [an abortion].” She remained pregnant, against her wishes.[122]

Aury, 24, said she became pregnant for the first time at age 17. She was in high school and using injections to prevent pregnancy. She took pills and tea to try to induce abortion, but they did not work. “I wanted to stay in school. I was only three months away from finishing high school.” Aury said the director of her school told her to stop attending when her pregnancy became obvious. “You couldn’t be pregnant in school, the director told me.” She negotiated to be allowed to attend classes once a week and managed to finish high school, but the experience took a toll on her emotional health. “I got depressed with the belly [pregnancy]. I had high blood pressure. It was the most tormenting thing I’ve lived in my life.” After giving birth, she had an intrauterine device (IUD) inserted but became pregnant again when the IUD migrated, rendering it ineffective. Again, she drank tea to try to induce abortion, but it didn’t work. She gave birth again. “I was 18 with two kids. It was difficult. I had the help of my husband, but you feel like the world is crumbling around you, especially when you have goal you want to reach, and dreams you want to achieve. I was too young.”[123]

Ana Paula, 16, had given birth one month before she spoke with Human Rights Watch in April 2018. She said she had tried to terminate the pregnancy:

I prepared a lot of remedies, beverages. But nothing happened. Every day, I took German malt. I would drink one every day.… I prepared it with other things, baking soda. I’d heat it.… I had an expulsion [of tissue from the uterus] after a few days, and I thought it was gone, but then I felt something moving. I went for a second sonogram, and I found out it was girl.

As soon as she left, she started crying. “All I could think about was the situation I was going through,” she said, explaining that her partner, age 29, did not have a job or a home for them.[124]

Noelia, a 33-year-old mother of four, told Human Rights Watch that when she became pregnant for the fourth time, her husband’s family accused her of infidelity, and she decided to end the pregnancy. “I took pills, those that pregnant women are not allowed to take. I got them at the corner store. It didn’t do anything to me…. I had to keep going with the pregnancy,” she said.[125]

The consequences of having a child against your will are lifelong. Yamaira, 39, tried to terminate an unwanted pregnancy 17 years ago, as a young mother with two children. She drank tea and took pills, but she was unable to terminate the pregnancy. It affected her life profoundly to have a third child: “I went through a lot of difficulty getting money. I’d even go hungry…. My health was affected. I got post-partum depression. I never recovered from it. I cried a lot. The doctor told me to be calm,… but I couldn’t calm down.”[126] She told Human Rights Watch that since giving birth to her third child, she has continually struggled with depression.

Deaths from Unsafe Abortion

Complications from unsafe abortion can be life-threatening. Globally, unsafe abortion accounts for 8 to 11 percent of maternal deaths each year.[127] In the Dominican Republic, at least eight percent of maternal deaths are attributed to complications from miscarriage or abortion.[128] Deaths from unsafe abortion can be prevented through safe and legal access to abortion. “The law [criminalizing abortion] reinforces unsafe abortion and maternal death,” said one doctor interviewed for this report. “It’s an issue related to death or survival.”[129]

In a 2018 study, the Center for Gender Studies (Centro de Estudios de Género, CEG-INTEC), with support from the Ministry of Public Health and the United Nations Population Fund (UNFPA), analyzed six maternal deaths that occurred in a hospital in the Dominican Republic between 2013 and 2014.[130] Two of the women died from sepsis. In one case, the woman died after arriving at a hospital in septic shock following a clandestine abortion with uterine perforation.[131] In the other case, it was unclear whether the woman induced an abortion or had a miscarriage.[132]

In a 2017 report, Women’s Link Worldwide documented seven maternal deaths in the Dominican Republic.[133] Two of the women died from serious infection linked to incomplete abortion. In one case, a 24-year-old woman died in 2015 from a serious infection following a clandestine abortion. Before her death, the infection caused gangrene in her extremities and she had to have both legs amputated.[134] In the other case, a woman did not know she was pregnant, and after drinking tea to regulate her menstrual cycle, she experienced bleeding and sought attention at a hospital, where she was treated for an incomplete abortion. She died of sepsis several weeks later.[135]

Some of the women and girls, as well as providers and advocates, interviewed for this report described deaths from unsafe abortion. One obstetrician-gynecologist at a public hospital said, “We had a patient referred to the hospital two years ago, where she had practiced an unsafe abortion, and because of that she had sepsis. She was in septic shock. She died. She was 19…. Since it’s illegal, the family would not say who or where it was done. It’s awful.”[136]

Catalina, a licensed nurse, told Human Rights Watch about a case she witnessed at a maternity hospital in Santo Domingo five years earlier. She said a woman arrived at the hospital with heavy bleeding after taking misoprostol to induce an abortion, and the medical providers at the hospital delayed treating her.

They use it as a type of punishment for abortion, and they don’t provide immediate attention.... She lost so much blood, and they couldn’t find a vein [to give her a blood transfusion]. She was awake, and saying, “Don’t let me die. Give me water.” She lost a lot of liquid, and she was thirsty. But they couldn’t find a vein, and it was too late.

By the time Catalina arrived, the medical providers were trying to save the woman’s life, but she had lost too much blood, and she died.[137]

Melina, 26, lost a friend in 2017. “She inserted Cytotec [misoprostol], and thought she expelled everything [from her uterus], but by the time she got to the hospital, there was no time because the residues had already damaged her internal organs. It caused her death.”[138] Raquel, 38, said a 19-year-old woman in her neighborhood died four years earlier due to hemorrhaging after she had an unsafe abortion.[139]

Dominican authorities have pledged to eliminate preventable maternal death and have set a goal of reducing the maternal mortality ratio to 70 per 100,000 live births.[140] Research has shown that expanding legal access to abortion can lead to significant reductions in maternal mortality.[141] Authorities in the Dominican Republic should decriminalize abortion without delay to prevent additional deaths from unsafe abortion.

Lack of Access to Legal Abortion Even in Cases of Rape, Incest, and Serious Health Risks

Rape and Incest

The Dominican Republic’s total ban on abortion has particularly harsh consequences for the significant number of women and girls who are survivors of domestic and sexual violence. According to the government’s 2013 demographic and health survey (ENDESA-2013), 35 percent of women and girls ages 15 to 49 who were ever married or in a union said they experienced some form of domestic violence, including physical, emotional, or sexual violence by an intimate partner.[142] One in ten women and girls in the Dominican Republic reported surviving sexual violence in her lifetime.[143] Of women who reported sexual violence, 61 percent said their partner or ex-partner was the perpetrator.[144] More than 60 percent of women and girls who said they experienced physical or sexual violence never sought help, and more than half of those who never sought help said they never told anyone about the abuse.[145] When women can engage with the health system without fear of prosecution or abuse, providers can more effectively screen for violence and connect their patients to services.

According to a 2013 WHO report on gender-based violence globally, women who have been physically or sexually abused by their partners are more likely to seek an abortion than women who have not experienced partner violence.[146] In its analysis, the WHO emphasizes the importance of healthcare providers “identify[ing] opportunities to provide support and link women with other services they need.”[147] Although the Dominican Republic is taking steps to address gender-based violence,[148] the total criminalization of abortion, including for pregnancies from rape and incest, undermines these efforts by removing possible pathways for survivors to report abuse and access support.

Human Rights Watch documented several cases of women and girls who became pregnant as a result of rape or incest and did not have the option to safely and legally terminate their pregnancies. In some cases, women and girls found ways to clandestinely end these pregnancies, but secrecy around abortion due to the country’s total ban kept them isolated from supportive and professional services, leaving them without a channel for reporting abuse. In other cases, survivors of violence were forced to continue pregnancies resulting from rape and incest.

International experts have advised that denial of safe abortion for survivors of rape and incest may amount to torture or cruel, inhuman, or degrading treatment.[149] The Committee against Torture, which monitors states’ compliance with the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) has noted that the prohibition of abortion in cases of rape means that “women concerned are constantly reminded of the violation committed against them, which causes serious traumatic stress and carries a risk of long-lasting psychological problems.”[150]

Several service providers interviewed for this report described cases of pregnancy from rape and incest they encountered through their work. When Human Rights Watch spoke with Antonella, a health educator in Santiago de los Caballeros, she had recently counseled a pregnant 11-year-old girl who had been raped by her stepfather. The girl came to a clinic with her mother, and she was 15 weeks pregnant. “She had pelvic pain,” Antonella said. “She didn’t even want to get shots. She’s just a little girl. She doesn’t know what’s going on in her life or in her body.” Antonella said that because abortion is illegal, she had no options except to refer the girl for prenatal care. “We’re going to refer her to the children’s hospital for nutritional advice.” She explained that the pregnancy was risky because the girl’s body was not yet developed. The case affected Antonella deeply, even after years of work with vulnerable and marginalized women and girls. “It got me so worried. I told my boss I don’t want to do work [with survivors of violence] anymore.”[151]

A lawyer with a nongovernmental organization in Monte Plata province who assists survivors of violence said she had worked on 39 child rape cases in the last year. She knew of four girls who became pregnant from rape or incest, between the ages of 12 and 16. Two had clandestine abortions. The lawyer said one, a 14-year-old rape survivor, suffered complications including fever and heavy bleeding. “She hemorrhaged,” she said. The other two girls continued the pregnancies and faced difficulties that pushed them out of school. “One of them got ostracized at school, by society. She dropped her regular life…. They isolate themselves. We’re trying to get them to reintegrate into the communities.”[152]

A doctor interviewed by Human Rights Watch said that she treated a 14-year-old rape survivor who was four months pregnant. She suspected the girl’s father was abusing her, but because of the ban on abortion, she felt that she could not give the girl the type of care she needed: “I could not take her to a hospital,” she explained. She told the patient and her father how to use medication to induce an abortion, but she could not refer the girl for other services.[153]

Regina, a psychologist in Santiago de los Caballeros, told Human Rights Watch that she had 10 women and girls under her care who were pregnant from rape—most of them girls under 18. She said she worked with survivors of violence to help them accept these pregnancies. “They cry every time they bring up the topic.” She described one case:

I have a mother [as a client in my practice] who has a son with her own father. She was 15 when he abused her [for the first time]. She was quiet for a long time because he threatened her. But when she became pregnant, she left home and moved in with an aunt. She was 16 when she got pregnant.[154]

Mary, an outreach worker in rural communities in Monte Plata province, told Human Rights Watch about a case she followed of a 14-year-old girl with a mental disability who became pregnant following a rape two years earlier. Mary suspected incest and believed the girl’s father had raped her, although the father had accused another man of being the rapist. When asked if the family had considered abortion, Mary said the family was very poor: “They live on the streets. She got pregnant like that. You know there’s no doctor [to help her]. We don’t have that law here [to permit abortion after rape].”[155]

Susi Pola, founder of the nongovernmental organization Núcleo de Apoyo a la Mujer (NAM), told Human Rights Watch that she recently spoke with a woman whose husband raped her. After suffering serious domestic violence, she obtained a restraining order against him. He violated the order, raped her, and she became pregnant again—she had already had three children in four years with him. She ended the pregnancy clandestinely by taking pills.[156] The woman’s story was one of five cases documented in a September 2018 report published by the Coalition for the Rights and Life of Women (Coalición por los Derechos y la Vida de las Mujeres). The report described the experiences of five women and girls who had clandestine abortions either because the pregnancy threatened their lives, they were pregnant from rape or incest, or they learned the fetus would not survive outside of the womb.[157]

Several women interviewed for this report recounted personal experiences with pregnancies from rape or incest. Dayelin, 22, had a clandestine abortion when she became pregnant after she was raped at age 12 by a 25-year-old man. “It was the first time I had intercourse. I didn’t want to have sex. I didn’t agree.” When she learned she was pregnant, she was deeply distraught: “I was crying and desperate. I didn’t want to have it. I was a girl. What would I do with a baby? A friend gave me a tea, and I had an abortion. I didn’t go to the doctor. I stayed at home. I was afraid to go to jail.” She said she experienced a lot of pain, but her friend warned her not to seek medical attention: “My friend told me to stay at home and endure to the pain. Going to the hospital would mean going to jail.” She had very little support and told only one friend about the experience. She became deeply depressed afterward, “I thought about killing myself. I drank Clorox [bleach].”[158]

Yesenia, 37, told Human Rights Watch that at age 20 she was in a relationship with an abusive partner. He raped her repeatedly, and she became pregnant. At first, she was reluctant to end the pregnancy, as she knew it was treated as a crime. “At that time, they were starting to promote the idea that if you had an abortion, you could go to jail,” she said. After delaying until the second trimester, she decided to try to terminate the pregnancy using home remedies, including a tea and a malt beverage. She suffered such serious complications that she had to stay in the hospital for a month. “There was so much blood,” she said. “I couldn’t tell them I had taken anything. I said it was a miscarriage, not an abortion.”[159]

Carmen, 33, was raped by her father starting at age 9. At 15, she became pregnant. Her father realized she was pregnant before she did. “He was counting my period. He knew the date it started and the date it ended…. I felt bad and tricked. He said he was going to say I got pregnant by one of his workers.” She said her father gave her pills to induce abortion, and he lied to her mother about the pregnancy: “My mom was home [when I had the abortion]. He told her his lie—that I slept with one of the workers, and the worker left.” She said, “[I experienced] a lot of pain. They took me to a small clinic in a nearby neighborhood. There they did the cleaning [to remove tissue from the uterus] under anesthesia.” Her father continued raping her afterward, until she got married and left home at age 19. She explained how difficult it was for her to seek help: “The fear. The fear is really difficult. When you’re afraid of someone, it’s very difficult for you to speak.”[160]

A few women interviewed by Human Rights Watch recounted stories of family members or friends who became pregnant from rape or incest and lacked access to safe and legal abortion. Karen, 18, told Human Rights Watch that her sister was raped by an uncle at age 13 and became pregnant. The family tried unsuccessfully to obtain a safe abortion for her. “She didn’t want to have [the baby], but she couldn’t interrupt the pregnancy because it’s illegal…. My aunt took her to the hospital to try to get an abortion, but they said it’s not legal, so it’s not possible.” Karen’s sister gave birth and the child is now 6 years old.[161]

“I know a girl who was raped and got pregnant by her stepfather,” said Madelyn, a 28-year-old woman interviewed for this report. “She was 11 when she was raped. Now she’s 14…. She continued the pregnancy, but she didn’t want that. She would jump down stairs trying to lose it because she didn’t want it.”[162]

Serious Health Risks

Abortion is criminalized in the Dominican Republic, even when a pregnancy threatens the woman’s life or health. Medical providers said that criminal penalties for abortion made it difficult for them to exercise their best judgment and provide the best standard of care when their pregnant patients faced serious health risks. Human Rights Watch asked one provider whether he could use his discretion to end pregnancy in such a circumstance: “In our country, the law doesn’t allow it.” He explained, “Sometimes you have your hands tied. You don’t know what to do. You have the law telling you that you can’t do it [perform an abortion], that pregnancy has to be preserved from conception to delivery…. But it doesn’t work like that. The pregnancy can put a woman’s life at risk.” This doctor admitted that he prioritized his duties as a doctor over the law when his patients were in imminent danger: “My job is to preserve the woman’s life. If I have to violate the law, I will.”[163]

Human Rights Watch documented several cases in which pregnant women and girls faced serious risks to their health or lives because the law did not permit them to access safe abortion. Madelyn, 28, told Human Rights Watch she was seriously injured in a car accident several years ago. As she was receiving emergency medical care, providers discovered that her intestines were perforated, and she had internal bleeding and needed emergency surgery. They also discovered that she was one month pregnant. She underwent surgery, and afterward, the doctor informed Madelyn’s mother that the pregnancy could cause serious problems:

He told my mom the pregnancy could interfere with the surgery. That my belly [growing with pregnancy] could open the surgery [surgical wound] because it was recent. My mom asked, “What can we do?” The doctor said, “I cannot do anything.” But he was very clear that my life was in danger. He said, “There’s nothing I can do because abortion is penalized.”

Madelyn said her mother was deeply distraught and pleaded with the doctor to help them end the pregnancy and protect her daughter’s life. Eventually, doctors discovered that the fetus no longer had a heartbeat, and gave her medicine to remove tissue from the uterus. Looking back, Madelyn questioned the government’s ban on abortion: “If my life is mine, I decide for my life. No one else.”[164]

When Human Rights Watch spoke with Sara, a 22-year-old single mother with two young children, she was two months pregnant. The pregnancy was not planned, and she said she feared for her health, because in her previous pregnancies, she had very high blood pressure and delivered prematurely. She said there was a man in her community who could help her get medication to induce abortion: “He does it privately. He doesn’t want anyone to know.” However, she knew it was a risk because abortion is illegal in the country: “You cannot do that here. If they find out, they can put you in jail.”[165]

Preeclampsia is the leading cause of maternal death in the Dominican Republic.[166] One doctor interviewed for this report explained, “If you interrupt the pregnancy, the blood pressure goes down immediately.”[167] Another doctor further explained how high blood pressure during pregnancy can be life-threatening: “The blood pressure goes up, and it affects the whole system. It can cause convulsions, it can cause the kidneys to shut down, platelets get low, bleeding. The only thing that cures it is delivery.”[168]

Camila, 24, became pregnant for the first time at age 22. The pregnancy was unplanned, and the delivery was complicated because she has a condition that can cause heavy bleeding.

In my family, women suffer myomas [benign tumors], and they have hemorrhages when pregnant. It’s difficult for women in my family to get pregnant. My mom has the same condition.… When my son was born, I had complications, and he did too. I have chronic anemia. I had to have a c-section, and I needed blood.

After she gave birth, the doctor advised her not to get pregnant again, given the risks to her health. When she realized she was pregnant for the second time a year after giving birth, she decided to have an abortion. She paid RD$10,500 [more than US$200] to go to a safe clinic, where a provider counseled her on how to have a medical abortion.

Some treatments for serious and potentially life-threatening illnesses can increase the risk of complications during pregnancy.[169] One doctor interviewed for this report described a case in which a pregnant patient was diagnosed with a serious health condition and wanted to end her pregnancy before beginning treatment for the condition. Because legal abortion was not an option, the provider risked criminal penalties to help the woman clandestinely terminate her pregnancy.[170]

Susi Pola, an advocate with the organization Núcleo de Apoyo a la Mujer (NAM), told Human Rights Watch about a case she was aware of where a 15-year-old girl had recently terminated a pregnancy clandestinely. She had three children already, and her doctor informed her that another pregnancy at such a young age would be dangerous to her health. She terminated the pregnancy by taking pills and a beverage.[171] The girl’s story was published in a recent report by the Coalition for the Rights and Life of Women.[172]

The death of 16-year-old Rosaura Almonte Hernández in 2012 illustrates the impact of the Dominican Republic’s criminal laws that block access to therapeutic abortion. Rosaura, known as “Esperancita,” was diagnosed with leukemia, but she was initially denied access to chemotherapy because she was seven weeks pregnant. Her mother requested access to therapeutic abortion, and her request was denied. Weeks later, under mounting international pressure, doctors provided Esperancita with chemotherapy, but she died in August 2012. In 2017, her mother, Rosa Hernández, with support from the organizations, Women’s Link Worldwide and Colectiva Mujer y Salud, filed a petition with the Inter-American Commission on Human Rights (IACHR) seeking justice for her daughter’s death.[173]

Under the criminal code in the Dominican Republic, women and girls are also denied access to abortion for unviable pregnancies, when the fetus has complications incompatible with life outside the womb. Human Rights Watch did not interview any women or girls who had unviable pregnancies, but a doctor said he had recently treated a patient who was 21 weeks pregnant when she learned that the fetus had anencephaly, a fatal congenital brain disorder. He was unable to offer her access to an abortion:

The only thing I explained is that she has the right [to decide to terminate the pregnancy], but we cannot do it. Legally, there is no way…. I believe it should be a legal option, and each woman should decide for herself what she should do. Because right now, we are violating their rights. We’re telling them, “You can’t do this with your body.”[174]

Stigma, Isolation, and Emotional Distress

Legal restrictions on abortion leave women and girls unable to speak openly about options when they experience unplanned or unwanted pregnancies. Many women and girls interviewed for this report described feelings of isolation and emotional distress when they learned they were pregnant, or when they decided to terminate pregnancies clandestinely. In some cases, those feelings were compounded by treatment by health providers.

Xiomara, 26, had an unplanned and unwanted pregnancy at age 20. Before learning she was pregnant, she had planned to take a job in Europe. “Here in this country, the economic situation is not good at all, so taking a job in Europe, and leaving [the country] was the best option I had.” She had also recently separated from her partner. “When I realized I was pregnant, I felt that my whole future disappeared, vanished,” she said. She was deeply depressed during the first trimester. “My body was rejecting the pregnancy. I started bleeding…. I wouldn’t sleep. I’d cry every day.” She tried to end the pregnancy by neglecting herself. “The doctor told me to stay in bed and raise my feet. I did the opposite.” She also said she took prescription medications that she believed could cause complications in pregnancy. “I took psychiatric medication I had previously used for anxiety. I took sleeping pills. I kept taking them, even though [I knew] they could harm the baby.” She said she never spoke to anyone about her desire to end the pregnancy. “I was ashamed to tell my doctor or my friends…. I felt trapped, with no future.” She remained pregnant, and after giving birth, she continued to struggle with depression for the first six months of the baby’s life.[175]

When Human Rights Watch asked what kind of support she needed when she learned she was pregnant, she said medical providers should offer support and counseling when they inform patients that they are pregnant:

The diagnosis of a pregnancy shouldn’t always be, “Congratulations.” It should be, “Okay, you’re pregnant. This is what happens next.”… [Some women] get overwhelmed when they learn they are pregnant … because they are scared. They should have someone there to tell you that everything you’re feeling now, a lot of women feel. It’s not an obligation to feel happy. When I realized I was pregnant, and the doctor told me, he made a party of it. I looked at him thinking, “Who told you I want to have a son?”[176]

Nicole, a 28-year-old woman who had an unwanted pregnancy, had a similar experience when she had a sonogram at six weeks gestation.

The doctor started pointing at the screen, saying, “Look, it’s a little baby!” and I was shocked…. The doctor is there to give you information in a neutral, professional manner, to provide a service. He should say, “You have this many weeks of pregnancy.” Instead, he says things that are not neutral, and plants ideas in people’s minds.[177]

Lucely, 18, had an unwanted pregnancy at age 16, and said she felt extremely isolated and alone: “The father of the girl [my daughter] had a lot of problems at that time. He didn’t have a job. They did a sonogram, and I realized [I was pregnant]. I wanted to die. Oh my god. I thought about having a child with no house, with no one. I felt alone in that moment…. I was almost in shock.” Lucely wanted to end the pregnancy, but she was already in the second trimester. “I drank tea, a really weird tea,” but she remained pregnant. “Everything ended right there,” she said, describing how the pregnancy changed her life. “I never went back.… I suffered a lot. My mom was far away. I was here alone. My father spoke bad to me. He’d insult me. He didn’t help me. I feel bad to even think about it. It’s like when you feel like no one loves you.”[178]

Maoli, 20, told Human Rights Watch she got pregnant unexpectedly at age 16 and had a clandestine abortion. As an adolescent girl, she said she felt very afraid, and told only her boyfriend and an older friend about the pregnancy. “I told her [my friend] what was going on, and she told me about a tea used for that [abortion], and I took it…. The next day I started bleeding, and I was in a lot of pain,” she said, rubbing her belly. Her friend eventually took her to a medical provider who attended to her, and the pregnancy ended. Four years later, as she recounted the experience to Human Rights Watch, she said it was still difficult to talk about the experience and the fear she felt: “I don’t like to remember it. I haven’t found another person to confide in about it…. I was afraid. Fearful that they [the doctor] would notice, realize [that I had an abortion]. That people would know. I was worried that they’d tell my parents.”[179]

Fabiana, a 26-year-old woman who helped a friend terminate an unwanted pregnancy, described how some women experience stigma around abortion:

Women don’t perceive abortion as something illegal. They don’t internalize the legal aspect of it. What they internalize is the idea that they could go to hell for it. What affects them most is the religious and moral aspect of it. That you’re a bad woman, a bad mother who killed your baby, that God would not allow you in heaven. That is really internalized and that causes a lot of pain and suffering.[180]

Mayerlin, 38, attempted to terminate an unwanted pregnancy at age 20. She tried various clandestine and unsafe methods, but she remained pregnant. She told Human Rights Watch that she felt that she could not speak to anyone about her desire to end the pregnancy. “I was afraid and ashamed…. As a mother, if I had had an abortion, society would have condemned and judged me.”[181]

Eridania, 28, had an unplanned pregnancy as a young woman. When she became pregnant, her partner disclosed that he was already married to another woman, and he abandoned her. “My parents also turned their backs on me,” she said, explaining how her family reacted when they learned she was pregnant as an unmarried woman. She said, “[I felt] very depressed in every sense, knowing that everyone had turned their backs on me. I couldn’t count on anyone. I had no economic security. No job.” She considered ending the pregnancy, but a psychologist at a public health facility dissuaded her from making that choice: “She talked to me about abortion, the harms, that it’s a murder because the first day of pregnancy is a life. That you cannot interrupt it because it’s part of you.”[182]

Vulnerability to Undue Pressure, Abuse, and Coercion

When abortion is legal and accessible, women and girls facing unplanned pregnancies can freely seek confidential, factual, and unbiased information from qualified professionals about a full range of options. Pre-abortion counseling can reveal whether women or girls are facing undue pressure, or coercion, from partners, parents, or other sources, around their decisions.[183] Because abortion is illegal in the Dominican Republic, pregnant patients are not provided with information about a full range of reproductive health options, including abortion. In the absence of a standard of care that includes information about safe and legal abortion, women and girls may be more susceptible to undue pressure fr0m partners or others who want to control their reproductive health.

Human Rights Watch interviewed some women and girls who said they were pressured, abused, or misled by others, often their partners, to terminate unplanned pregnancies they wanted to continue. In extreme cases, as two cases in recent media reports show, women and girls may face abuse or coercion to have abortions against their wishes. While women and girls may face coercion or abuse around pregnancy decisions even in settings where abortion is legal and accessible, criminalization forces discussions of abortion to happen clandestinely, and often informally, denying women standardized, reliable, and confidential reproductive health counseling to make pregnancy decisions without undue influence from anyone else.

A young woman interviewed by Human Rights Watch said a neighbor gave her a substance to induce an abortion without informing her, even though she did not want to terminate her pregnancy. Maria Fernanda told Human Rights Watch that her father began raping her when she was 11 or 12. At 13, she became pregnant as a result. She was already entering the third trimester when she found out. “I didn’t know what was going on. I had a fever. I was sick. The doctor gave me a [pregnancy] test, and it was positive.” She said she never wanted to end the pregnancy, but other people urged her and tried to coerce her to do so. “There were people who wanted to give me things without me knowing. I didn’t understand. I was a girl.… I drank a very sour tea, but thank god, it didn’t harm me or the pregnancy. A neighbor prepared it. They said it was for the pain. I was too innocent [to understand what was happening].” Though the pregnancy was difficult, she was happy with her decision: “I felt sad and depressed for what had happened, but I endured the pregnancy, and at nine months, I had my boy.”[184]

Alicia, 17, said her partner hurt her to try to induce a miscarriage when he learned she was pregnant. She said that at age 14 she believed she was pregnant, though she was in the early stages of a pregnancy and had not confirmed with a test. When her partner found out, he hit her in the abdomen to try to induce a miscarriage: “My friend told him I was pregnant. And when he learned, he beat me really hard on the belly. When I went to the bathroom after he beat me, some liquid came out, with blood in it.”[185] She miscarried.

Paola, 31, was 22 years old when she said she was pressured to have an abortion against her wishes by her partner, who impregnated her, and who she later learned had another partner. “I did a blood test at the hospital, and I was three months along. I felt excited. I was going to have it [continue the pregnancy], but then that person [who got me pregnant] didn’t want it, so he bought pills for me—Cytotec. I took the pills and I lost the pregnancy.” She described how she took the pills at home, alone, and went to the hospital the next day for medical attention: “I got dizzy, and I started bleeding. I had high blood pressure. My blood pressure went up a lot. They did the cleaning [of the uterus].” She found it hard to talk about and said at the time she felt unable to speak to anyone else about her options: “Had I had his support, if he told me to have the baby, and he’d provide for us—even if he kept his other partner—I wouldn’t have done this. I didn’t have any support from my family.”[186] Paola said the interview with Human Rights Watch was the first time she had ever spoken about the experience with anyone other than her former partner.

Two recent cases widely reported by the media in the Dominican Republic also illustrate how the criminalization of abortion can lead to coercion and abuse. In early 2018, a 20-year-old woman in the city of San José de Ocoa was detained on abortion-related charges. She sought medical attention at a hospital for a miscarriage, and her medical provider reported her to authorities for inducing an abortion. The woman said that her partner gave her misoprostol without her knowledge, claiming it was a medication to help with pain she experienced after a fall in the second trimester of her pregnancy.[187]

The brutal murder of 16-year-old Emely Peguero in 2017, who was five months pregnant at the time of her death, also illustrates how women and girls can be subjected to abuse and coercion. The preliminary forensic report on her death detailed signs of unsafe abortion, as well as injuries to the head, that led to hemorrhage. The BBC quoted the forensic report as stating: “Remains of the fetus were found in her womb, contusion of the cervix and vaginal canal, perforation of the uterus with indications that great force was applied in that area and scattered organs of an induced abortion.”[188] Peguero’s father said she did not want to have an abortion. Her partner, Marlon Martínez, pled guilty to her murder, and his mother was arrested on charges of complicity in the murder.[189] In June 2018, Martínez and his mother were instructed to go to trial.

III. The Dominican Republic’s Human Rights Obligations

The criminalization of abortion is incompatible with the Dominican Republic’s international human rights obligations. Authoritative interpretations of international human rights law establish that denying women and girls access to abortion is a form of discrimination and jeopardizes a range of human rights, including the rights to life; health; freedom from cruel, inhuman, and degrading treatment; nondiscrimination and equality; privacy; information; and freedom to decide the number and spacing of children.

The Dominican Republic is obligated to respect, protect, and fulfil the rights guaranteed under the international and regional human rights treaties to which it is a party, including the International Covenant on Civil and Political Rights (ICCPR),[190] the International Covenant on Economic, Social and Cultural Rights (ICESCR),[191] the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT),[192] the Convention on the Elimination of Discrimination Against Women (CEDAW),[193] the Convention on the Rights of the Child (CRC),[194] and the American Convention on Human Rights.[195] Fulfilment of the Dominican Republic’s obligations under these and other relevant treaties includes ensuring that abortion is safe, legal, and accessible.

Right to Life

Denial of access to safe, legal abortion puts the lives of women and girls at risk. International human rights bodies and experts have repeatedly stated that restrictive abortion laws contribute to maternal deaths from unsafe abortion and jeopardize the right to life. For instance, the UN Human Rights Committee (HRC), which monitors states’ compliance with the ICCPR, has noted the relationship between restrictive abortion laws and threats to women’s and girls’ lives. It has frequently expressed concern about criminalization of abortion and has called for expanded access.[196]

In 2017, the HRC called on the Dominican Republic to:

Amend its legislation to guarantee safe, legal and effective access to voluntary termination of pregnancy where the life or health of the pregnant woman or girl is in danger or where carrying the pregnancy to term could cause the pregnant woman or girl substantial harm or suffering, especially in cases where the pregnancy is the result of rape or incest or when it is non-viable.[197]

The UN CEDAW Committee, which monitors state compliance with the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), has repeatedly called for states to “legalize abortion not only in cases in which the life of the pregnant woman is threatened, but also in cases of threats to her health, pregnancies resulting from rape or incest, and cases of severe fetal impairment, and to decriminalize abortion in all cases.”[198]

Similarly, the UN Committee on the Rights of the Child, which monitors the implementation of the CRC, has noted that “the risk of death and disease during the adolescent years is real, including from preventable causes such as … unsafe abortions” and urged states to “decriminalize abortion to ensure that girls have access to safe abortion and post-abortion services, review legislation with a view to guaranteeing the best interests of pregnant adolescents and ensure that their views are always heard and respected in abortion-related decisions.”[199]

Moreover, the UN Committee on Economic, Social and Cultural Rights (CESCR), which monitors compliance with the ICESCR, has called on states to amend restrictive abortion laws and to increase access to legal abortion in order to decrease maternal deaths.[200]

In its 2016 review of the Dominican Republic, CESCR noted with concern “the large number of unsafe abortions that are performed and the high maternal mortality rate,” and urged the government to “[f]ast-track the discussion and adoption by Congress of the bill that would decriminalize abortion in cases where the procedure is necessary (rape, danger to the mother’s life or physical or mental health, fetal non-viability) in order to safeguard women’s fundamental rights.”[201]

Regional human rights experts have also raised concerns about restrictive abortion laws. The Inter-American Commission on Human Rights (IACHR) in a 2018 statement urged states, “to adopt legislation designed to ensure that women can effectively exercise their sexual and reproductive rights, with the understanding that denying the voluntary interruption of pregnancy in certain circumstances constitutes a violation of the fundamental rights of women, girls, and female adolescents.”[202]

In 2017 the IACHR stated:

Denying access by women and girls to legal and safe abortion services or post-abortion care can cause prolonged and excessive physical and psychological suffering to many women, especially in cases involving risks to their health, unviability of the fetus, or pregnancies resulting from incest or rape. Without being able to effectively exercise their sexual and reproductive rights, women cannot realize their right to live free from violence and discrimination.[203]

While most international human rights instruments are silent concerning the starting point for the right to life, the American Convention on Human Rights is the only international human rights instrument that contemplates the right to life from the moment of conception. Under article 4, “[e]very person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception. No one shall be arbitrarily deprived of his life.”[204]

However, this provision is not unqualified and has been interpreted by the bodies that monitor the human rights provisions in the American regional system as not providing an absolute right to life before birth. In 1981, the Inter-American Commission on Human Rights was asked to establish whether or not the right-to-life provisions provided by the American Convention on Human Rights and the American Declaration on the Rights and Duties of Man were compatible with a woman’s right to access safe and legal abortions. The commission concluded that they are. In the case of the Declaration, the commission noted that the conferees in Bogotá in 1948 rejected language that would have extended the right to the unborn and “thus it would appear incorrect to read the Declaration as incorporating the notion that the right of life exists from the moment of conception.”[205]

With regard to the Convention, the commission found that the wording of the right to life in article 4 was very deliberate and that the Convention’s founders intended the “in general” clause to allow for non-restrictive domestic abortion legislation. As the commission phrased it: “It was recognized in the drafting session in San José that this phrase left open the possibility that states parties to a future Convention could include in their domestic legislation ‘the most diverse cases of abortion,’” allowing for legal abortion under this article.[206]

Furthermore, the Inter-American Court of Human Rights, which issues binding decisions on state parties to the American Convention, has concluded that embryos cannot be understood to be a person for the purposes of article 4(1) of the Convention.[207] The Court noted that “it can be concluded from the words ‘in general’ that the protection of the right to life under this provision is not absolute, but rather gradual and incremental according to its development, since it is not an absolute and unconditional obligation, but entails understanding that exceptions to the general rule are admissible.”[208]

Right to Health

The right to health is protected in numerous human rights treaties.[209] International bodies have repeatedly stated that criminalization of or unreasonable restrictions on access to abortion violate the right to health. CESCR has stated that, “States must reform laws that impede the exercise of the right to sexual and reproductive health. Examples include laws criminalizing abortion…”[210] In country-specific concluding observations, CESCR has recommended that states advance women’s health by providing for exceptions to criminalization of abortion and removing barriers to access.[211]

The CEDAW Committee has affirmed states’ obligations to “take appropriate legislative, judicial, administrative, budgetary, economic and other measures to the maximum extent of their available resources to ensure that women realize their rights to health care.”[212] It explained that “barriers to women’s access to appropriate health care include laws that criminalize medical procedures only needed by women and that punish women who undergo those procedures.”[213]

The Committee on the Rights of the Child has warned of the danger of unsafe abortion to adolescent girls’ health. It has often urged states to decriminalize abortion in all circumstances, and to ensure that adolescent girls have access to safe abortions.[214]

In its 2015 review of the Dominican Republic, the Committee expressed concern regarding “[p]regnant girls resorting to unsafe abortions, because abortion is criminalized,” and urged the Dominican Republic to “[e]xpedite the adoption of the proposal to decriminalize abortion and ensure access to safe abortion and post-abortion care services, irrespective of whether abortion is legal or not.”[215]

Right to be Free from Torture and Other Cruel, Inhuman, or Degrading Treatment

Criminalization and inaccessibility of abortion is incompatible with the right to freedom from torture and other cruel, inhuman, or degrading treatment or punishment. The UN Committee against Torture has said that criminalization of abortion with few exceptions may result in women experiencing severe pain and suffering if they are compelled to continue pregnancy. It has expressed concern at the severe physical and mental anguish and distress experienced by women and girls due to abortion restrictions. The Committee has called on governments to “allow for legal exception to the prohibition of abortion in specific circumstances in which the continuation of pregnancy is likely to result in severe pain and suffering, such as when the pregnancy is the result of rape or incest or in cases of fatal fetal impairment.”[216]

Similarly, the Human Rights Committee has ruled in individual cases against Ireland, Peru, and Argentina that the governments violated the right to freedom from torture or other cruel, inhuman or degrading treatment by failing to ensure access to abortion services in these cases.[217] It pointed out that this right relates not only to physical pain, but also to mental suffering.[218]

The CEDAW Committee and the Committee on Economic, Social and Cultural Rights have also said that denial or delay of access to legal abortion may amount to torture or cruel, inhuman, or degrading treatment.[219] The UN special rapporteur on torture has said that “[h]ighly restrictive abortion laws that prohibit abortions even in cases of incest, rape or fetal impairment or to safeguard the life or health of the woman violate women’s right to be free from torture and ill-treatment.”[220]

Furthermore, the Committee of Experts of the Follow-up Mechanism to the Inter-American Convention on the Prevention, Punishment and Eradication of Violence against Women, noted that laws that establish an absolute prohibition of abortion “perpetuate the exercise of violence against women, girls and adolescents … and violate the prohibition of torture and mistreatment.”[221] The committee concluded that states should establish “laws and policies that enable the termination of pregnancy at the very least in the following cases: i) risk to the life or health of the woman; ii) inability of the fetus to survive; and iii) sexual violence, incest and forced insemination.”[222]

Rights to Nondiscrimination and Equality

The rights to nondiscrimination and equality are set forth in all major international human rights treaties,[223] as well as the American Convention on Human Rights.[224] CEDAW prohibits discrimination against women in all spheres, including in the field of health care.

In a 2014 statement, the CEDAW Committee observed that “failure of a State party to provide services and the criminalization of some services that only women require is a violation of women's reproductive rights and constitutes discrimination against them.”[225] In country-specific concluding observations, the CEDAW Committee has often stated that restrictive abortion laws constitute discrimination against women.[226]

Moreover, the Human Rights Committee has held that lack of availability of reproductive health information and services, including abortion, undermines women’s right to nondiscrimination.[227]

Similarly, the Committee on the Rights of the Child has also said that punitive abortion laws constitute a violation of children’s right to freedom from discrimination.[228] The Committee on Economic, Social and Cultural Rights has said, “A wide range of laws, policies, and practices undermine the autonomy and right to equality and non-discrimination in the full enjoyment of the right to sexual and reproductive health, for example, criminalization of abortion or restrictive abortion laws.”[229]

The Inter-American Commission on Human Rights has expressed that limitations on accessing health services that are required only by women, including therapeutic abortion, generate inequalities between men and women with respect to the enjoyment of their rights.[230]

Right to Privacy

The ICCPR provides that “[n]o one shall be subjected to arbitrary or unlawful interference with his privacy, family, home or correspondence, nor to unlawful attacks on his honor and reputation,”[231] and other treaties and authoritative interpretations reinforce the right to privacy and medical confidentiality. Similarly, article 11(2) of the American Convention on Human Rights states that “[n]o one may be the object of arbitrary or abusive interference with his private life, his family, his home, or his correspondence, or of unlawful attacks on his honor or reputation.”[232]

In several individual cases, the HRC has found that criminalization of abortion, or a state’s refusal to act in accordance with a woman’s decision to undergo a legal abortion, constituted a violation of the right to privacy.[233] It has also called for respect for professional secrecy of health providers and confidentiality for patients who undergo abortion.[234]

The Committee on the Rights of the Child has emphasized, “All adolescents must have access to confidential adolescent-responsive and non-discriminatory reproductive and sexual health information and services, available both on and off-line, including … safe abortion services.”[235] It has recommended that governments ensure that children have access to confidential medical counsel and assistance without parental consent, including for reproductive health services.[236] It has specifically called for confidential access for adolescent girls to legal abortions.[237]

The CESCR has recommended that states ensure that the personal data of patients undergoing abortion remain confidential and has commented on the problem of women seeking health care for complications from unsafe abortions being reported to authorities.[238] Likewise, the Committee against Torture has called for protection of privacy for women seeking medical care for complications related to abortion.[239]

Right to Information

The right to information is set forth in numerous human rights treaties.[240] For example, CEDAW provides that states should provide women “[t]he same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights.”[241]

The right to information includes both a negative obligation for states to refrain from interference with the provision of information by private parties and a positive responsibility to provide complete and accurate information necessary for the protection and promotion of rights, including the right to health.[242]

The CESCR has stated that the right to health includes the right to health-related education and information.[243] It has said:

Information accessibility includes the right to seek, receive, and disseminate information and ideas concerning sexual and reproductive health issues…. All individuals and groups, including adolescents and youth, have the right to evidence-based information on all aspects of sexual and reproductive health, including … safe abortion and post abortion care.[244]

 The Committee has called on the Dominican Republic to “ensure access to and availability of sexual and reproductive health services and information for all women and teenage girls, particularly in rural areas.”[245]

The CEDAW Committee and the CRC have called on the Dominican Republic and other states to ensure that children have access to reproductive and sexual health education and information, including in schools.[246] The CRC has recommended that states “adopt or integrate a comprehensive gender-sensitive sexual and reproductive health policy for adolescents, emphasizing that unequal access by adolescents to such information and services amounts to discrimination.”[247]

The Inter-American Commission on Human Rights has noted that women cannot fully enjoy their human rights without information and education on health care services.[248] It has specifically asserted that states’ obligation to provide information on sexuality and reproduction is “particularly relevant” since it “helps people be prepared to make free and informed decisions concerning these aspects that are so intimate to their lives.”[249] For this reason, the commission has called on states to provide timely, complete, accessible, and reliable information on reproductive health, in a proactive manner.[250]

Right to Decide the Number and Spacing of Children

CEDAW provides that “States Parties shall ... ensure, on a basis of equality of men and women…. The same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education, and means to enable them to exercise these rights.”[251]

Freedom from Gender-Based Violence

The Dominican Republic has clear obligations under international and regional human rights treaties to protect women and girls from sexual and domestic violence, including by private actors. The CEDAW Committee stated in General Recommendations 28 and 19 that violence against women constitutes a form of discrimination and states have a due diligence obligation to prevent, investigate, prosecute, and punish acts of gender-based violence.[252] In its General Recommendation 19, the CEDAW Committee stated, “States may also be responsible for private acts if they fail to act with due diligence to prevent violations of rights or to investigate and punish acts of violence.”[253]

The Dominican Republic has similar obligations under the Inter-American Convention on the Prevention, Punishment, and Eradication of Violence Against Women, known as the Convention of Belém do Pará, to “apply due diligence to prevent, investigate, and impose penalties for violence against women.”[254] In addition, the Convention on the Rights of the Child (CRC) states that children must be protected from “all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation—including sexual abuse—and ensure that victims of such acts receive legal and psycho-social redress.”[255]

The full criminalization of abortion in the Dominican Republic undermines the government’s efforts to prevent, investigate, prosecute, and punish acts of violence. Women and girls pregnant from rape or in the context of abusive relationships who seek to terminate pregnancies must do so clandestinely, without the support of authorities who could take steps to end the violence.

 

Acknowledgments

This report was researched and written by Margaret Wurth, senior researcher in the Children’s Rights Division at Human Rights Watch.

Heather Barr, senior researcher in the Women’s Rights Division, edited the report.

Michael Garcia Bochenek, senior counsel to the Children’s Rights Division; Amanda Klasing, senior researcher in the Women’s Rights Division; and Tamara Taraciuk Broner, Americas senior researcher, reviewed and commented on the report. Chris Albin-Lackey, senior legal advisor, provided legal review, and Tom Porteous, deputy program director, provided program review.

Susan Raqib, senior coordinator, and Lily Acton, former intern, in the Children’s Rights Division conducted background research for this report. Design and production assistance were provided by Tabashshum Islam, associate in the Women’s Rights Division; Fitzroy Hepkins, administrative manager; and Jose Martinez, senior administration coordinator. Gabriela Haymes translated this report into Spanish, and Claudia Núñez, Spanish web editor at Human Rights Watch, vetted the Spanish translation.

We are deeply grateful to Yaneris González Gómez, who showed extraordinary compassion and dedication while working with Human Rights Watch as an interpreter and fixer for this project.

Human Rights Watch benefitted from the time and insights offered by many Dominican and international nongovernmental organizations, activists, and experts. In particular, we would like to thank the following individuals and groups for their support and collaboration: Colectiva Mujer y Salud; CE-MUJER; Centro de Investigación para La Acción Femenina (CIPAF); Centro de Estudios de Género (CEG-INTEC); Círculo de Mujeres con Discapacidad, Inc. (CIMUDIS); Comunidad de Lesbianas Inclusivas Dominicanas (COLESDOM); Comité de América Latina y el Caribe para la Defensa de los Derechos de las Mujeres – República Dominicana (CLADEM-RD); Confederación Nacional de Mujeres Campesinas (CONAMUCA); Coalición por los Derechos y la Vida de las Mujeres; Carmela Cordero; Foro Feminista; Instituto de Género y Familia de la Universidad Autónoma de Santo Domingo (UASD); Junta de Mujeres Mamá Tingó (JMMT); Movimiento de Mujeres Dominico Haitianas (MUDHA); Movimiento de Mujeres Unidas (MODEMU); Núcleo de Apoyo a la Mujer (NAM); Paola Pelletier; Sergia Galván; and TÚ, MUJER.

We also wish to thank American Jewish World Service (AJWS); Center for Reproductive Rights (CRR); Planned Parenthood Federation of America (PPFA); Oxfam – Dominican Republic; Plan International República Dominicana; Women’s Equality Center (WEC); and Women’s Link Worldwide for input and guidance on our project design.

Most importantly, we are deeply grateful to the courageous and resilient women and girls who shared their stories with us.

 

 

[1] Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989), entered into force September 2, 1990, art. 1.

[2] World Health Organization (WHO), “Health for the World’s Adolescents: A second chance in the second decade,” ch. 2 (2014), http://www.who.int/maternal_child_adolescent/documents/second-decade/en/ (accessed August 9, 2018).

[3] Center for Reproductive Rights, “The World’s Abortion Laws 2018,” http://worldabortionlaws.com/ (accessed June 25, 2018).

[4] Penal Code of the Dominican Republic, 1884, art. 317, modified by laws 1690 of April 8, 1948, 224 of June 26, 1984, and 46-99 of May 20, 1999. “El que por medio de alimentos, brevajes, medicamentos, sondeos, tratamientos o de otro modo cualquiera, causare o cooperare directamente a causar el aborto de una mujer embarazada, aun cuando ésta consienta en él, será castigado con la pena de reclusión menor.”

[5] Penal Code of the Dominican Republic, 1884, art. 317. “Los médicos, cirujanos, parteras, enfermeras, farmacéuticos y otros profesionales médicos, que, abusando de su profesión, causaren el aborto o cooperaren a él, incurrirán en la pena de cinco a veinte años de reclusión mayor, si el aborto se efectuare.”

[6] Penal Code of the Dominican Republic, 1884, art. 317. “Se impondrá la pena de prisión de seis meses a dos años a las personas que hayan puesto en relación o comunicación una mujer embarazada con otra persona para que le produzca el aborto, siempre que el aborto se haya efectuado, aun cuando no hayan cooperado directamente al aborto. La misma pena se impondrá a la mujer que causare un aborto o que consintiere en hacer uso de las substancias que con ese objeto se le indiquen o administren o en someterse a los medios abortivos, siempre que el aborto se haya efectuado.”

[7] Center for Reproductive Rights, “The World’s Abortion Laws 2018,” http://worldabortionlaws.com/.

[8] Human Rights Watch interview with Katherine Jaime and Orlidy Inoa, Comité de América Latina y el Caribe para la Defensa de los Derechos de las Mujeres – República Dominicana (CLADEM-RD), Santo Domingo, Dominican Republic, February 12, 2018.

[9] Constitution of the Dominican Republic, art. 37.

[10] For example, Human Rights Watch interviews with Katherine Jaime and Orlidy Inoa, Comité de América Latina y el Caribe para la Defensa de los Derechos de las Mujeres – República Dominicana (CLADEM-RD), Santo Domingo, Dominican Republic, February 12, 2018; Zobeyda Cepeda, Oxfam, Santo Domingo, February 14, 2018; Myrna Flores Chang, manager of the Gender and Rights Program, Fernando de la Rosa, head of education, and Leopoldina Cairo, manager of programming and evaluation, Profamilia, Santo Domingo, Dominican Republic, February 20, 2018; Dr. José De Lancer, obstetrician-gynecologist, Santo Domingo, Dominican Republic, April 13, 2018.

[11] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[12] Human Rights Watch interview with Dr. José De Lancer, obstetrician-gynecologist, Santo Domingo, Dominican Republic, April 13, 2018.

[13] “Imponen tres meses de prisión a mujer se habría provocado aborto,” Listin Diario, February 18, 2018, https://www.listindiario.com/la-republica/2018/02/18/503212/imponen-tres... (accessed June 25, 2018); “Video: Joven que guarda prisión tras aborto ofrece su versión de los hechos,” Ocoa en Red, February 12, 2018, http://ocoaenred.com/index.php/noticias/policia-y-justicia/7261-video-jo... (accessed July 5, 2018).

[14] Human Rights Watch interviews with Cinthya Velasco, executive director, Colectiva Mujer y Salud, Santo Domingo, Dominican Republic, April 12, 2018; Myrna Flores Chang, manager of the Gender and Rights Program, Fernando de la Rosa, head of education, and Leopoldina Cairo, manager of programming and evaluation, Profamilia, Santo Domingo, Dominican Republic, February 20, 2018.

[15] Human Rights Watch interview with Fátima Lorenzo, executive director, Ciudad Alternativa, Santo Domingo, Dominican Republic, February 20, 2018.

[16] Human Rights Watch interview with doctor, date and location withheld for security reasons; Cinthya Velasco, executive director, Colectiva Mujer y Salud, Santo Domingo, Dominican Republic, April 12, 2018; Myrna Flores Chang, manager of the Gender and Rights Program, Fernando de la Rosa, head of education, and Leopoldina Cairo, manager of programming and evaluation, Profamilia, Santo Domingo, Dominican Republic, February 20, 2018.

[17] Guttmacher Institute, “Abortion Worldwide 2017: Uneven Progress and Unequal Access,” March 2018, https://www.guttmacher.org/report/abortion-worldwide-2017 (accessed June 27, 2018), p. 8.

[18] Guttmacher Institute, “Abortion in Latin America and the Caribbean,” March 2018, https://www.guttmacher.org/fact-sheet/abortion-latin-america-and-caribbean (accessed June 27, 2018).

[19] Guttmacher Institute, “Abortion Worldwide 2017: Uneven Progress and Unequal Access,” March 2018, https://www.guttmacher.org/report/abortion-worldwide-2017 (accessed June 27, 2018), p. 51.

[20] The Guttmacher Institute estimated there were 82,000 abortions in the Dominican Republic in 1990. Stanley K. Henshaw, Susheela Singh, and Taylor Haas, “The Incidence of Abortion Worldwide,” International Family Planning Perspectives, vol. 25, suppl. (1999), p. S35.

[21] Profamilia, “Situación del aborto en República Dominicana,” November 2016, http://profamilia.org.do/wp-content/uploads/2017/08/Situación-del-aborto-en-RD-min.pdf (accessed June 28, 2018), pp. 58, 63.

[22] Bela Ganatra, Caitlin Gerdts, Clémentine Rossier, et al., “Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model,” The Lancet, vol. 390 (2017), p. 2374.

[23] Bela Ganatra, Caitlin Gerdts, Clémentine Rossier, et al., “Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model,” The Lancet, vol. 390 (2017), p. 2376.

[24] World Health Organization (WHO), “Preventing Unsafe Abortion,” February 2018, http://www.who.int/en/news-room/fact-sheets/detail/preventing-unsafe-abo... (accessed June 27, 2018).

[25] Guttmacher Institute, “Abortion in Latin America and the Caribbean,” https://www.guttmacher.org/fact-sheet/abortion-latin-america-and-caribbean.

[26] Pan American Health Organization (PAHO), Health Information Platform for the Americas (PLISA) Database, “Health Situation in the Americas: Basic Indicators 2017,” http://www.paho.org/data/index.php/en/indicators.html (accessed October 1, 2018).

[27] Ministry of Public Health, Pan American Health Organization (PAHO), and World Health Organization (WHO), “Basic Health Indicators: Dominican Republic,” 2015, http://www.msp.gob.do/oai/documentos/Estadisticas/2017/IndicadoresSalud/... (accessed June 26, 2018).

[28] Email from Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, to Human Rights Watch, November 3, 2018.

[29] Ministerio de Economía, Planificación y Desarrollo, Unidad Asesora de Análisis Económico y Social, “Sistema de Indicadores Sociales de la República Dominicana (SISDOM),” vol. II (2016), http://economia.gob.do/wp-content/uploads/drive/UAAES/SISDOM/2016/Datos%... (accessed October 1, 2018), p. 153.

[30] Email from Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, to Human Rights Watch, November 3, 2018.

[31] See, for example, A. Faúndes, L. C. Santos, M. Carvalho, C. Gras, “Post-abortion complications after interruption of pregnancy with misoprostol,” Advances in Contraception, vol. 12, no. 1 (1996), pp. 1-9.

[32] World Health Organization (WHO), “Safe abortion: technical and policy guidance for health systems: second edition,” 2012, http://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.... (accessed July 12, 2018).

[33] See, for example, “N.L. Moreno‐Ruiz, L. Borgatta, S. Yanow, N. Kapp, E.R. Wiebe, B. Winikoff, “Alternatives to mifepristone for early medical abortion,” International Journal of Gynecology and Obstetrics, vol. 96, no. 3 (2007), pp. 212-218.

[34] Ministerio de Salud Pública (MSP), Dirección General de Medicamentos, Alimentos y Productos Sanitarios (DIGEMAPS), “Cuadro Básico de Medicamentos Esenciales 2018,” June 2018, http://sns.gob.do/descarga-documentos/atencion-primaria/ (accessed July 10, 2018).

[35] Suellen Miller, Tara Lehman, Martha Campbell, et al., “Misoprostol and declining abortion-related morbidity in

Santo Domingo, Dominican Republic: a temporal association,” International Journal of Obstetrics and Gynaecology, vol. 112 (2005), pp. 1291-1296.

[36] Mónica Sánchez and Kate Vasilof, Untold Research, “Encuesta de Opinión Pública sobre el aborto en la República Dominicana,” June 2018, http://www.mujeresdelsur-afm.org.uy/sites/default/files/Resultados%20Des...  (accessed October 1, 2018).

[37] See, for example, “Danilo observó Código Penal porque viola la Constitución y los derechos de la mujer,” Acento, November 28, 2014, https://acento.com.do/2014/actualidad/8199658-danilo-observo-codigo-pena... (accessed June 25, 2018); “Danilo observa artículos sobre el aborto en CP,” Listin Diario, November 29, 2014, https://www.listindiario.com/la-republica/2014/11/28/347211/Danilo-obser... (accessed June 25, 2018).

[38] In the Dominican Republic, the term “observation” refers to changes the president recommends to a piece of legislation. A presidential “observation” functions as a veto.

[39] Letter from Danilo Medina, president of the Dominican Republic, to Abel Martínez Durán, president of the Chamber of Deputies, November 28, 2014, http://acento.com.do/wp-content/uploads/Observaci%C3%B3n-del-Presidente-... (accessed June 25, 2018).

[40] Human Rights Watch interview with Jeanette Abreu, Lorena Valera, and Mildred Suero, Centro de Investigación para La Acción Femenina (CIPAF), Santo Domingo, Dominican Republic, February 12, 2018. See also, Harolyn Gavilán, “Coalición pide despenalización del aborto en las tres causales,” Listin Diario, https://www.listindiario.com/la-republica/2018/07/16/524349/coalicion-pi... (accessed August 1, 2018).

[41] Tribunal Constitucional, República Dominicana, Sentencia TC/0599/15, 2015.

[42] Ibid.

[43] See, for example, “Presidente Danilo Medina observa el Código Penal,” El Dia, December 19, 2016, http://eldia.com.do/presidente-danilo-medina-observa-el-codigo-penal/ (accessed June 26, 2018).

[44] Letter from Danilo Medina, president of the Dominican Republic, to Dr. Reinaldo Pared Perez, president of the Senate, December 19, 2016. On file with Human Rights Watch.

[45] Cámara de diputados, “Proyecto de ley de salud sexual y reproductiva,” 2017. On file with Human Rights Watch.

[46] Ministerio de Salud Pública (MSP), Dirección General de Medicamentos, Alimentos y Productos Sanitarios (DIGEMAPS), “Cuadro Básico de Medicamentos Esenciales 2018,” June 2018, http://sns.gob.do/descarga-documentos/atencion-primaria/ (accessed July 10, 2018).

[47] Ministerio de Salud Pública (MSP), Centro de Estudios Sociales y Demográficos (CESDEM) and ICF International, “Encuesta Demográfica y de Salud (ENDESA) 2013,” October 2014, https://dhsprogram.com/pubs/pdf/FR292/FR292.pdf (accessed July 10, 2018), p. 114.

[48] Ministerio de Salud Pública (MSP), Dirección General de Medicamentos, Alimentos y Productos Sanitarios (DIGEMAPS), “Cuadro Básico de Medicamentos Esenciales 2018,” June 2018, http://sns.gob.do/download/350/atencion-primaria/6968/cuadro-basico-medi... (accessed July 10, 2018); Human Rights Watch interview with Dr. José De Lancer, obstetrician-gynecologist, Santo Domingo, Dominican Republic, April 13, 2018.

[49] According to the Ministry of Public Health’s 2013 Demographic and Health Survey (ENDESA-2013), 52 percent of pregnancies were planned and wanted at the moment they occurred, 35 percent were unplanned at the moment they occurred, and 13 percent were unwanted. Ministerio de Salud Pública (MSP), Centro de Estudios Sociales y Demográficos (CESDEM) and ICF International, “Encuesta Demográfica y de Salud (ENDESA) 2013,” October 2014, https://dhsprogram.com/pubs/pdf/FR292/FR292.pdf (accessed July 10, 2018), p. 108.

[50] Unmet need for contraception is defined by the United Nations as a percentage of married or in-union women of reproductive age who are fertile and wish to delay or prevent pregnancy, yet they are not using any method of contraception. See, for example, United Nations, Department of Economic and Social Affairs, Population Division, “World Contraceptive Use 2018,” http://www.un.org/en/development/desa/population/publications/dataset/co... (accessed July 10, 2018); Ministerio de Salud Pública (MSP), Centro de Estudios Sociales y Demográficos (CESDEM) and ICF International, “Encuesta Demográfica y de Salud (ENDESA) 2013,” October 2014, https://dhsprogram.com/pubs/pdf/FR292/FR292.pdf (accessed July 10, 2018), pp. 122-123.

[51] Human Rights Watch interview with Carolina, 30, Santo Domingo, Dominican Republic, April 13, 2018.

[52] Human Rights Watch interview with Madelyn, 28, Santo Domingo, Dominican Republic, April 14, 2018. See, for example, Gerard J. Molloy, Heather Graham, and Hannah McGuinness, “Adherence to the oral contraceptive pill: a cross-sectional survey of modifiable behavioural determinants,” BMC Public Health, vol. 12, no. 828, pp. 1-8.

[53] Human Rights Watch interview with Daralis, 24, Santo Domingo, Dominican Republic, April 15, 2018.

[54] Human Rights Watch interview with Madelyn, 28, Santo Domingo, Dominican Republic, April 14, 2018.

[55] Human Rights Watch interview with Natalie, 22, Santo Domingo, Dominican Republic, April 14, 2018.

[56] For example, Human Rights Watch interviews with Gabriela, 27, Violeta, 26, and Clara, 22, San Cristóbal province, Dominican Republic, February 16, 2018; Tatiana, 27, Santo Domingo, Dominican Republic, April 14, 2018; Aury, 24, Santo Domingo, Dominican Republic, April 14, 2018; Adelyn, 20, Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[57] Human Rights Watch interview with Samantha, 18, Santo Domingo, Dominican Republic, April 14, 2018.

[58] Human Rights Watch interview with Lisbeth, 16, Santo Domingo, Dominican Republic, April 15, 2018.

[59] Human Rights Watch interviews with Larissa, 22, San Cristóbal province, Dominican Republic, February 16, 2018; Rayneli, 15, Santo Domingo, Dominican Republic, April 15, 2018; Paola, 31, Santo Domingo, Dominican Republic, April 13, 2018; Carolina, 30, Santo Domingo, Dominican Republic, April 13, 2018; Eridania, 28, Monte Plata province, Dominican Republic, February 21, 2018; Vanessa, 37, Santiago de los Caballeros, Dominican Republic, April 17, 2018; Xiomara, 26, Santo Domingo, Dominican Republic, February 18, 2018.

[60] Human Rights Watch interviews with Isamar, 31, Santo Domingo, Dominican Republic, February 20, 2018; Eridania, 28, Monte Plata province, Dominican Republic, February 21, 2018.

[61] See, for example, Herbert B. Peterson, Zhisen Xia, Joyce M. Hughes, et al., “The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization,” American Journal of Obstetrics and Gynecology, vol. 174, no. 4 (1996), pp. 1161–1170.

[62] Human Rights Watch interview with Maoli, 20, Santo Domingo, Dominican Republic, April 13, 2018; Karen, 18, Santo Domingo, Dominican Republic, April 20, 2018.

[63] Human Rights Watch interview with Lucely, 18, San Cristóbal province, Dominican Republic, April 16, 2018.

[64] Human Rights Watch interview with Rebeca, 26, San Cristóbal province, Dominican Republic, February 16, 2018; Juliana, 16, Santiago de los Caballeros, Dominican Republic, April 18, 2018; Stephany, 24, Santo Domingo, Dominican Republic, April 13, 2018; Yamaira, 39, Santo Domingo, Dominican Republic, April 13, 2018; Xiomara, 26, Santo Domingo, Dominican Republic, February 18, 2018.

[65] Human Rights Watch interview with Melina, 26, San Cristóbal province, Dominican Republic, February 16, 2018.

[66] Human Rights Watch interview with Nayely, 29, San Cristóbal province, Dominican Republic, April 16, 2018.

[67] Human Rights Watch interview with Camila, 24, Santo Domingo, Dominican Republic, April 14, 2018.

[68] Human Rights Watch interview with Regina, psychologist, Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[69] Human Rights Watch interview with Gabriela, 27, Violeta, 26, and Clara, 22, San Cristóbal province, Dominican Republic, February 16, 2018.

[70] Human Rights Watch interview with Daralis, 24, Santo Domingo, Dominican Republic, April 15, 2018.

[71] Human Rights Watch interview with Adelyn, 20, Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[72] Human Rights Watch interview with Sergia Galván, advocate, Santo Domingo, Dominican Republic, April 19, 2018.

[73] Human Rights Watch interview with Liliana Dolis, general coordinator of the Movimiento de Mujeres Dominico-Haitianas (MUDHA), Santo Domingo, Dominican Republic, February 16, 2018.

[74] Human Rights Watch interview with Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, Santo Domingo, Dominican Republic, April 20, 2018.

[75] Human Rights Watch interviews with Camila, 24, Santo Domingo, Dominican Republic, April 14, 2018

[76] Human Rights Watch interview with Juliana, 16, Santiago de los Caballeros, Dominican Republic, April 18, 2018.

[77] Human Rights Watch interview with Gabriela, 27, Violeta, 26, and Clara, 22, San Cristóbal province, Dominican Republic, February 16, 2018.

[78] Human Rights Watch interview with Isamar, 31, Santo Domingo, Dominican Republic, February 20, 2018.

[79] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[80] Human Rights Watch interview with Stephany, 24, Santo Domingo, Dominican Republic, April 13, 2018.

[81] See, for example, Guttmacher Institute, “Abortion Worldwide 2017: Uneven Progress and Unequal Access,” March 2018, https://www.guttmacher.org/report/abortion-worldwide-2017 (accessed June 27, 2018), pp. 21-23.

[82] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[83] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[84] The World Health Organization (WHO) classifies abortions as safe if they are provided by trained healthcare workers using methods recommended by WHO, such as medical abortion, and appropriate for the duration of the pregnancy. Bela Ganatra, Caitlin Gerdts, Clémentine Rossier, et al., “Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model,” The Lancet, vol. 390 (2017), p. 2374.

[85] Human Rights Watch interviews with Camila, 24, Santo Domingo, Dominican Republic, April 14, 2018; Nicole, 28, Santo Domingo, Dominican Republic, April 12, 2018.

[86] Human Rights Watch interview with Nicole, 28, Santo Domingo, Dominican Republic, April 12, 2018.

[87] Human Rights Watch interview with Camila, 24, Santo Domingo, Dominican Republic, April 14, 2018.

[88] Human Rights Watch interview with Dr. José De Lancer, obstetrician-gynecologist, Santo Domingo, Dominican Republic, April 13, 2018.

[89] Human Rights Watch interview with obstetrician-gynecologist, Santiago de los Caballeros, Dominican Republic, April 18, 2018.

[90] Human Rights Watch interview with obstetrician-gynecologist, date and location withheld for security reasons.

[91] Human Rights Watch interview with Melina, 26, San Cristóbal province, Dominican Republic, February 16, 2018.

[92] Human Rights Watch interview with Alejandro, 24, Santo Domingo, Dominican Republic, February 17, 2018.

[93] Human Rights Watch interview with three health outreach workers, Santo Domingo, Dominican Republic, February 19, 2018.

[94] Human Rights Watch interview with Paola, 31, Santo Domingo, Dominican Republic, April 13, 2018.

[95] Human Rights Watch interview with Alicia, 17, Santo Domingo, Dominican Republic, April 15, 2018.

[96] See, for example, Daniel Grossman, Sarah E. Baum, Denitza Andjelic, et al., “A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: A cohort study,” PLoS One, vol. 13, no. 1 (2018), pp. 1-16.

[97] The term “obstetric violence” refers to negligent, disrespectful, or abusive treatment by health providers when women and girls seek reproductive healthcare during pregnancy, abortion, childbirth, or the post-partum period. See, for example, Virginia Savage and Arachu Castro, “Measuring mistreatment of women during childbirth: a review of terminology and methodological approaches,” Reproductive Health vol. 14, no. 138 (2017), pp. 1-27.

[98] The World Health Organization recommends vacuum aspiration as opposed to dilatation and curettage for incomplete abortion. World Health Organization (WHO), “Safe abortion: technical and policy guidance for health systems: second edition,” 2012, http://apps.who.int/iris/bitstream/handle/10665/70914/9789241548434_eng.... (accessed July 12, 2018), p. 7.

[99] Ministerio de Salud Pública, “Protocolos de Atención para Obstetrícia y Ginecología, Volumen I,” March 2016, http://www.msp.gob.do/oai/Documentos/Publicaciones/ProtocolosAtencion/Pr... (accessed July 13, 2018), pp. 35-70.

[100] Centro de Estudios de Género, Instituto Tecnológico de Santo Domingo (CEG-INTEC) and United Nations Population Fund (UNFPA), “Análisis de Género en la Mortalidad Materna de República Dominicana,” March 2018, http://dominicanrepublic.unfpa.org/es/publications/an%C3%A1lisis-de-g%C3... (accessed July 14, 2018); Women’s Link Worldwide, “Maternidad Libre y Segura en República Dominicana: una deuda con los derechos de las mujeres,” 2017, https://www.womenslinkworldwide.org/files/d64ad5156e3c5bb537ccc17bbfe447... (accessed July 14, 2018).

[101] Human Rights Watch interview with Juana Ferrer, Lidia Ferrer Paredes, and Vanessa Rodriguez, Confederación Nacional de Mujeres Campesinas (CONAMUCA), Santo Domingo, Dominican Republic, February 19, 2018.

[102] Human Rights Watch interview with Rayneli, 15, Santo Domingo, Dominican Republic, April 15, 2018.

[103] Human Rights Watch interview with Bianca, 30, San Cristóbal province, Dominican Republic, April 16, 2018.

[104] Human Rights Watch interview with Adelyn, 20, Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[105] Human Rights Watch interview with Camila, 24, Santo Domingo, Dominican Republic, April 14, 2018.

[106] Human Rights Watch interview with Madelyn, 28, Santo Domingo, Dominican Republic, April 14, 2018.

[107] Human Rights Watch interview with Aury, 24, Santo Domingo, Dominican Republic, April 14, 2018.

[108] Human Rights Watch interview with Mayerlin, 38, Monte Plata province, Dominican Republic, February 21, 2018.

[109] Human Rights Watch interview with Elizabeth Velez, Catholics for Choice, Santo Domingo, Dominican Republic, February 18, 2018.

[110] Human Rights Watch interview with Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, Santo Domingo, Dominican Republic, April 20, 2018.

[111] See, for example, Thália Velho Barreto de Araújo, Estela M. L. Aquino, Greice M. S. Menezes, “Delays in access to care for abortion-related complications: the experience of women in Northeast Brazil,” Cadernos de Saúde Pública, vol. 34, no. 6 (2018), pp. 1-11.

[112] See, for example, Abdhalah Kasiira Ziraba, Chimaraoke Izugbara, Brooke A Levandowski, et al., “Unsafe abortion in Kenya: a cross-sectional study of abortion complication severity and associated factors,” BMC Pregnancy and Childbirth vol. 15, no. 34 (2015), pp. 1-11.

[113] Guttmacher Institute, “Abortion Worldwide 2017: Uneven Progress and Unequal Access,” March 2018, https://www.guttmacher.org/report/abortion-worldwide-2017 (accessed June 27, 2018), p. 42.

[114] Human Rights Watch interview with Carolina, 30, Santo Domingo, Dominican Republic, April 13, 2018.

[115] Human Rights Watch interview with Yamaira, 39, Santo Domingo, Dominican Republic, April 13, 2018.

[116] Mayo Clinic, “Miscarriage,” July 20, 2016, https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriag... (accessed August 1, 2018).

[117] Human Rights Watch interview with Aury, 24, Santo Domingo, Dominican Republic, April 14, 2018.

[118] Human Rights Watch interviews with Xiomara, 26, Santo Domingo, Dominican Republic, February 18, 2018; Yamaira, 39, Santo Domingo, Dominican Republic, April 13, 2018.

[119] Human Rights Watch interview with Rebeca, 26, San Cristóbal province, Dominican Republic, February 16, 2018.

[120] The Dominican Republic has very high rates of child marriage: 37 percent of women ages 20 to 49 were married before age 18 and 12.5 percent before age 15. Plan International Dominican Republic, “Bride Girls: Portrayal of the forced marriage of young and adolescent girls, in the Provinces of Azua, Barahona, Pedernales, Elias Piña, and San Juan,” March 2017, https://plan-international.org/sites/files/plan/field/field_document/pla... (accessed August 1, 2018), p. 11.

[121] Human Rights Watch interview with Larissa, 22, San Cristóbal province, Dominican Republic, February 16, 2018.

[122] Human Rights Watch interview with Mayerlin, 38, Monte Plata province, Dominican Republic, February 21, 2018.

[123] Human Rights Watch interview with Aury, 24, Santo Domingo, Dominican Republic, April 14, 2018.

[124] Human Rights Watch interview with Ana Paula, 16, Santo Domingo, Dominican Republic, April 15, 2018.

[125] Human Rights Watch interview with Noelia, 33, Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[126] Human Rights Watch interview with Yamaira, 39, Santo Domingo, Dominican Republic, April 13, 2018.

[127] Guttmacher Institute, “Abortion Worldwide 2017: Uneven Progress and Unequal Access,” https://www.guttmacher.org/report/abortion-worldwide-2017; See also, Lale Say, Doris Chou, Alison Gemmill, et al., “Global causes of maternal death: a WHO systematic analysis,” Lancet Global Health vol. 2 (2014), pp. 323–33.

[128] Email from Dr. José Mordán, head of the Department of Family Health at the Ministry of Public Health, to Human Rights Watch, November 3, 2018.

[129] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[130] Centro de Estudios de Género, Instituto Tecnológico de Santo Domingo (CEG-INTEC) and United Nations Population Fund (UNFPA), “Análisis de Género en la Mortalidad Materna de República Dominicana,” March 2018, http://dominicanrepublic.unfpa.org/es/publications/an%C3%A1lisis-de-g%C3... (accessed July 14, 2018).

[131] Ibid., See, “Caso 6: Teresa,” pp. 64-67.

[132] Ibid., See, “Caso 1: Miriam,” pp. 47-50.

[133] Women’s Link Worldwide, “Maternidad Libre y Segura en República Dominicana: una deuda con los derechos de las mujeres,” https://www.womenslinkworldwide.org/files/d64ad5156e3c5bb537ccc17bbfe447....

[134] Ibid., See, “Massiel: las consecuencias de la penalización del aborto,” pp. 51-54.

[135] Ibid., See, “Cristina: las falencias en la red de servicios de salud,” pp. 33-38.

[136] Human Rights Watch interview with obstetrician-gynecologist, date and location withheld for security reasons.

[137] Human Rights Watch interview with Catalina, licensed nurse, Santo Domingo, Dominican Republic, February 18, 2018.

[138] Human Rights Watch interview with Melina, 26, San Cristóbal province, Dominican Republic, February 16, 2018.

[139] Human Rights Watch interview with Raquel, 38, Santo Domingo, Dominican Republic, April 14, 2018.

[140] Ministerio de Salud Pública (MSP), “Instituciones de salud de RD trabajan en la reducción mortalidad materna y neonatal,” May 1, 2018, http://www.msp.gob.do/Instituciones-de-salud-de-RD-trabajan-en-la-reducc... (accessed July 12, 2018).

[141] See, for example, Anibal Faúndes and Iqbal H. Shah, “Evidence supporting broader access to safe legal abortion,” International Journal of Gynecology and Obstetrics, vol. 131 (2015), pp. S56–S59.

[142] Ministerio de Salud Pública (MSP), Centro de Estudios Sociales y Demográficos (CESDEM) and ICF International, “Encuesta Demográfica y de Salud (ENDESA) 2013,” October 2014, https://dhsprogram.com/pubs/pdf/FR292/FR292.pdf (accessed July 10, 2018), p. 325.

[143] Ibid., pp. 323-324.

[144] Ibid., p. 325.

[145] Ibid., pp. 337-338.

[146] The study states that victims of sexual or physical violence are two times more likely to seek an abortion than women who have not experienced partner violence, but the impact of the legal status of abortion on this decision is not clear. World Health Organization, Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence, 2013, p. 2, http://apps.who.int/iris/bitstream/10665/85239/1/9789241564625_eng.pdf (accessed August 22, 2018).

[147] Ibid., p. 3.

[148] See, for example, Ley No. 24-97, 1997; Ministerio de Salud Pública, Ruta de Coordinación y Articulación Interinstitucional para la Atención de Niños, Niñas y Adolescentes Victimas de Violencia en Republica Dominicana, February 2017. On file with Human Rights Watch.

[149] See, for example, CEDAW Committee, General Recommendation 35 on gender-based violence against women (2017), para. 18; CESCR, General Comment 22, para. 10.

[150] Committee against Torture, “Consideration of reports submitted by States parties under article 19 of the Convention. Concluding observations of the Committee against Torture: Paraguay,” U.N. Doc. CAT/C/PRY/CO/4-6, December 14, 2011, para. 22. See also, in similar terms, Committee against Torture, “Consideration of reports submitted by States parties under article 19 of the Convention. Concluding observations of the Committee against Torture: Nicaragua,” U.N. Doc. CAT/C/NIC/CO/1, June 10, 2009, para. 16.

[151] Human Rights Watch interview with Antonella, health educator, Santiago de los Caballeros, April 18, 2018.

[152] Human Rights Watch interview with lawyer and advocate, Monte Plata province, Dominican Republic, February 21, 2018.

[153] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[154] Human Rights Watch interview with Regina, psychologist, Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[155] Human Rights Watch interview with Mary, outreach worker, Monte Plata province, Dominican Republic, February 21, 2018.

[156] Human Rights Watch interview with Susi Pola, founder, Núcleo de Apoyo a la Mujer (NAM), Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[157] Coalición por los Derechos y la Vida de las Mujeres, “Causales de Vida: Estudio de cinco casos de aborto por causales en República Dominicana,” September 2018, https://oxfam.app.box.com/s/bfuu7gdvb1pmg83eichggk30yih07njk (accessed September 6, 2018).

[158] Human Rights Watch interview with Dayelin, 20, Santiago de los Caballeros, Dominican Republic, April 18, 2018.

[159] Human Rights Watch interview with Yesenia, 37, Santo Domingo, Dominican Republic, February 20, 2018.

[160] Human Rights Watch interview with Carmen, 33, Santiago de los Caballeros, Dominican Republic, April 18, 2018.

[161] Human Rights Watch interview with Karen, 18, Santo Domingo, Dominican Republic, April 14, 2018.

[162] Human Rights Watch interview with Madelyn, 28, Santo Domingo, Dominican Republic, April 14, 2018.

[163] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[164] Human Rights Watch interview with Madelyn, 28, Santo Domingo, Dominican Republic, April 14, 2018.

[165] Human Rights Watch interview with Marta, 30, and Sara, 22, San Cristóbal province, Dominican Republic, February 16, 2018.

[166] Ministerio de Economía, Planificación y Desarrollo, Unidad Asesora de Análisis Económico y Social, “Sistema de Indicadores Sociales de la República Dominicana (SISDOM),” vol. II (2016), http://economia.gob.do/wp-content/uploads/drive/UAAES/SISDOM/2016/Datos%... (accessed October 1, 2018), p. 154.

[167] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[168] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[169] See, for example, Centers for Disease Control and Prevention, “Treating for Two: Medicine and Pregnancy, Findings by Health Condition,” 2018, https://www.cdc.gov/pregnancy/meds/treatingfortwo/findings-by-condition.... (accessed September 18, 2018).

[170] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[171] Human Rights Watch interview with Susi Pola, founder, Núcleo de Apoyo a la Mujer (NAM), Santiago de los Caballeros, Dominican Republic, April 17, 2018.

[172] Coalición por los Derechos y la Vida de las Mujeres, “Causales de Vida: Estudio de cinco casos de aborto por causales en República Dominicana,” https://oxfam.app.box.com/s/bfuu7gdvb1pmg83eichggk30yih07njk.

[173] Women’s Link Worldwide, “Madre de “Esperancita” exige justicia ante Comisión Interamericana de Derechos Humanos,” August 17, 2017, https://www.womenslinkworldwide.org/informate/sala-de-prensa/madre-de-es... (accessed July 16, 2018).

[174] Human Rights Watch interview with doctor, date and location withheld for security reasons.

[175] Human Rights Watch interview with Xiomara, 26, Santo Domingo, Dominican Republic, February 18, 2018.

[176] Human Rights Watch interview with Xiomara, 26, Santo Domingo, Dominican Republic, February 18, 2018.

[177] Human Rights Watch interview with Nicole, 28, Santo Domingo, Dominican Republic, April 12, 2018.

[178] Human Rights Watch interview with Lucely, 18, San Cristóbal province, Dominican Republic, April 16, 2018.

[179] Human Rights Watch interview with Maoli, 20, Santo Domingo, Dominican Republic, April 13, 2018.

[180] Human Rights Watch interview with Flor de Liz, 26, Santo Domingo, Dominican Republic, February 17, 2018.

[181] Human Rights Watch interview with Mayerlin, 38, Monte Plata province, Dominican Republic, February 21, 2018.

[182] Human Rights Watch interview with Eridania, 28, Monte Plata province, Dominican Republic, February 21, 2018.

[183] See, for example, Lauren Ralph, Heather Gould, Anne Baker, and Diana Greene Foster, “The Role of Parents and Partners in Minors' Decisions to Have an Abortion and Anticipated Coping After Abortion,” Journal of Adolescent Health, vol. 54, no. 4 (2014), pp. 428-434.

[184] Human Rights Watch interview with Maria Fernanda, 23, Santiago de los Caballeros, Dominican Republic, April 18, 2018.

[185] Human Rights Watch interview with Alicia, 17, Santo Domingo, Dominican Republic, April 15, 2018.

[186] Human Rights Watch interview with Paola, 31, Santo Domingo, Dominican Republic, April 13, 2018.

[187] “Imponen tres meses de prisión a mujer se habría provocado aborto,” Listin Diario, February 18, 2018, https://www.listindiario.com/la-republica/2018/02/18/503212/imponen-tres... (accessed June 25, 2018); “Video: Joven que guarda prisión tras aborto ofrece su versión de los hechos,” Ocoa en Red, February 12, 2018, http://ocoaenred.com/index.php/noticias/policia-y-justicia/7261-video-jo... (accessed July 5, 2018).

[188] Ana Gabriela Rojas, “Emely Peguero: el asesinato de una adolescente embarazada que puso el foco sobre el terrible número de feminicidios en República Dominicana,” BBC World, October 16, 2017, https://www.bbc.com/mundo/noticias-america-latina-41617665 (accessed July 15, 2018).

[189] Ibid.

[190] Ratified by the Dominican Republic on January 4, 1978.

[191] Ratified by the Dominican Republic on January 4, 1978.

[192] Ratified by the Dominican Republic on January 24, 2012.

[193] Ratified by the Dominican Republic on September 2, 1982.

[194] Ratified by the Dominican Republic on June 11, 1991.

[195] Ratified by the Dominican Republic on January 21, 1978.

[196] See, for example, HRC concluding observations on El Salvador, UN Doc. CCPR/C/SLV/CO/7 (2018); Guatemala, UN Doc. CCPR/C/GTM/CO/4 (2018); Lebanon, UN Doc. CCPR/C/LBN/CO/3 (2018); Cameroon, UN Doc. CCPR/C/CMR/CO/5 (2017).

[197] HRC concluding observations on Dominican Republic, UN Doc. CCPR/C/DOM/CO/6 (2017).

[198] See, for example, CEDAW Committee concluding observations on Chile, UN Doc. CEDAW/C/CHL/CO/7 (2018); Fiji, UN Doc. CEDAW/C/FJI/CO/5 (2018); Marshall Islands, UN Doc. CEDAW/C/MHL/CO/1-3 (2018); Republic of Korea, UN Doc. CEDAW/C/KOR/CO/8 (2018); Saudi Arabia, UN Doc. CEDAW/C/SAU/CO/3-4 (2018); Suriname, UN Doc. CEDAW/C/SUR/CO/4-6 (2018); Guatemala, UN Doc. CEDAW/C/GTM/CO/8-9 (2017); Paraguay, UN Doc. CEDAW/C/PRY/CO/7 (2017); Costa Rica, UN Doc. CEDAW/C/CRI/CO/7 (2017); El Salvador, UN Doc. CEDAW/C/SLV/CO/8-9 (2017).

[199] Committee on the Rights of the Child, General Comment No. 20 on the implementation of the rights of the child during adolescence, UN Doc. CRC/C/GC/20 (2016), paras. 13 and 60.

[200] See, for example, concluding observations of the Committee on Economic, Social and Cultural Rights (CESCR) on the Republic of Korea, UN Doc. E/C.12/KOR/CO/4 (2017); The Philippines, UN Doc. E/C.12/PHL/CO/5-6 (2016); Kenya, UN Doc. E/C.12/KEN/CO/2-5 (2016); and Pakistan, UN Doc. E/C.12/PAK/CO/1 (2017).

[201] CESCR concluding observations on the Dominican Republic, UN Doc. E/C.12/DOM/CO/4 (2016), paras. 59-60.

[202] Inter-American Commission on Human Rights, “IACHR Urges El Salvador to End the Total Criminalization of Abortion,” March 7, 2018, http://www.oas.org/en/iachr/media_center/PReleases/2018/042.asp (accessed May 23, 2018).

[203] Inter-American Commission on Human Rights, “IACHR Urges All States to Adopt Comprehensive, Immediate Measures to Respect and Protect Women’s Sexual and Reproductive Rights,” October 23, 2017, https://mailchi.mp/dist/iachr-urges-all-states-to-adopt-comprehensive-immediate-measures-to-respect-and-protect-womens-sexual-and-reproductive-rights?e=07a43d57e2 (accessed May 23, 2018).

[204] American Convention on Human Rights, art. 4(1).

[205] Inter-American Commission on Human Rights, White and Potter (“Baby Boy Case”), Resolution No. 23/81, Case No. 2141, U.S., March 6, 1981, OAS/Ser.L/V/II.54, Doc. 9 Rev. 1, October 16, 1981, para. 14(a).

[206] Ibid., para 14(6).

[207] Inter-American Court, Artavia Murillo and others Case, Judgment of November 28, 2012, Inter-Am Ct.H.R., Series C. No. 257, para. 264.

[208] Ibid.

[209] ICESCR, art. 12(1); CRC art. 24; CEDAW, art. 12.

[210] CESCR, General Comment No. 22 on the right to sexual and reproductive health (2016), para. 40.

[211] See, for example, concluding observations of the CESCR on the Republic of Korea, UN Doc. E/C.12/KOR/CO/4 (2017); Pakistan, UN Doc. E/C.12/PAK/CO/1 (2017); Honduras, UN Doc. E/C.12/HND/CO/2 (2016); Poland, UN Doc. E/C.12/POL/CO/6 (2016); the Philippines, UN Doc. E/C.12/PHL/CO/5-6 (2016); Costa Rica, UN Doc. E/C.12/CRI/CO/5 (2016); Kenya, UN Doc. E/C.12/KEN/CO/2-5 (2016); and Macedonia, UN Doc. E/C.12/MKD/CO/2-4 (2016).

[212] CEDAW Committee, General Recommendation No. 24 on women and health, UN Doc. A/54/38/Rev.1 (1999), para. 17.

[213] Ibid.

[214] See discussions above under “the right to life.”

[215] CRC, Concluding observations on Dominican Republic, UN Doc. CRC/C/DOM/CO/3-5 (2015), paras. 51-52.

[216] See, for example, concluding observations of the Committee against Torture on Timor-Leste, UN Doc. CAT/C/TLS/CO/1 (2017); Ireland, UN Doc. CAT/C/IRL/CO/2 (2017); and Ecuador, UN Doc. CAT/C/ECU/CO/7 (2016).

[217] Whelan v. Ireland, CCPR/C/119/D/2425/2014 (2017); Mellet v. Ireland, CCPR/C/116/D/2324/2013 (2016); K.L. v. Peru, CCPR/C/85/D/1153/2003 (2005); and L.M.R. v. Argentina, CCPR/C/101/D/1608/2007 (2011).

[218] Ibid., See also HRC General Comment No. 20 on the prohibition of torture, or other cruel, inhuman or degrading treatment or punishment, UN Doc. HRI/GEN/1/Rev.1 (1994), para. 5.

[219] CEDAW Committee, General Recommendation 35 on gender-based violence against women (2017), para. 18; CESCR, General Comment 22, para. 10.

[220] Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, UN Doc. A/HRC/31/57 (2016), para. 43.

[221] Follow-up Mechanism to the Convention of Belém Do Pará (Mesecvi) Comittee Of Experts (Cevi), “Declaration on Violence against Women, Girls and Adolescents and their Sexual and Reproductive Rights,”, OEA/Ser.L/II.7.10, September 19, 2014, http://www.oas.org/es/mesecvi/docs/CEVI11-Declaration-EN.pdf (accessed May 23, 2018), pp. 3-4.

[222] Ibid., p. 7.

[223] See, for or example, ICCPR, art. 2 and ICESCR, art. 2.

[224] American Convention on Human Rights, arts. 1(1) and 24.

[225] CEDAW Committee, “Statement of the Committee on the Elimination of Discrimination against Women on sexual and reproductive health and rights: Beyond 2014 ICPD review” (Feb. 2014).

[226] See, for example, the CEDAW Committee concluding observations noted under the analysis of the right to life and right to health above.

[227] See, for example, HRC concluding observations on the Philippines, UN Doc. CCPR/C/PHL/CO/4 (2012); Paraguay, UN Doc. CCPR/C/PRY/CO/3 (2013); Peru, UN Doc. CCPR/C/PER/CO/5 (2013); and Ireland, UN Doc. CCPR/C/IRL/CO/4 (2014). See also L.M.R. v. Argentina, UN Doc. CCPR/C/101/D/1608/2007 (2011).

[228] See, for example, CRC concluding observation on Namibia, UN Doc. CRC/C/NAM/CO/2-3 (2012).

[229] CESCR General Comment No. 22, para. 34.

[230] Inter-American Commission on Human Rights, “Access to Maternal Health Services from a Human Rights Perspective”, OEA/Ser.L/V/II. Doc. 69, http://cidh.org/women/SaludMaterna10Eng/MaternalHealthTOCeng.htm (accessed October 25, 2015), para. 53. See also Inter-American Court, Artavia Murillo and others Case, Judgment of November 28, 2012, Inter-Am Ct.H.R., Series C. No. 257, paras. 294 and 299. And, Inter-American Commission on Human Rights, “Legal Standards related to Gender Equality and Women’s Rights in the InterAmerican Human Rights System: Development and Application Updates from 2011 to 2014” (2015) http://www.oas.org/en/iachr/reports/pdfs/LegalStandards.pdf (accessed May 2, 2016) citing Inter-American Commission on Human Rights, “Annex to the Press Release Issued at the Close of the 147th Session: Human rights and the criminalization of abortion in South America,” held on March 15, 2013.

[231] ICCPR, art. 17(1).

[232] American Convention on Human Rights, art. 11(2).

[233] See Whelan v. Ireland, CCPR/C/119/D/2425/2014 (2017); Mellet v. Ireland, CCPR/C/116/D/2324/2013 (2016); K.L. v. Peru, CCPR/C/85/D/1153/2003 (2005); and L.M.R. v. Argentina, CCPR/C/101/D/1608/2007 (2011).

[234] See, for example, HRC concluding observation on El Salvador, UN Doc. CCPR/C/SLV/CO/7 (2018).

[235] CRC General Comment No. 20 on the implementation of the rights of the child during adolescence (2016), para. 59.

[236] See, for example, CRC concluding observations on Poland, UN Doc. E/C.12/POL/CO/6 (2016); Indonesia, UN Doc. CRC/C/IDN/CO/3-4 (2014); Venezuela, UN Doc. CRC/C/VEN/CO/3-5 (2014); and Morocco, UN Doc. CRC/C/MAR/CO/3-4 (2014).

[237] See, for example, CRC concluding observations on Sri Lanka, UN Doc. CRC/C/LKA/CO/5-6 (2018); and India, UN Doc. CRC/C/IND/CO/3-4 (2014).

[238] See, for example, CESCR concluding observations on El Salvador, UN Doc. E/C.12/SLV/CO/3-5 (2014); and Slovakia, UN Doc. E/C.12/SVK/CO/2 (2012).

[239] See, for example, CAT concluding observations on Paraguay, UN Doc. CAT/C/PRY/CO/4-6 (2011); and Peru, UN Doc. CAT/C/PER/CO/5-6 (2013).

[240] ICCPR, art. 19(2); American Convention on Human Rights, art. 13(1). See also Inter-American Court, Claude-Reyes and others Case, Judgment of September 19, 2006 Inter-Am Ct.H.R., Series C. No. 151, para. 264.

[241] CEDAW, art. 16(e).

[242] See ICESCR, art. 2(2). See also CESCR General Comment No. 14 on the right to the highest attainable standard of health (2000); and CESCR General Comment No. 22 on the right to sexual and reproductive health (2016).

[243] CESCR General Comment No. 14, para. 11.

[244] CESCR General Comment No. 22, para. 18.

[245] CESCR, “Concluding observations on the fourth periodic report of the Dominican Republic,” October 21, 2016, E/C.12/DOM/CO/4, para. 60(c).

[246] CEDAW Committee, “Concluding observations on the combined sixth and seventh periodic reports of the Dominican Republic,” July 30, 2013, CEDAW/C/DOM/CO/6-7, para. 33(d); Committee on the Rights of the Child, “Concluding observations on the combined third to fifth periodic reports of the Dominican Republic,” March 5, 2015, CRC/C/DOM/CO/3-5, para. 52. See also, for example, CEDAW Committee concluding observations on Burkina Faso, UN Doc. CEDAW/C/BFA/CO/7 (2017); Costa Rica, UN Doc. CEDAW/C/CRI/CO/7 (2017); Ireland, UN Doc. CEDAW/C/IRL/CO/6-7 (2017); and Uruguay, UN Doc. CEDAW/C/URY/CO/8-9 (2016); and CRC concluding observations on Guatemala, UN Doc. CRC/C/GTM/CO/5-6 (2018); Panama, UN Doc. CRC/C/PAN/CO/5-6 (2018); and Sri Lanka, UN Doc. CRC/C/LKA/CO/5-6 (2018).

[247] CRC General Comment No. 20, para. 59. See also para. 61, where the Committee notes that “[a]ge-appropriate, comprehensive and inclusive sexual and reproductive health education, based on scientific evidence and human rights standards and developed with adolescents, should be part of the mandatory school curriculum and reach out-of-school adolescents.”

[248] Inter-American Commission on Human Rights, “Access to Information in Reproductive Health from A Human Rights Perspective,” OEA/Ser.L/V/II. Doc. 61, http://www.cidh.oas.org/pdf%20files/womenaccessinformationreproductivehealth.pdf (accessed October 25, 2015), para. 91.

[249] Ibid., para. 25.

[250] Ibid., para. 92.

[251] CEDAW, art. 16(1).

[252] CEDAW Committee, General Recommendation 28, On the core obligations of States parties under article 2 of the Convention on the Elimination of All Forms of Discrimination against Women, U.N. Doc. CEDAW/C/GC/28 (2010), paras. 19 and 34; CEDAW Committee, General Recommendation 19, Violence against Women, (Eleventh session, 1992), Compilation of General Comments and General Recommendations Adopted by Human Rights Treaty Bodies, U.N. Doc. HRI\GEN\1\Rev.1 (1994) (hereinafter General Recommendation 19), p. 84, para. 9.

[253] CEDAW Committee, General Recommendation 19, Violence against Women, U.N. Doc.A/47/38 (1992) para. 9.

[254] Inter-American Convention on the Prevention, Punishment and Eradication of Violence Against Women (“Convention of Belém do Pará”), adopted September 6, 1994, by the General Assembly of the OAS, entered into force May 3, 1995, ratified by the Dominican Republic on January 10, 1996 arts. 7(b), 9.

[255] CRC, art. 19.

Posted: January 1, 1970, 12:00 am

The Dominican Republic’s total ban on abortion threatens women's health and lives and violates their rights. Abortion is illegal in the Dominican Republic in all circumstances, even when a pregnancy is life-threatening, unviable, or the result of rape. Women and girls facing unwanted pregnancies have clandestine abortions, often at great risk to their health and lives. Many experience health complications from unsafe abortions, and some die. Some women and girls face abuse, neglect, or mistreatment by healthcare providers. The ban does not stop abortion but drives it underground and makes it less safe. As a starting place toward meeting the country’s human rights obligations, Congress should decriminalize abortion in three circumstances, Human Rights Watch said.

Posted: January 1, 1970, 12:00 am

Video

Dominican Republic: What happens when abortion is totally banned?

The Dominican Republic’s total ban on abortion threatens women's health and lives and violates their rights. Abortion is illegal in the Dominican Republic in all circumstances, even when a pregnancy is life-threatening, unviable, or the result of rape. 

(Santo Domingo) – The Dominican Republic’s total ban on abortion threatens women's health and lives and violates their rights, Human Rights Watch said in a report released today. Abortion is illegal in the Dominican Republic in all circumstances, even when a pregnancy is life-threatening, unviable, or the result of rape.

The 78-page report, “‘It’s Your Decision, It’s Your Life’: The Total Criminalization of Abortion in the Dominican Republic,” documents that women and girls facing unwanted pregnancies have clandestine abortions, often at great risk to their health and lives. Many experience health complications from unsafe abortions, and some die. Some women and girls face abuse, neglect, or mistreatment by healthcare providers. The ban does not stop abortion but drives it underground and makes it less safe. As a starting place toward meeting the country’s human rights obligations, Congress should decriminalize abortion in three circumstances.

“Women and girls in the Dominican Republic have always defied the abortion ban, but they have been forced to put their health and lives on the line to end pregnancies clandestinely,” said Margaret Wurth, senior women’s rights researcher at Human Rights Watch and the author of the report. “Congress should decriminalize abortion and ensure that women and girls have access to safe and legal abortion by trained providers, instead of leaving them to use dangerous underground methods.”

Human Rights Watch interviewed 50 women and girls ages 15 to 43, in four provinces, all of whom had been pregnant at least once, and dozens of health and social service providers and other experts.

The country’s criminal code imposes prison sentences of up to two years on women and girls who induce abortions and up to 20 years for medical professionals who provide them. Prosecutions are rare, but the criminal penalties create pervasive fear and harmful stigma. The penalties leave medical providers unable to terminate a pregnancy when it is medically advisable without risking their careers and possible prison time. The ban disproportionately harms women and girls from poor and rural areas, who are less likely to be able to travel to another country where abortion is legal or locate safer clandestine abortion providers.

Research shows that restrictive laws and criminal penalties do not reduce the incidence of abortion. Expert bodies charged with interpreting international human rights law have determined that denying women and girls access to abortion is a form of discrimination that jeopardizes a range of human rights.

Rosa Hernández stands in her home below a photo of her daughter, Rosaura Almonte Hernández, who died in 2012 at age 16. Rosaura, known as “Esperancita,” had leukemia. Doctors initially denied her chemotherapy treatment because she was pregnant, and the Dominican Republic’s abortion ban prohibited her from terminating the pregnancy.

© 2018 Tatiana Fernández Geara for Human Rights Watch
Public Health Ministry data suggests that nearly half the pregnancies in the country are unplanned or unwanted. Many women and girls said they felt “depressed,” “terrified,” “desperate,” or “trapped, with no future,” when they discovered they were pregnant. Some continued unwanted pregnancies, due to personal beliefs or fear of unsafe abortion.

Others tried to end pregnancies, including by taking or inserting pills; using home remedies; trying to induce poor health, for example by denying themselves food or water; taking prescription medications contraindicated during pregnancy; or trying to induce physical trauma. One woman said she beat her belly with a concrete block.

At least 8 percent of the country’s maternal deaths are caused by complications from illegal abortion or miscarriage, according to the Public Health Ministry. “We’ve always recognized that unsafe abortion is an important health problem because women have to appeal to clandestine methods to find an answer to their situation,” said Dr. José Mordán, head of the ministry’s Department of Family Health.

Interview: Defying the Dominican Republic’s Abortion Law

Interview: Defying the Dominican Republic’s Abortion Law

The Dominican Republic is one of the few countries left that bans abortion under all circumstances. This means that women and girls resort to secretly taking pills or herbs and drinking certain teas, all potentially dangerous ways to end unwanted pregnancies. Researcher Margaret Wurth talks to Amy Braunschweiger about what this means for women’s lives.

Complications can include heavy bleeding and infection. The use of misoprostol – a medication used to induce labor and to treat stomach ulcers – for medical abortion has reduced the risk of complications in countries where legal access is restricted. But 25,000 women and girls still seek medical attention for complications related to abortion or miscarriage in the public health system each year.

Some women and girls said they faced negligence, mistreatment, or abusive behavior by health personnel when they sought care for urgent sexual and reproductive health concerns, including being turned away, facing unreasonable delays, and being treated without anesthesia or pain management. Fear of prosecution or abuse by health care professionals led some to delay or go without seeking care following complications from clandestine abortions or during miscarriages.

For over two decades, legislators in the Dominican Republic have debated a new penal code. President Danilo Medina and women’s rights groups have urged lawmakers to decriminalize abortion when the life of the woman or girl is in danger, when the pregnancy resulted from rape or incest, and when the fetus has serious complications incompatible with life outside of the womb. President Medina has twice vetoed revised penal code versions that maintained the total abortion ban, but the National Congress has resisted reform.

Historic votes in Ireland and Argentina in 2018 and a landmark decision to partially decriminalize abortion in Chile in 2017 are just a few examples of global progress toward expanding legal access to abortion. Between 2000 and 2017, 27 countries expanded access to abortion. The Dominican Republic should join the countries affirming that access to abortion is a human right, Human Rights Watch said.

“Congress has an opportunity to enact long-awaited reforms to the Dominican Republic’s penal code and decriminalize abortion, or at least liberalize access,” Wurth said. “Women and girls should not have to wait any longer for the government to guarantee their sexual and reproductive rights.”

Quotes from the report

“I was terrified. I was going crazy, thinking if I can’t even find food for these two babies [I already have], how will I feed a third?”
– “Juliana,” a 16-year-old mother of two, on learning she was pregnant unexpectedly in early 2018. She used home remedies to end the pregnancy but was still experiencing pain and dizziness from complications.

“I started thinking I was not going to survive it…. It was really intense. I suffered a lot.”
– “Melina,” a 26-year-old mother of four young children, on her experience having a clandestine abortion.

“When I went to see her, she had a fever, and she was shaking…. She was afraid to say she had an abortion…. When we went to the doctor, I stayed outside.… I dropped her off and left. And I went back for her. But I didn’t stay because it’s illegal, and I didn’t know if there could be consequences.”
– “Alejandro,” 24, on helping a 28-year-old friend get medical care for complications from an unsafe abortion in 2017.

“It was the first time I had intercourse. I didn’t want to have sex. I didn’t agree. [When I learned I was pregnant,] I was crying and desperate…. A friend gave me a tea, and I had an abortion. …My friend told me to stay at home and endure to the pain. Going to the hospital would mean going to jail.”
Dayelin, 22, describing a clandestine abortion when she became pregnant at age 12 after she was raped by a 25-year-old man.

“Sometimes you have your hands tied. You don’t know what to do. You have the law telling you that you can’t do it [perform an abortion]…. But it doesn’t work like that. The pregnancy can put a woman’s life at risk…My job is to preserve the woman’s life. If I have to violate the law, I will.”
– A doctor in the Dominican Republic.

Posted: January 1, 1970, 12:00 am

Two students at a free non-government school for poor children in the Lyari neighborhood of Karachi, Pakistan. The school provides a few hours of classes per day to children who otherwise have no access to education.

© Insiya Syed for Human Rights Watch, September 2018
Pakistan’s new government has promised to fix one of the country’s biggest conundrums—how to get more girls into school. The UK—which gives more aid to Pakistan than any other country, much of it for education—should both push and help Imran Khan’s government to keep that promise.

Pakistan is facing an education crisis, especially for girls. More than 22 million of Pakistan’s children are out of school, most of them girls. Thirty-two percent of primary school age girls do not attend school, compared with 21 percent of boys. By ninth grade, when children are about age 14, just 13 percent of girls are still in education.

A new Human Rights Watch report cites the government’s under-investment in education, corruption, lack of schools, prohibitive school fees and other education costs, corporal punishment, and a failure to enforce compulsory education as the main culprits. Human Rights Watch also found that education, both in government and low-cost private schools, is often of a poor quality.

Girls also face additional hurdles from Pakistan’s patriarchal society and gender discrimination, child marriage and sexual harassment all make it harder for girls to get an education. Insecurity doesn’t help either. In the past five years, there have been hundreds of attacks on schools, teachers and students, giving already-reluctant parents yet more reasons to keep girls home.

Imran Khan was elected prime minister in July 2018. A relative newcomer to politics, he was supported by many young Pakistanis looking for change and a tough new approach to ending corruption.

He made big promises. Khan’s Pakistan Tehreef i-Insaf political party manifesto pledges reform in virtually every area of government, from tackling climate change to boosting tourism. Among those promises are ones crucial to Pakistan’s girls and women, including what it claims is “the most ambitious education agenda in Pakistan’s history”, spanning reform of and investment in the entire education sector.

The UK prides itself on supporting the rights of women and girls. From the 2014 Girl Summit on child marriage, to William Hague and Angelina Jolie’s initiative to prevent sexual violence in conflict, to the 2018 endorsement of the Safe Schools Declaration, to Boris Johnson’s pledge to prioritize girls’ education, the UK government has sought to be a leader in this field.

Pakistan receives more UK aid money than any other country, and the UK is Pakistan’s second largest bilateral donor, after the US. DFID’s planned aid budget for Pakistan this year is £325 million, and two of DFID’s three largest programmes in Pakistan are education projects, with a total budget of over £108 million. “Investing in girls and women is transformational – for their family, their community, and for the country”, DFID writes, describing its support for girls’ education in Punjab province, and noting that each extra year of schooling raises women’s wages by up to 20 per cent.

All true. And all reasons why the most important thing the UK can do for Pakistani girls is to push—and help—Khan to keep his promises to them. Pakistan’s education crisis results from decades of underinvestment and mismanagement. The government has consistently invested far less in education than is recommended by international standards. As of 2017, Pakistan was spending less than 2.8 percent of its gross domestic product on education—far below the recommended 4 to 6 percent—leaving the sector severely under-funded. Government schools are in such short supply that even in Pakistan’s major cities, many children cannot safely reach a school on foot in a reasonable amount of time. The situation is far worse in rural areas. And there are many more schools for boys than for girls.

Khan’s government can fix this, but many other issues are competing for its attention. The country is in an economic free fall, forcing Khan to desperately seek financial backing. Protests over a recent blasphemy ruling have rocked the country. Security issues are a perennial obsession.

Achieving the nation-wide sweeping reforms Pakistan desperately needs will be difficult and demands resources. There is a high risk these efforts will fall by the wayside.

The UK has an important role to play. Funding education projects is crucial. But so is speaking up for education reform at the highest political levels and insisting that Pakistan’s government be a full partner in the effort to educate its girls—and boys. The UK government should call on Pakistan to boost education spending to at least 4 percent of GDP, provide equal numbers of schools for girls and boys, and ensure that every child has access to—and attends—school.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

More than 22 million children in Pakistan are out of school, and the majority of them are girls. The Pakistan government should do more to provide all children with access to education.

Posted: January 1, 1970, 12:00 am

Video

Video: Girls Deprived of Education in Pakistan

More than 22 million children in Pakistan are out of school, and the majority of them are girls. The Pakistan government should do more to provide all children with access to education.

(London) – The Pakistan government is failing to educate a huge proportion of the country’s girls, Human Rights Watch said in a report released today.

The 111-page report, “‘Shall I Feed My Daughter, or Educate Her?’: Barriers to Girls’ Education in Pakistan,” concludes that many girls simply have no access to education, including because of a shortage of government schools – especially for girls. Nearly 22.5 million of Pakistan’s children – in a country with a population of just over 200 million – are out of school, the majority of them girls. Thirty-two percent of primary school age girls are out of school in Pakistan, compared with 21 percent of boys. By ninth grade, only 13 percent of girls are still in school.

“The Pakistan government’s failure to educate children is having a devastating impact on millions of girls,” said Liesl Gerntholtz, women’s rights director at Human Rights Watch. “Many of the girls we interviewed are desperate to study, but instead are growing up without the education that would help them have options for their future.”

Human Rights Watch interviewed 209 people for the report – most of them with girls who never attended school or were unable to complete their education, and their families – in all four of Pakistan’s provinces: Balochistan, Khyber Pakhtunkhwa, Punjab, and Sindh. Human Rights Watch also interviewed parents, educators, experts, and activists, and visited schools.

Among the factors keeping girls out of school, Human Rights Watch found, are the government’s under-investment in schools, lack of schools, prohibitive school fees and related costs, corporal punishment, and a failure to enforce compulsory education. Human Rights Watch also found poor quality within both government and low-cost private schools, a lack of government regulation of private schools, and corruption.

Witness: Creating Neighborhood Schools in Pakistan

Witness: Creating Neighborhood Schools in Pakistan

Shazia, a teacher who grew up playing in Lyari’s streets, has long worried about the swarms of kids there, some getting in trouble, very few attending school. She wanted them to have a better future, so she quit her paying teaching job and founded the Lyari school – where neighborhood children can study for free.

In addition to these factors within the education system, girls are also blocked from attending school by external factors including child labor, gender discrimination, child marriage, sexual harassment, insecurity, and attacks on education.

The Pakistan government has consistently invested far less in education than is recommended by international standards. As of 2017, Pakistan was spending less than 2.8 percent of its gross domestic product on education – far below the recommended 4 to 6 percent – leaving the government’s education system severely under-funded. Government schools are in such short supply that even in Pakistan’s major cities, many children cannot reach a school on foot safely in a reasonable amount of time. The situation is far worse in rural areas. And there are many more schools for boys than for girls.

Aisha, around age 30, lives with her husband and their six children in an area of Peshawar where the nearest government school for boys, offering nursery school through 10th grade, is less than a five-minute walk away. The nearest government school for girls is a 30-minute walk and goes only through fifth grade. Aisha’s daughter left school when she was 9 because of her parents’ concerns about her safety walking to school.

Students at morning exercises at Behar Colony Government Secondary school for girls located in the Lyari neighborhood of Karachi, Pakistan. 

© Insiya Syed for Human Rights Watch, September 2018.
“Even parents who are not educated themselves understand that their daughters’ future depends on them going to school, but the government is abandoning these families,” Gerntholtz said. “Pakistan’s future depends on educating its children, including its girls.”

An “upward bottleneck” exists as children, especially girls, get older. Secondary schools are in shorter supply than primary schools, and colleges have even less capacity, especially for girls. Many girls who complete the top level at one school cannot access a school where they could go on to the next level. In the absence of an adequate system of government schools, there has been a massive growth in the number of private schools, many of them low-cost. But poor families often cannot afford any tuition fees and the government’s near-total failure to regulate and monitor these schools means that many are of poor quality.

Newly-elected Prime Minister Imran Khan’s political party’s manifesto promises major reforms to the education system, including for girls’ education. “We will prioritise establishment and upgradation of girls’ schools and provide stipends to girls and women for continuing their education,” the manifesto says. It pledges to “put in place the most ambitious education agenda in Pakistan’s history, spanning reform of primary, secondary, tertiary, vocational, and special education.”

“The government recognizes that education reform is desperately needed and promises to make this a priority, especially for girls – a positive step,” Gerntholtz said. “We hope that our findings will help the government to diagnose the problems and identify solutions that will give every Pakistani girl a bright future.”

Selected Quotes from People Interviewed

Lack of investment and shortage of government schools

“I could send them if there was a government school.”
—Akifah, 28, mother of three children, ages 10, 8, and 7. The family moved from a village near Multan to Karachi three years earlier, looking for work, and had no choice but to settle in an area where there were only private schools the family cannot afford, and no government schools within reach.

“My parents said, ‘If you are interested enough you can walk there.’ Whoever wanted to, went. I found it too far. The path is lonely and isolated and there have been cases of two or three kidnappings in that area… But then I realized I needed to study so I convinced my parents and I got friends to go so we walked to school together.”
—Asifa, 20, in Punjab, who delayed attending school until she was 9 or 10 because it was a 45-minute walk from her village. The school only went through eighth grade, so after that she went to live with her sister in a town where grades nine and ten were available. 

“The state has never taken education seriously—proper resources have never been allocated in any state. The problem is the priories of government—education is not a priority and they don’t allocate the budget.”
—Head of a nongovernmental organization working on women’s rights, Punjab.

“[E]very mother wants their child to be educated, but there is not a state system to deliver the services.”
—Head of a community-based organization, Karachi.

Gender discrimination in the government’s provision of schools

“If you have 10 schools for boys, you have 5 for girls.”
—An education expert from Khyber Pakhtunkhwa.

Poverty and the cost of education

“The government doesn’t help the poor. We can’t educate our children, and we can’t feed ourselves.”
—Rukhsana, 30, mother of three out-of-school children, whose husband is rarely able to work due to illness, who was unable to pay for school fees and related costs, Karachi.

“The school may be free, but there are always demands for money for something or the other. Copies, stationery, every day there is a new expense. A school bag alone costs 500 rupees [US$4.76]…. Every day, every day, it’s something.”
—Zarifah, a mother of five out-of-school children, Balochistan.

“I wanted my daughters to get educated, but I couldn’t because of poverty. My husband’s salary is 12,000 rupees [$114] a month. At the end of the month, we are always out [of money] and wonder what to do – it is all gone. I want a school for girls who belong to poor families.”

—Halima, 38, in Karachi, mother of five daughters, ages 13 to 19, none of whom studied more than a year or two. Her husband works in a chewing gum factory.

Quality concerns and corruption

“A lot of times the teacher showed up late or he would not show up at all. We would just go and sit and then come home.”
—Hakimah, 17, Karachi, describing her primary school.

“For the last five years, everyone has to pay [to obtain a government teaching position]. It’s worth it just for the salary – it’s an investment. This has an impact on the quality of the teaching – there’s no teaching.”
—Director of a community-based organization, Karachi.

“Once or twice a year they [inspectors] come, unannounced. They come for a half hour. They want tea and to be entertained. You have to please them or they will say that your school is not good. Once I made the inspector wait and he got mad and left and said, ‘I will write a bad report.’ My colleague went to his house and gave him 25,000 rupees [$238] and we got a good report.”
—Private school principal, describing government monitoring of the school, Punjab.

Posted: January 1, 1970, 12:00 am

She opened the school around 2014 in a room in her grandmother’s home. At first, Shazia only had three students, but she went door-to-door recruiting more children, telling parents about the school and encouraging kids to attend. She makes a special effort to recruit girls, who are less likely than their brothers to be in school. It wasn’t easy – many  parents didn’t understand the importance of education, especially for daughters. But the students came, and now around 50 children ages 6 to 17 attend her school, and Shazia has two additional volunteers helping out.

“Every child should acquire an education,” she says.

Yet in Pakistan, nearly 22.5 million children are out of school. The situation is dire for Pakistan’s girls, only 13 percent of whom make it to ninth grade, according to a new Human Rights Watch report, “‘Shall I Feed My Daughter, or Educate Her’: Barriers to Girls’ Education in Pakistan.” One reason is that families simply cannot afford education. While government schools are free, there are too few of them – and families must still pay for uniforms, school supplies, and exam fees. Private schools are too expensive for many poor families. Both government and low-cost private schools sometimes offer poor quality education, leaving people skeptical of school’s benefits.

As ever more poor children grow up illiterate in Pakistan, people like Shazia are taking action in their communities, improvising, teaching children, and trying to bridge the gap between what the government provides and what kids need.

Shazia is young, only 23, and dresses like other women in the area, with a colorful scarf worn loosely around her head and shoulders. She speaks with poise and confidence, and is clearly a force when it comes to realizing her vision.

Video

Video: Girls Deprived of Education in Pakistan

More than 22 million children in Pakistan are out of school, and the majority of them are girls. The Pakistan government should do more to provide all children with access to education.

Her own family was poor – her mother passed away when she was only 4 or 5 but her father saw to it that she received a good education. She grew up in Lyari, but at that time, the neighborhood was safe and she and the other kids played in the streets. This changed by the time she was old enough to take her high school exams. “We used to be really scared that [someone] might start firing over here any minute or a bomb could land here anytime.”

Also, the schools weren’t good. As they still do today, people sometimes obtained teaching contracts through corruption, keeping the salary without showing up. Regularly without a teacher, Shazia would often teach herself her lessons.

In her school, Shazia teaches Urdu, English, and math, and the kids read poetry. But before starting lessons, she plays indoor games with the children and teaches them soccer and boxing. Otherwise, the children would never come back, she says. Once they like coming to the school, the academic lessons begin.

Many of her students have never been to school. “We have a lot of girls, especially girls who cannot read anything. They cannot even read their own names,” she says. The gang violence, which peaked in 2015 but has since been quelled, interrupted the education of some of her kids. Older children who haven’t attended schools are told they are too old to enroll in government schools – hers is possibly their only option. 

A mother takes her daughter to school in Islamabad. government schools generally offer free tuition, but parents and students are still obliged to pay for uniforms, school supplies, and exams fees. These costs put education out of reach for many poor families.

© REUTERS/Sara Farid, February 2014

But it’s not easy convincing parents to let their children take classes. Many parents never went to school, Shazia says, and expect children to work, selling merchandise or food on the street or doing work like sewing or embroidery at home. Girls are often also responsible for household work and fetching water. Some girls who come to Shazia’s school have to look after their younger siblings while their mom works. “Girls leaving their house is thought of as something really wrong,” she said.

But these challenges don’t stop Shazia. She tells parents that their children need a place to go while they work, otherwise they could get in trouble. A few parents still refuse. But some of the children come despite this, because they want to and no one is home to stop them. Ten or 15 children study with her in the evening after working all day.

Shazia admits the children can be difficult. It’s hard to control them as they’re not used to adults telling them what to do, and some act out because of problems at home. At first, Shazia was very gentle, but they didn’t listen to her. Over time, she learned that by being stricter – for example, telling the kids that if they didn’t listen, she won’t let them play games – the children began to listen to her. No adult at her school is ever allowed to hit children.

Students at Behar colony government Secondary School for girls in the lyari neighborhood of Karachi, Pakistan.

© Insiya Syed for Human Rights Watch, September 2018

Because the kids don’t have backpacks or books, Shazia often buys supplies with her own money. Her school is also supported by local nongovernmental organizations, like Arado Pakistan, which has donated furniture and paper. “It’s very difficult to keep this school running, but it is also not impossible.”

She’s extremely grateful to her family – they allowed her to quit a paying job to work for free for the betterment of her community – and to her grandmother specifically, who let her start the school in her home.

She hopes her school is a haven for all students, and especially for girls, who make up 70  percent of her students. She says most people in her community don’t believe girls can or should work at an office or get a job outside of the country like boys can. She disagrees. “If we want to change this mind set now, we’d have to change ourselves,” she says, believing parents of girls should give them “encouragement and convince them to go further.”

Her goal is not just to teach her students how to read and write, but how to be good human beings. “Who knows what they’ll do when they grow up?” she says. 

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Summary

If we don’t get education, our nation won’t progress.
—Rabiya, 23, single mother of a daughter, Karachi, July 2017.

Pakistan was described as “among the world’s worst performing countries in education,” at the 2015 Oslo Summit on Education and Development. The new government, elected in July 2018, stated in their manifesto that nearly 22.5 million children are out of school. Girls are particularly affected. Thirty-two percent of primary school age girls are out of school in Pakistan, compared to 21 percent of boys. By grade six, 59 percent of girls are out of school, versus 49 percent of boys. Only 13 percent of girls are still in school by ninth grade. Both boys and girls are missing out on education in unacceptable numbers, but girls are worst affected.

Political instability, disproportionate influence on governance by security forces, repression of civil society and the media, violent insurgency, and escalating ethnic and religious tensions all poison Pakistan’s current social landscape. These forces distract from the government’s obligation to deliver essential services like education—and girls lose out the most.

There are high numbers of out-of-school children, and significant gender disparities in education, across the entire country, but some areas are much worse than others. In Balochistan, the province with the lowest percentage of educated women, as of 2014-15, 81 percent of women had not completed primary school, compared to 52 percent of men. Seventy-five percent of women had never attended school at all, compared to 40 percent of men. According to this data, Khyber Pakhtunkhwa had higher rates of education but similarly huge gender disparities. Sindh and Punjab had higher rates of education and somewhat lower gender disparities, but the gender disparities were still 14 to 21 percent.

Across all provinces generation after generation of children, especially girls, are locked out of education—and into poverty. In interviews for this report, girls talked again and again about their desire for education, their wish to “be someone,” and how these dreams had been crushed by being unable to study.

Lack of access to education for girls is part of a broader landscape of gender inequality in Pakistan. The country has one of Asia’s highest rates of maternal mortality. Violence against women and girls—including rape, so-called “honor” killings and violence, acid attacks, domestic violence, forced marriage and child marriage—is a serious problem, and government responses are inadequate. Pakistani activists estimate that there are about 1,000 honor killings every year. Twenty-one percent of females marry as children.

Pakistan’s education system has changed significantly in recent years, responding to an abdication by the government of responsibility to provide, through government schools, an adequate standard of education, compulsory and free of charge, to all children. There has been an explosion of new private schools, largely unregulated, of wildly varying quality. A lack of access to government schools for many poor people has created a booming market for low-cost private schools, which in many areas are the only form of education available to poor families. While attempting to fill a critical gap, these schools may be compromised by poorly qualified and badly paid teachers, idiosyncratic curricula, and a lack of government quality assurance and oversight.

Girls attend lessons at a school on the outskirts of Islamabad. Poor facilities at many schools make it difficult for children to study, with a lack of safe and adequate toilets particularly affecting girls who have commenced menstruation.

© 2013 Zohra Bensemra/Reuters

Secondly, there has been a massive increase in the provision of religious education, ranging from formal madrasas to informal arrangements where children study the Quran in the house of a neighbor. Religious schools are often the only type of education available to poor families. They are not, however, an adequate replacement, as they generally do not teach non-religious subjects.

Pakistan’s highly decentralized structure of government means that many decisions regarding education policy are made at the subnational level. The result is a separate planning process in every province, on a different timeline, with varying approaches, levels of effectiveness and commitment to improving access to education for girls. This leads to major differences from one province to the next, including on such basic issues as whether children are charged fees to attend government schools, and how much teachers are paid.

In every province, however, there is a serious gender disparity, a high percentage of both boys and girls who are out of school, and clear flaws in the government’s approach to education.

Video

Video: Girls Deprived of Education in Pakistan

More than 22 million children in Pakistan are out of school, and the majority of them are girls. The Pakistan government should do more to provide all children with access to education.

Barriers to Girls’ Education Within the School System

Many of the barriers to girls’ education are within the school system itself. The Pakistan government simply has not established an education system adequate to meet the needs of the country’s children, especially girls. While handing off responsibility to private school operators and religious schools might seem like a solution, nothing can absolve the state of its obligation, under international and domestic law, to ensure that all children receive a decent education—something that simply is not happening in Pakistan today. Moreover, despite all the barriers, many people interviewed for this report described a growing demand for girls’ education, including in marginalized communities.

Students walk to school in Behar colony of Karachi. A shortage of government schools, especially for girls, leaves many girls walking long distances to school during which they often face sexual harassment. Shortage of schools or sexual harassment may lead to girls being shut out or dropping out of education entirely.

© Insiya Syed for Human Rights Watch, September 2018

Lack of Investment

The government does not adequately invest in schools. Pakistan spends far less on education than is recommended by the United Nations Educational, Scientific and Cultural Organization (UNESCO) in its guidance on education. Many professionals working in the education sector described a situation in which the government seemed disinterested, and government disengagement on education is evident from the national level to the provincial and local levels.

One result is that there are not enough government schools for all children to have access to one. Government schools are in such short supply that even in Pakistan’s major cities many children cannot reach a school on foot safely and in a reasonable amount of time. The situation is far worse in rural areas, where schools are even more scarce, and it is less likely that private schools will fill the gap. Families that can access a government school often find that it is overcrowded.

An “upward bottleneck” exists as children, especially girls, get older. Secondary schools are in shorter supply than primary schools, and colleges are even more scarce, especially for girls. Schools are more likely to be gender segregated as children get older, and there are fewer schools for girls than for boys. Many girls are pushed out of continuing studies because they finish at one school and cannot access the next grade level.

Students check the attendance register at Behar colony government Secondary School for girls in the lyari neighborhood of Karachi, Pakistan.

© Insiya Syed for Human Rights Watch, September 2018

High Cost of Education

Poor families struggle to meet the costs of sending their children to school. Government schools are generally more affordable than private education, but they sometimes charge tuition, registration or exam fees, and they almost always require that students’ families foot the bill for associated costs. These include stationery, copies, uniforms, school bags, and shoes. Text books are sometimes provided for free at government schools, but sometimes families must pay for these as well.

The many poor families who cannot access a government school are left with options outside the government school system. The range of private schools, informal tuition centers, nongovernmental organization (NGO) schools, and madrasas creates a complex maze for parents and children to navigate. Many girls experience several—or all—of these forms of study without gaining any educational qualifications.

Poor Quality of Education

Many families expressed frustration about the quality of education available to them. Some said it was so poor that there was no point sending children to school. In government schools, parents and students complained of teachers not showing up, overcrowding, and poor facilities. At private schools, particularly low-cost private schools, concerns related to teachers being badly educated and unqualified, and the instruction being patchy and unregulated. Teachers in both government and private schools pressure parents to pay for out-of-school tutoring, an additional expense. In both government and private schools, use of corporal punishment and abusive behavior by teachers was widely reported.

Students at Behar colony government Secondary School for girls in the lyari neighborhood of Karachi, Pakistan. Only 13 percent of girls in Pakistan are still in school by ninth grade. While there is an overall shortage of schools for girls, the shortage becomes worse as girls progress beyond primary school.

© Insiya Syed for Human Rights Watch, September 2018

No Enforcement of Compulsory Education

One reason so many children in Pakistan do not go to school is that there is no enforced government expectation that children should study. Pakistan’s constitution states, “The State shall provide free and compulsory education to all children of the age of five to sixteen years in such manner as may be determined by law.” However, there is no organized effort by government in any province to ensure that all children study. When children are not sent to school, no government official reaches out to the family to encourage or require that the child study. When a child drops out of school, individual teachers sometimes encourage the child to continue studying, but there is no systematic government effort to enroll or retain children in school. This violates international standards Pakistan has signed up to which require that education be free and compulsory at least through primary school.

Corruption

Corruption is a major issue in the government school system and exists in several forms. One of the most pervasive is nepotism or bribery in the recruitment of teachers and principals. Some people simply purchase teaching positions, and others obtain their jobs through political connections. When people obtain teaching positions illicitly, they may not be qualified or motivated to teach, and they may not be expected to. Especially in rural areas, some schools sit empty because corruption has redirected the teacher’s salary to someone who does not teach, according to education experts.

Barriers to Girls’ Education Outside the School System

Aside from the barriers to education within the school system, girls also face barriers in their homes and in the community. These include poverty, child labor, gender discrimination and harmful social norms, and insecurity and dangers on the way to school.

Poverty

For many parents, the most fundamental barrier to sending their children to school is poverty. Even relatively low associated costs can put education out of reach for poor families, and there are many poor families in Pakistan. In 2016, the government determined that about 60 million Pakistanis—6.8 to 7.6 million families—were living in poverty, about 29.5 percent of the country’s population.

Many children, including girls, are out of school because they are working. Sometimes they are engaged in paid work, which for girls often consists of home-based industries, such as sewing, embroidery, beading, or assembling items. Other children—almost always girls—are kept home to do housework in the family home or are employed as domestic workers.

Social Norms

Some families do not believe that girls should be educated or believe girls should not study beyond a certain age. Attitudes regarding girls’ education vary significantly across different communities. In some areas, families violating cultural norms prohibiting girls from studying can face pressure and hostility. When families violate norms against girls’ education, the girls themselves may face harmful consequences. Many people, however, described growing acceptance of the value of girls’ education, even in conservative communities; the government should be encouraging this change.

Students at Behar colony government Secondary School for girls in the lyari neighborhood of Karachi, Pakistan.

© Insiya Syed for Human Rights Watch, September 2018

Girls are often removed from school as they approach puberty, sometimes because families fear them engaging in romantic relationships. Other families fear older girls will face sexual harassment at school and on the way there and back.

Harmful gender norms create economic incentives to prioritize boys’ education. Daughters normally go to live with, and contribute to, their husband’s family, while sons are expected to remain with their parents—so sending sons to school is seen as a better investment in the family’s economic future.

Child marriage is both a consequence and a cause of girls not attending school. In Pakistan, 21 percent of girls marry before age 18, and 3 percent marry before age 15. Girls are sometimes seen as ready for marriage as soon as they reach puberty, and in some communities, child marriage is expected. Some families are driven to marry off their daughters by poverty, and others see child marriage as a way of preempting any risk of girls engaging in romantic relationships outside marriage. Staying in school helps girls delay marriage, and girls often are forced to leave school as soon as they marry or even become engaged.

Insecurity

Many families and girls cited security as a barrier to girls studying. They described many types of insecurity, including sexual harassment, kidnapping, crime, conflict, and attacks on education. Some families said insecurity in their communities worsened in recent years, meaning younger children have less access to education than older siblings.

Families worry about busy roads; the large distance many girls must travel to school increases risks and fears. Many girls experienced sexual harassment on the way to school, and police demonstrate little willingness to help prevent harassment. Girls sometimes hesitate to complain about harassment out of fear they will be blamed, or their parents’ solution will be to take them out of school.

Laiba, age eight, with Shazia, the founder of the lyari School. The lyari School is a free school in Karachi, Pakistan providing classes for local children who otherwise have no access to education. activists and community groups have created such informal schools in a number of areas without access to government schools.

© Insiya Syed for Human Rights Watch, September 2018

Girls and families also fear kidnapping, another fear exacerbated by long journeys to school. This fear is heightened when girls are older and seen as being at greater risk of sexual assault. Attacks on education are disturbingly common in Pakistan. When violence happens in a school or in a neighborhood, it has long term consequences for girls’ education. Families across different parts of the country described incidents of violence in their communities that kept girls out of school for many years afterwards.

Armed Conflict and Targeted Attacks on Schools

Many parts of Pakistan face escalating levels of violence related to insurgency, and ethnic and religious conflict. This is having a devastating impact on girls’ access to education, and ethnic conflict often spills into schools.

One of the features of conflict in Pakistan has been targeted attacks against students, teachers, and schools. The most devastating attack on education in recent years in Pakistan was the December 2014 attack on the Army Public School in Peshawar city, where militants killed 145 people, almost all of them children. This attack was far from isolated, however. Between 2013 and 2017, hundreds of schools were attacked, typically with explosive devices, killing several hundred students and teachers, and damaging and destroying infrastructure. One-third of these attacks specifically targeted girls and women, aiming to interrupt their studies.

Pakistan can, and should, fix its school system. The government should invest more resources in education and use those resources to address gender disparities and to ensure that all children—boys and girls—have access to, and attend, high quality primary and secondary education. The future of the country depends on it.

 

Key Recommendations

To the Federal Government of Pakistan

  • Increase expenditure on education in line with UNESCO recommended levels needed to fulfill obligations related to the right to education.
  • Strengthen oversight of provincial education systems’ progress toward achieving parity between girls and boys and universal primary and secondary education for all children, by requiring provinces provide accurate data on girls’ education, monitoring enrolment and attendance by girls, and setting targets in each province.
  • Strengthen the federal government’s role in assisting provincial governments in provision of education, with the goal of ending gender disparities in all provinces.
  • Work with provincial governments to improve the quality of government schools and quality assurance of private schools.
  • Raise the national minimum age of marriage to 18 with no exceptions and develop and implement a national action plan to end child marriage, with the goal of ending all child marriage by 2030, as per Sustainable Development Goal target 5.3.
  • Endorse and implement the Safe Schools Declaration, an international political agreement to protect schools, teachers, and students during armed conflict.

To Provincial Governments

  • Direct the provincial education authority to make girls’ education a priority within the education budget, in regard to construction and rehabilitation of schools, training and recruitment of female teachers, and provision of supplies, to address the imbalance between the participation of girls and boys in education.
  • Strengthen enforcement of anti-child labour laws.
  • Instruct police officials to work with schools to ensure the safety of students, including monitoring potential threats to students, teachers and schools, and working to prevent harassment of students, especially girls.
  • Ensure that anyone encountering corruption by government education officials has access to effective and responsive complaint mechanisms.

To Provincial Education Authorities

  • Rehabilitate, build, and establish new schools, especially co-ed and girls’ schools.
  • Until government schools are available, provide scholarships to good-quality private schools for girls living far from government schools.
  • Provide free or affordable transport for students who travel long distances or through difficult environments to get to a government school.
  • Abolish all tuition, registration, and exam fees at government schools.
  • Provide poor students with all needed items including school supplies, uniforms, bags, shoes, and textbooks.
  • Instruct all principals to identify out-of-school children in their catchment areas and work with families to get them into school.
  • Explore options for increasing attendance by girls from poor families through scholarships, food distribution, or meal programs at girls’ schools.
  • When children quit school or fail to attend, ensure all schools reach out to determine the reasons and re-engage the student in school.
  • Require each school to develop and implement a security plan with attention to concerns of girls including sexual harassment.
  • Develop a plan to expand access to middle and high school for girls through the government education system, including establishment of new schools.
  • Strengthen the system for monitoring and quality assurance of all schools, not only for government schools but also private schools and madrasas.
  • Prohibit all forms of corporal punishment in schools; take appropriate disciplinary action against any employee violating this rule.
  • Ensure that all schools have adequate boundary walls, safe and private toilets with hygiene facilities, and access to safe drinking water.

 

Methodology

This report is primarily based on research conducted in Pakistan in 2017 and 2018. Human Rights Watch researchers carried out a total of 209 individual and group interviews, mainly in Karachi, Lahore, Peshawar, and Quetta.

Most of the interviewees—a total of 119—were girls and young women who either had missed all of their primary and secondary education or had started some education but were unable to continue and dropped out. We also interviewed 60 parents and other family members of children who either had not attended school or had dropped out.

In addition, we interviewed 12 teachers, and four school principals. An additional 18 interviews were with education experts, activists and community workers, or local officials.

Interviews with children and families were usually conducted in their homes, or at the home of a neighbor. Some interviews were conducted in the offices of community-based organizations or at schools. Whenever possible, interviews were conducted privately with only the interviewee, a Human Rights Watch researcher, and, where necessary, an interpreter present. Interviews were conducted in Urdu, Punjabi, Pashto, Sindhi, Saraiki, Brahui, and, with some experts and educators, in English. In a few cases, interviews were conducted through double translation. Some interviews with experts were conducted by phone or in person outside of Pakistan.

Laiba, age eight, a student at the lyari School. laiba’s older sister is not able to study at all because she is responsible for housework and caring for her younger siblings.

© Insiya Syed for Human Rights Watch, September 2018

All interviewees were advised of the purpose of the research and how the information would be used. We explained the voluntary nature of the interview and that they could refuse to be interviewed, refuse to answer any question, and terminate the interview at any point. Interviewees did not receive any compensation. The names of children and family members have been changed to pseudonyms to protect their privacy. The names of other interviewees have sometimes been withheld at their request.

We selected research sites in Karachi, Lahore, Peshawar, and Quetta with the goal of getting a sample of different experiences of out-of-school children and their families, including in urban environments. We made an effort to include families who migrated to the city from rural areas, and refugee families. We also conducted interviews in some rural areas, but the research was primarily in urban areas. Security challenges affected our choice of research sites.

In this report, the terms “child” and “children” are used to refer to anyone under the age of 18, consistent with usage under international law.

At the time of the research for this report, the exchange rate was approximately 105 Pakistani rupees=US$1. We have used this rate for conversions in the text.

 

I.  Background

Pakistan was described as “among the world’s worst performing countries in education,” at the 2015 Oslo Summit on Education and Development.[1] The new government, elected in July 2018, stated in their manifesto that nearly 22.5 million children are out of school.[2] Thirty-two percent of primary school age girls are out of school in Pakistan, versus 21 percent of boys in that age group.[3] This represents a total of almost 5 million children of primary school age who are not in school, 62 percent of them girls.[4]

As children reach middle school level—sixth grade, when children would typically be about age 10 or 11—the total number of out of school children increases, and the gender disparity persists. In 2016, 59 percent of middle school girls were out of school versus 49 percent of boys.[5] According to 2013-2014 data, by ninth grade, only 13 percent of girls are still in school.[6]

Both boys and girls are missing out on education in unacceptable numbers, but girls are worst affected, especially poor girls. Among the poorest students, only 30 percent of boys finish primary school, and only 16 percent of girls.[7] By lower secondary school, the numbers of the poorest children completing their studies is even more unequal: 18 percent of boys and 5 percent of girls.[8] Only one percent of the poorest girls finish upper secondary school, compared with 6 percent of the poorest boys.[9]

Political instability, disproportionate influence on governance by security forces, repression of civil society and the media, violent insurgency, and escalating ethnic and religious tensions all poison Pakistan’s current social landscape. These forces distract from the government’s obligation to deliver essential services like education—and girls lose out the most.[10]

There are high numbers of out-of-school children, and significant gender disparities in education, across the entire country, but some areas are much worse than others. As of 2014-2015, which is the most recent published data, the percentage of people who had ever attended school was:

Balochistan:                  25 percent of women, 60 percent of men

Khyber Pakhtunkhwa:   36 percent of women, 74 percent of men

Sindh:                           50 percent of women, 71 percent of men

Punjab:                         56 percent of women, 74 percent of men

 

Similar gender and regional disparities existed among those who completed primary school:

Balochistan:                  19 percent of women, 48 percent of men

Khyber Pakhtunkhwa: 28 percent of women, 59 percent of men

Sindh:                           43 percent of women; 62 percent of men

Punjab:                         47 percent of women; 61 percent of men[11]

Across all provinces, generation after generation of children, especially girls, are locked out of education—and into poverty. In interviews for this report, girls talked again and again about their desire for education, their wish to “be someone,” and the ways in which these dreams had been crushed by being unable to study.

Lack of access to education for girls is part of a broader landscape of gender inequality in Pakistan. The country has one of Asia’s highest rates of maternal mortality.[12] Violence against women and girls—including rape, so-called “honor” killings and violence, acid attacks, domestic violence, forced marriage and child marriage—is a serious problem, and government responses are inadequate.[13] Pakistani activists estimate that there are about 1,000 honor killings every year.

One particularly concerning theme in some interviews for this report was numerous families in which children were less educated than their parents, or younger siblings were less educated than older siblings. Some families were unrooted by poverty or insecurity in ways that blocked children from studying. Some encountered financial difficulties that made it impossible for children to reach the educational level their parents had achieved. In some communities, schools had closed, or the route to school had become more unsafe. In a few families, views hostile to girls’ education had hardened over time.[14]

A girl studying at the lyari school.

© Insiya Syed for Human Rights Watch, September 2018

Pakistan’s education system has changed significantly in recent years, responding to an abdication by the government of responsibility to provide, through government schools, an adequate standard of education, compulsory and free of charge, to all children. There has been an explosion of new private schools, largely unregulated, of wildly varying quality. The number of private schools increased by 69 percent during the period from 1999-2000 to 2007-2008 alone, a period during which the number of government schools increased by only 8 percent.[15] This increased the private schools’ share of total student enrollment to 34 percent.[16] The All Pakistan Private Schools Federation has 197,000 member schools.[17]

There has also been a massive increase in the number of programs offering religious education, ranging from formal madrasas to informal arrangements where children study the Quran in the house of a neighbor. Because many religious schools are informal, it is difficult to estimate how many exist, but commentators agree that the number has risen sharply over recent decades.[18]

A variety of nonprofit schools also exist in Pakistan, though there are far too few to meet the needs of the many families struggling to access education. They range from tiny informal arrangements, such as individuals tutoring a few children in their home for free, to “informal schools” some of which are funded by international donors, to organizations like the Citizens Foundation which boasts over 200,000 students.[19] The Citizens Foundation charges low fees—175 rupees per month (US$1.67).[20]

Some nonprofit private schools are only for girls.[21] Others are based in particularly marginalized communities including, for example, schools located in areas with many Afghan immigrants or in fishing communities.[22]

The lines between nonprofit schools and private tuition can be blurred, with some informal schools representing a mix of philanthropy and business, with some teachers charging students who can pay and letting the poorest children attend for free.[23] Tuition teachers sometimes aim to transition their students into a government school but face the same barriers—usually distance and cost—that kept the students out of school in the first place.[24]

In addition to schools run as charities, nongovernmental organizations (NGOs) also sometimes help other schools, for example by providing books to schools in poor areas.[25] The demand for assistance is far greater than the supply. Many families said they had sought assistance from charities to educate their children but were unable to find help.[26]

The area outside the classroom at the lyari School, a free nongovernment school in Karachi, Pakistan serving children who otherwise do not have access to education.

© Insiya Syed for Human Rights Watch, September 2018

Research on educational outcomes for different types of educational institutions suggests that when you control for the differences in intake characteristics of students between government and private schools, their outcomes are in terms of testing achievement are similar.[27] On the other hand, outcomes for children who studied only at madrasas were considerably worse.[28]

Pakistan’s highly decentralized structure of government means that decisions regarding education policy are mostly made at the subnational level, consisting of four provinces (Balochistan, Khyber Pakhtunkhwa, Punjab, and Sindh), the capital area containing Islamabad, and the federally-administered tribal areas near the Afghanistan border, and the administrative entities of Azad Kashmir and Gilgit-Baltistan. Every province has a separate planning process, on a different timeline, with varying approaches and levels of effectiveness and commitment to improving access to education for girls.[29] The result is that education policies and practices vary significantly from one part of the country to the next, including on such basic issues as whether children are charged fees to attend government schools, and how much teachers are paid.

Despite all the barriers, many people interviewed for this report described a growing demand for girls’ education, including in marginalized communities. Aziza, 45, lives in a fishing community on the fringes of Karachi. She never studied; all her five children attended at least a few years of school, though none went beyond primary education. “Now it reflects well on the parent when a child is able to do well for themselves,” Aziza said. “Back then in this area we had no experience of educated people, but now we do. So, everyone is interested now in getting an education.”[30]

Some experts pointed to growing acceptance that girls should study. A school headmaster cited four reasons for this: 1) a desire by boys and men to marry educated brides; 2) growing availability of education as a result of the spread of private schools; 3) efforts by the government to push people away from studying in madrasas and toward mainstream education; and 4) a growing belief by families that educated women better contribute to their families, even if their role is only inside the home.[31]

Bushra, second from the right, a 10th grader at Behar colony government Secondary School for girls, at home with her family. Bushra’s mother, far left, never studied; she married at age 14. like an increasing number of parents who also did not have the chance to attend school, she sees the value of education, including for girls, and hopes for a better life for her daughters.

© Insiya Syed for Human Rights Watch, September 2018

Alima is sending her 20-year-old daughter to college, where she is in 11th grade, even though the family struggles to survive on the money Alima earns as a seamstress and her husband as a fruit seller. [32]  Alima’s two older children, both sons, left school in ninth and 10th grades to work as weavers to help meet the family’s rent. “Because she’s the last child we put in all this effort for her,” Alima said. “If it was up to me, I would put the same kind of focus on all my children, but because of our financial situation I couldn’t. Now, because there are four people in the family earning, we can.… I hope she can study to the point where she doesn’t have to live like me.”[33]

“A lot of work is behind this awareness,” an NGO worker in a poor area of Karachi said, describing what she said was swiftly growing demand for education in the area. She attributed the change to the work of NGOs and others in creating schools in the area. “The literacy rate here is quite high compared to some other areas,” she said. “There are a lot of schools here and people are generally aware regarding the importance of education.”[34]

“Some people say girls should take care of homes, they shouldn’t study,” said a school headmaster in Punjab. “Since they are children, they are preparing to be housewives. But very few people think like this now.”[35]

“I’ve never even seen the face of a school,” said Razia, 37, a mother of four. “I really wanted to study, but my father wouldn’t let me.… In our family it is a tradition that girls don’t study.” Razia struggled to teach herself to read, and she says girls’ education is more accepted now, including in her own family. “The girls in my family are all studying now,” she said. “Things have changed because education changes you…. Before people weren’t educated and now they are and that’s made them accept girls.”[36]

 

II.      Barriers to Girls’ Education within the School System

           

[E]very mother wants their child to be educated but there is not a state system to deliver the services.
—Head of a community-based organization, Karachi, July 2017

While girls face barriers to education outside the school system, many of the most serious barriers to girls’ education are within the school system. The government’s education system suffers from a chronic lack of investment. This means that many children are too far from the nearest school to travel there safely in a reasonable amount of time, if they do not have access to transportation, a problem that becomes more acute as children reach higher grades and schools are in ever-shorter supply. Compulsory education exists on paper but there is no functioning mechanism to require that children go to school. Corruption and nepotism affect who gains employment in the school system, and rural areas are particularly underserved. The Pakistan government has not established an education system adequate to meet the needs of the country’s children.

Lack of Investment

The government does not adequately invest in schools. A 2015 paper commissioned by the United Nations Education, Scientific and Cultural Organization (UNESCO) found that to meet the 2030 Sustainable Development Goals education targets, which include universal completion of primary and secondary school, Pakistan would need to at least double the percentage of GDP going to education.[37]

According to UNESCO guidance to governments, in order for the government to fulfill its obligations on education, it should spend at least 15 to 20 percent of the total national budget, and 4 to 6 percent of GDP, on education.[38] Pakistan is one of about 33 countries which meets neither of these benchmarks, and the percentage increase in expenditure on education has sometimes lagged behind the rate of economic growth, reducing the percentage of GDP spent on education.[39]

Bushra, a 10th grader, sews to help earn money for her school expenses. her mother is a seamstress. education costs often increase as children advance in grades, and while many poor families go to great lengths to access education for their children, too many find it impossible given the lack of schools and expense.

© Insiya Syed for Human Rights Watch, September 2018

As of 2016, 12.6 percent of Pakistan’s total expenditure went to education, and as of 2017, 2.758 percent of Pakistan’s GDP was spent on education—both figures well below recommended benchmarks.[40] This low investment continues in spite of a government commitment in 2009 to spend 7 percent of GDP on education, and makes Pakistan the only country in Asia to spend more on its military than on education.[41]

In its 2017-2025 National Education Policy, the government is blunt about its own neglect of the education system, writing:

Pakistan’s education sector has persistently suffered from under-investment by the state, irrespective of the governments in power. Years of lack of attention to the education sector in the form of inadequate financing, poor governance as well as lack of capacity, has translated into insufficient number of schools, low enrolment, poor facilities in schools, high dropout rate, shortage and incompetent teachers, etc. All of this has led to poor quality of education for those who are fortunate enough to get enrolled and no education for the rest.[42]

This diagnosis is refreshingly honest. But there are few signs that it is triggering solutions. Professionals working in the education sector described a situation in which the government seemed disinterested, sometimes pointing out that policymakers send their children to high quality and expensive private schools, and lack any personal investment in the quality of government education.[43] “The state has never taken education seriously—proper resources have never been allocated in any state,” the head of an NGO in Punjab told Human Rights Watch. “The problem is the priories of government—education is not a priority and they don’t allocate the budget.”[44]

Several experts pointed to the government failing to spend even the inadequate amount allocated to education, including funding from the government budget and from international donors, saying underspending occurs consistently and across regions.[45] “Money is going to waste. There’s no system. You need a system of checks and balances and monitoring and political will. You have to have the will,” an expert in Sindh said.[46]

Lack of Enforcement of Compulsory Education

If parents won’t allow their girls to go to school, what can the government do?
—Zarafshan, 18, forced out of school by her uncle at age 12, Karachi, July 30, 2017.

Pakistan’s constitution states, “The State shall provide free and compulsory education to all children of the age of five to sixteen years in such manner as may be determined by law.”[47] Under Pakistan’s decentralized system of service delivery, responsibility rests with provincial governments to pass and enforce laws making education compulsory. In reality, however, there is no organized effort by government to ensure that all children study.

When children are not enrolled in school, no government official reaches out to the family to encourage or require that the child study. When a child drops out of a government school, individual teachers may encourage the child to continue studying, but there is no systematic government effort to enroll or retain children in school. This is incompatible with the constitution and international standards Pakistan has signed up to which require that education be free and compulsory at least through primary school.

Some children try to enforce their right to education through their parents. “My younger daughters go up to their father and say, ‘Put us in school or the government will throw you in jail,’” Zunaisha, 35, said, laughing. “But their father says he can’t afford it.” Zunaisha’s oldest daughter, Hafsa, 16, interjected: “He won’t allow it.” Hafsa was forced to leave school after a year, something she deeply regrets, saying she now has no dreams. “You can only have interests and hobbies if you have an education.” She tried to convince her parents to let her four younger sisters, ages seven to 15, study, but without success. “It’s my father and brothers who don’t let me go to school,” she said. “I think it should be mandatory for girls to study until the 1oth grade. Then if they want to, they can study further.”[48]

Outreach by the government to encourage families to access education—and explain that education is compulsory—could make an immediate difference. Safina, 40, never went to school. She is a mother of 10 children, ages six to 22. One of her children is studying, but she said her other children refused to go and said they were not interested. “The government should have meetings with the parents and explain that kids should go to school,” she said. She suggested the government should send people house to house to talk about education. “Nobody came,” she said. “I wish the same things everyone wishes—that my kids go on to study.”[49]

Saba is one of the almost 22.5 million children in Pakistan who are out of school, the majority of whom are girls. She sells potatoes on the street outside a private school and longs to attend school herself. Poor families often prioritize boys’ education, as grown sons are expected to support their parents in the future while girls marry and join their in-laws’ household.

© Insiya Syed for Human Rights Watch, September 2018

In the absence of compulsory education, children sometimes decide themselves whether to study. “My father tried to make me go [to school]—he had no good job but still he wanted his kids to go,” said Kaarima, 19. Her father washes cars for a living. She left school at age 10, after fourth grade, because, she said, she was “not interested.” Some of Kaarima’s siblings study, and some do not.[50] Kaarima’s mother, Sahar, said she and her husband tried to make Kaarima continue studying but she refused. Sahar believes the government should force children to go to school. “It’s good if the government takes this initiative because kids have their own will.”[51] 

Some families are not aware that government schools, with free tuition, are available. Saira, 30, has three sons and one daughter, ages six to 12. Her husband is physically abusive and did not allow Saira to leave the house, but he was away from the home after he found work as a cleaner in a school. “He didn’t want to pay for education, but once he started working, I could sneak out and ask at the church for friends to help our kids go to school,” Saira said. “We didn’t know school was free back then—that’s why the kids didn’t go earlier.” A priest explained that government schools were free, and her husband agreed to enroll the three older children. “When they got admission I cried so much, because I was so happy. When I saw other children in uniform I always wondered, ‘When are my kids going to study?’” Saira never attended school.[52]

Not only are children not required to study, in numerous cases parents and children described situations where teachers urged children to drop out. Palwashay, 16, was in fifth grade and age 14 or 15, when her teacher at government school said she was too old for her grade and should leave. She had low marks and had failed the exam to progress to sixth grade. Her family hopes now to send her to private school.[53]

Shortage of Government Schools

They should open a government school for all of us.
—Ghazal, 16, speaking in a group of 11 out-of-school girls in a poor area of Karachi, July 30, 2017.

There simply are not enough government schools for all children to have access to one. Even in Pakistan’s major cities many children cannot reach a government school on foot in a reasonable amount of time and a safe manner. When families can access a government school, they often find that it is overcrowded.

“The government needs to spend more money and open more schools,” said the head of an NGO working with out of school children. He described an area where his NGO worked: “In two union councils, there was one [government] school. An area that size needs five to ten schools.”[54]

In Peshawar, a local government official said the closest government school was a 40-minute walk away. Because of this, she said, most children start school late, at ages eight to 12, because parents wait for them to be old enough to walk to school on their own.[55] Some parents struggle to pay for a nearby private school for the first year or two of education while they wait for children to become old enough to travel alone to more distant—and more affordable—government schools.[56]

Saba, age 11, who does not attend school, with her mother. Saba’s mother cooks potatoes and Saba sells them on the street. Almost 13 percent of Pakistani children aged 10 to 14 years are in paid employment, rising to 33 percent among children ages 15 to 17--and work, also including housework or child care, often keeps girls out of schools.

© Insiya Syed for Human Rights Watch, September 2018

Pakistan has many more boys’ school than girls’ schools, despite the greater safety concerns and restrictions on freedom of movement many girls face.[57] On a national level, in 2016 the government reported equal numbers of middle schools for boys and girls, but major disparities in the number of girls’ primary schools (66,000 girls’ schools out of 165,900 total) and secondary schools (13,400 girls’ schools out of 32,100 total).[58] The disparities become even greater at the level of professional colleges and universities.[59]

In some provinces and local areas, disparities can be higher. For example, in Balochistan there are more than twice as many schools for boys as for girls.[60] A similar disparity exists in Khyber Pakhtunkhwa: “If you have ten schools for boys, you have five for girls,” an education expert from the province explained.[61] Another expert described an area with 14 high schools for boys and only one for girls.[62]

Aisha, around age 30, lives with her husband and their six children in an area of Peshawar where the nearest government school for boys, offering nursery school through 10th grade, is less than a five-minute walk away. The nearest government school for girls is a 30-minute walk and goes only through fifth grade. Aisha’s daughter quit school at age nine because of her parents’ concerns about her safety walking to school.[63]

Many neighborhoods are education deserts for poor families. “I could send them if there was a government school,” said Akifah, 28, a mother of three children, ages ten, eight, and seven. The family had moved from a village near Multan to Karachi three years earlier, looking for work, and had no choice but to settle in an area where there are only private schools the family cannot afford, but no government schools within reach.[64]

The distance to school often increases as children get older, especially for girls. Schools are more likely to be gender segregated as children get older, and there are fewer schools for girls than for boys. If a primary school is nearby, secondary school is often further, and high school further yet, due to smaller numbers of girls’ schools at the higher levels. The government has acknowledged this gap. For example, the Balochistan provincial education plan identifies it as a barrier for girls, saying, “School availability is further limited by ‘upward bottlenecks’ created by the drastic reduction of the number of schools at the middle and secondary levels, leading to the exclusion of many children, especially girls.”[65]

This gap makes the transition from fifth to sixth grade impossible for many girls. Beenish, 14, left school after fifth grade, because the closest secondary school was a 10 to 15-minute drive. “Both of my parents want me to study,” she said, explaining they would allow her to continue if there was a school nearby. But, she said, she is not allowed to walk through the bazaar, which is on the route to the government secondary school, because her family sees it as unsafe, and the family cannot afford to pay for her transportation. She longs to return to school: “I wake up, I pray, I read the Quran, and I do housework—that’s my day,” she said. “My request to the government is to upgrade the primary school to the secondary level so I can continue my studies.”[66]

A mother takes her daughter to school in Islamabad. government schools generally offer free tuition, but parents and students are still obliged to pay for uniforms, school supplies, and exams fees. These costs put education out of reach for many poor families.

© REUTERS/Sara Farid, February 2014

Girls face another difficult transition when they complete 10th grade. In Pakistan, 10th grade ends with an examination called a secondary school certificate, or SSC. After passing the SSC, students who wish to continue studying go on to a different school, often referred to as an intermediate college, where 11th and 12th grades are taught. Government colleges are in short supply.

Ghazal, 16, lives in a poor area of Karachi. There are two government schools within walking distance of her home, and she completed 10th grade. But to continue she would need to go to a college, and the nearest government college is a half hour drive away, an insurmountable barrier to her poor family. “We don’t have money for more,” she said flatly.[67]

Government colleges, where children study beyond 10th grade, are few and far between, which creates not only barriers in terms of distance, but also fierce competition for admission. “It is competitive to get into government colleges,” the principal of a private school explained. “If children have poor marks, they go to a private college.”[68]

“My hope is that they make government colleges in this area—that is our main issue,” said Asima, 16. “There is one lakh of population here [100,000 people] and no institution for higher learning nearby. The government should take this into account and open an institute here.” She said government schools in their neighborhood go only to eighth grade. She studied to eighth grade at government school, then attended private school for grades nine and ten, but now faces dropping out because her family will only permit her to continue if she can find a job at a college and pay the fees herself. The closest government college is four or five kilometers away, and the family cannot afford for her to travel there by rickshaw.[69]

Urban Versus Rural Differences

The situation is often far harder for families living in rural areas. In villages and the countryside, the distance to a government school can be far greater, and private schools are less likely to be available as they often struggle to earn a profit outside of cities and thus are less likely to fill in gaps created by lack of government schools. Some interviewees said there was no school—government or private—in their village of origin.[70]

Two students at a free non-government school for poor children in the Lyari neighborhood of Karachi, Pakistan. The school provides a few hours of classes per day to children who otherwise have no access to education.

© Insiya Syed for Human Rights Watch, September 2018

In rural areas, like cities, government schools are increasingly scarce as children move from primary to secondary to high school. “In every village, there is a government school, but no college, no higher school,” the headmaster of a private school in a small town in Punjab told Human Rights Watch. “There’s nothing past 10th grade. It’s 13 or 14 kilometers to a college [for children in villages].”[71]

Asifa, 20, delayed attending school until she was nine or ten years old, because it was a 45-minute walk from her village. “My parents said, ‘If you are interested enough you can walk there.’ Whoever wanted to went,” she said. “I found it too far. The path is lonely and isolated and there have been cases of two or three kidnappings in that area…. But then I realized I needed to study so I convinced my parents and I got friends to go so we walked to school together.” The school only went through eighth grade, so after that her only option was to go live with her sister in a town where grade nine and ten is available.[72]

Mina, 22, wanted to be a doctor, but in her village the only way to attend ninth grade is to travel to a college in a town a 45-minute drive away. “I left school because the science teacher wasn’t available until late and I couldn’t come home so late,” she said, explaining the class ended at 6 or 7 p.m. “I asked them to move the time, but the teacher said no.”[73]

Corruption

Corruption is pervasive in Pakistan, which is ranked 117 out of 180 countries on the 2017 Transparency International Corruption Perception Index.[74] Corruption is a major issue in the government school system.

One of the most pervasive forms is bribery or nepotism in recruitment. Some people simply purchase teaching positions. The director of a community-based organization said that the bribe paid to secure a government teaching position varies but averages around 200,000 rupees (US$1,905). “For the last five years, everyone has to pay. It’s worth it just for the salary—it’s an investment. This has an impact on the quality of the teaching—there’s no teaching. Even the building is being used by the landlord in that area in some places for his own purposes. He’s a powerful man—no one dares challenge him.”[75]

Others obtain jobs through political connections. “I did a BA in arts and have a certificate in teaching—and then an MP from this area helped me,” said a government school headmaster, explaining how he obtained his position. “[Government recruitment] is done on a political basis. Maybe 10 percent is on merit.”[76]

An education expert explained that politicians put people loyal to them into positions in the education system not only for bribes, but also for political influence, as teachers can play a role in elections. “They mobilize people, they help fix elections,” he said. “Teachers are influential people.”[77]

When people purchase a teaching position, they do not necessarily teach. “Everywhere you’ll find a government school—the building is there, the teacher is on the payroll, but there is no teacher and no students,” the director of a community-based organization said. “I personally know many teachers who have other jobs. They are earning 60,000 rupees a month [$571]. They have to give some to the district education officer—it varies, sometimes 10 percent. This is a pattern.” He said there is nothing communities can do: “Teachers are political appointments. They have paid money to get these appointments. There is no pressure because these people cannot be pressured.”[78] UNESCO in 2017 cited findings regarding diverted funds, over 2,000 fake teacher identity cards, and 349 “ghost” schools.[79]

The impact of corruption is particularly devastating in rural areas. “There is pressure on principals in cities to enforce some things,” a staff member at a private school said. “But in the villages sometimes the principals don’t even show up.”[80]

“At least in Karachi the government [education] system is functional,” the director of a community-based organization said. In rural areas, particularly in Sindh and Balochistan, he said there was no pressure on government officials to deliver education effectively, describing local government agencies as “non-functional.” “[A] school is there, but no teachers and no students,” he said.[81]

There is also corruption within schools. “There was a girl in the class who was really dull, but she paid 3,000 rupees [$29] and came first,” said Beena, 40. “My niece cried a lot and said, ‘Why couldn’t you pay so I could come first?’” The girl’s mother added: “The teacher asked for money, but I couldn’t give it, and then [my daughter] passed matric, but with a D.”[82] Beena added: “My friend’s son did well—he studied for his matric. His teacher said, ‘If you do something for me—if you pay us 3,000 rupees—we’ll pass you.’ He said, ‘If I’m doing well, why should I pay?’ Then he failed on three out of four papers at his intermediate course in 12th grade and he got discouraged and left.”[83]

Corruption is an issue in both government and private schools, and some parents said that demands for bribes are more of a problem in private schools, perhaps because of the low salaries.[84]

High Cost of Education

The government doesn’t help the poor. We can’t educate our children, and we can’t feed ourselves.
—Rukhsana, 30, mother of three, with a husband rarely able to work due to illness, Karachi, July 2017.

For most of Pakistan’s families, education costs money.

The decision whether to charge fees at government schools is taken at the subnational level, resulting in a patchwork of different practices. In Sindh, most interviewees reported that government schools did not charge fees. In Punjab, interviewees consistently said they paid fees at government schools, most frequently 10 rupees ($0.09) per month for pre-school classes, and 20 rupees for children in primary school.[85] In Balochistan, a government teacher said her school charged an annual admission fee of up to about 30 rupees ($0.29) and local businesses sometimes assisted children whose families struggled to meet the costs.[86] Children must also pay for exam fees, which can be about 20 rupees at primary level at 30 rupees at secondary level ($0.19 and $0.29).[87]

Government schools are also not automatically less expensive than private schools when you take into account associated costs, which may include registration, exams, books, uniforms, and transport. Private schools often have fewer associated costs, for example for books and uniforms, and may offer discounts on fees. Private schools may also be closer, eliminating or reducing transportation costs.

Costs, even if small, put education out of reach for poor families, and there are many poor families in Pakistan. In 2016, the government set a new “poverty level,” an indicator designating adults subsisting on under 3,030 rupees per month ($29) as living in poverty. Using this benchmark, the government in 2016 determined that about 60 million Pakistanis—6.8 to 7.6 million families—were living in poverty, about 29.5 percent of the country’s population.[88]

Children often switch between government and private school for financial reasons. “My children were in private school initially,” said Pariza, 44, mother of eight. “But the switched to government school because we didn’t have the money for private school.”[89]

Associated Costs of Government Schooling

Parents said sending a child to government school, even at the primary level, cost as much as 5,000 rupees per year in associated costs ($0.48).[90] “The school may be free, but there are always demands for money for something or the other,” said Zarifah, a mother of five. “Copies, stationery, every day there is a new expense. A school bag alone costs 500 rupees [$4.76]…. Every day, every day, it’s something.” Zarifah’s oldest daughter studied to second grade but the family took her out of school because of the expense. Zarifah says she would like to send all her children to school, “but our resources are limited.” She adds: “I cannot send just one child to school as this would be unfair to the other children. They will feel hurt at being left out.” Zarifah’s oldest daughter now studies the Quran with a neighbor; the other children are not in education.[91]

Government schools often provide some, but not all, of the textbooks children need and families must also pay for school supplies. “Some books are provided, and some we buy,” said Aqiba, 18, discussing her family’s struggles to keep Aqiba’s two younger siblings in government school. “They keep adding new books every 15 or 30 days that we have to buy. For example, they added a coloring book recently. We spend 3,000 rupees [$29] per month for books.”[92] Several families estimated that it cost 500-600 rupees per year ($5-6) per child in school supplies for them to send their children to government primary school.[93] Others said the cost was much more, as they had to buy replacements and new notebooks throughout the year.[94]

Uniforms can cost over 1,000 rupees ($9.52).[95] Children who cannot afford uniforms may be excluded from school. For girls, parents must also buy a dupatta [scarf] which one mother said cost another 750 rupees ($7).[96] Students may need several uniforms per school year, and may need uniforms for different seasons.[97] A few government schools give free uniforms to selected students, but such assistance is rare.[98] Shoes cost about 500 ($4.76) rupees new, or perhaps half that if you can find them used.[99]

Paveena, 13, said only one girl in her extended family ever went to school. “My six-year-old cousin really cried for it, so her older brother put her in [school],” Paveena said. “But she only went for a month. She would leave the house at 7 a.m., reach the school at 10 a.m. [But] she was going in her home clothes, instead of the uniform, so the teacher took her out.” Paveena said the uniform cost 1,000 rupees ($9.52) and the family could not afford it. “We really want to go to school, but we don’t have the means.”[100]

Muskaan lives in a neighborhood of Lahore where she says the nearest government middle school for girls is a 15 to 20-minute trip by rickshaw. To make the trip every day would cost 3,500 rupees ($33) per month.[101]

Ann finished eighth grade at a school near her home but would have to travel by rickshaw to reach a school teaching ninth grade. A rickshaw would cost 40 rupees each way ($0.38). Her mother is a tailor, her father a construction worker, and she has three brothers. “I assessed my situation myself and saw the issues with transportation and expense for transportation,” she said. “So, I decided not to pursue it. Then I did housework instead.”[102]

Higher grades are more expensive than lower grades, even in government colleges, in terms of both tuition and associated costs. “For science classes for the matric [10th grade exam] you have to buy special things, like test tubes for 500 rupees [$4.76] each,” said Alima, whose daughter is in 11th grade. “You need frogs. We can find them for free but at this time of year you can’t find them. They sell them for 200 rupees [$1.90]…. I had to look for a frog for two days on the ground, but I couldn’t find one. I went to a fish seller and he said he would get me one for 100 rupees [$0.95]. My daughter needed it for the science practicum class.” Alima’s daughter also had to contribute 500 rupees ($4.76) toward a science set used by the class.[103] 

Madrasa and Informal Tuition as Alternatives to School

Tutoring is sometimes seen as a more affordable option for parents who cannot afford the cost of school.[104] Madrasas are also frequently used as an alternative for girls not able to attend school.[105] Some children attend madrasa in addition to regular school.

Madrasas and tutoring are often closer and cheaper than school. Shumila, 12, said she and her sisters could only attend madrasa because there was no government school for girls (the closest was a 25-minute walk away) in their neighborhood in Quetta. There was a private school a 10-minute walk away that they could not afford, and six or seven madrasas, including one a two-minute walk from their home which was free.[106]

Low cost tutoring is often available. Some madrasas charge fees, but many are free. Both tutoring and madrasas are generally free of associated costs that come with government and private schools. They are also typically easier for children to join, often accepting children on a rolling basis without administrative requirements such as identification and birth certificates.

The lines between a madrasa education and informal tutoring can be blurred. Asadah, 12, is the oldest of six children in her family. She left school after second grade, because the family could no longer afford the expense, and she was needed to help with chores at home. She has managed to go back to studying by attending Quran lessons at a neighbor’s house every morning; her family pays the neighbor 100 rupees per day ($0.95). She is the only child in the family in any type of education. “I then come home and teach my siblings,” she says.[107]

While madrasas and tutoring can provide some education for children who otherwise would go without, they are not an adequate substitute for school. They do not generally teach a full curriculum, and typically lack a path for transitioning students to the formal education system or helping them obtain formal educational qualifications. Students at madrasas often learn only religious subjects. Children attending informal tuition learn whatever the teacher chooses to teach, in whatever time the child shows up.

Najiba, 12, was unable to go to school because there is no government school in her area and her family cannot afford private school. She went to madrasa instead, six days a week for three hours a day, but studied only the Quran, which she said she has now finished.[108]

Sahar, 34, sends three of her children to madrasa, two in lieu of regular school and one in addition to regular school; the family receives a discount at the madrasa because they are poor, so they pay 600 rupees ($6) per month for all three children.[109]

Busrah, 17, lives in a poor fishing community in Karachi. She attended a private school that cost 600 rupees ($6) a month through fifth grade. When her family could no longer pay, she moved to a government school for grade six. “I didn’t complete sixth grade,” she said. “I just didn’t think the place was right. At private school the teacher used to focus on the students but at government school they didn’t.” After leaving the government school, Busrah joined a madrasa, but left after a year. “They had this whole concept of purdah, but I can’t do this because I have to fetch water, so that didn’t work out,” she said, explaining that the madrasa required girls to cover their whole body, including wearing gloves and socks, anytime they were outside their home. “It’s very hot.”[110]

Quality of Education

There are not enough good quality schools [in this area]. Parents get disheartened and take kids out.
—Career counselor at a youth center in a poor area of Karachi, July 2017.

Poor families, unable to afford elite private schools, are left with the options of government schools or low-cost private schools. Parents in this situation often expressed concerns about the quality of education. Some felt that the quality was so poor that there was no point sending children to school at all.

The government itself acknowledges concerns about poor quality government schools. For example, the Balochistan government writes: “The quality of education also remains poor and the exponential growth of private schools in the province indicates the low levels of confidence in public sector schooling.”[111]

Quality concerns differ in government versus private schools. In government schools, parents and students complained of teachers not showing up, overcrowding, and poor facilities. At private schools, particularly low-cost private schools, concerns more often related to teachers being poorly educated and under qualified. In both government and private schools, use of corporal punishment and abusive behavior by teachers was widely reported.

Quality Concerns in Government Schools

Families had a range of complaints about government schools, including absent and abusive teachers, violent forms of punishment, overcrowding and insecurity in the schools, poor facilities including lack of toilets and water, and frustrations with the curriculum.

Teacher Absences and Qualifications

Many families complained of teachers being absent from school. “Sometimes students go to school and there’s no teacher, so they miss out on their studies,” said Tehreem, 21, who attended government school before becoming a teacher. “This happens here. I am speaking from experience. Throughout the year they wouldn’t teach us, and then for the last three months there would be all this pressure before exams. In a week, they would come once or twice. Mostly this is the case in primary schools—this a crucial development time for children, but the teacher is not there.” Of her current unpaid work in a free tuition center, she said, “We feel happy doing this, and we want these children to get a better education than what we got in government schools.”[112]

Atifa, 16, and her sister, Hakimah, 17, live in Karachi. They both left school after fifth grade. “A lot of times the teacher showed up late or he would not show up at all. We would just go and sit and then come home,” Hakimah said, about their primary school. Their younger sister, Zafra, 12, left school after grade two or three. “I had the same issues—teachers wouldn’t show up. I left because of that—I didn’t feel I was learning.”

After completing fifth grade, Atifa and Hakimah tried to register for secondary school. “We’ve been trying to get admission there for a while,” Hakimah said, of the government secondary school nearest their home, a 15-minute walk away. “But we would go, and they would say, ‘The headmistress is not here—come another day.’ We went three or four times and then gave up.… Then finally we tried the private school, but we found it cost too much money for us—700 or 800 rupees per student per month [$7-8].”[113]

Many interviewees pointed to teacher absences as one of the key factors in their preference for private schools. “In private schools they have to always show up,” said Layla, 50, a grandmother, after explaining that teachers are often absent at the nearby government school.[114]

Although teachers in government schools typically earn more than private school teachers, some experts cited poor salaries as a reason for teacher absenteeism in government schools, along with the corruption issues discussed above. “The issues are teacher salaries—they are paid badly and there is no job security because now the government is giving short term contracts,” a labor rights expert in Punjab said. “If teachers are paid well in government schools, the quality will improve.” He said teacher salaries start at 15,000 rupees ($143) per month—the equivalent of the national minimum wage.[115] Government teachers interviewed for this report reported earning monthly salaries ranging from the 8,000 rupees ($76) paid to a primary school teacher in Karachi to a high school teacher in Peshawar who said she earned 78,000 rupees ($743) per month.[116]

The director of a community-based organization said that the Sindh government had discussed creating a biometric system using fingerprints to track teacher attendance, but it was never implemented. “There was no interest from the high level. There is no shortage of money in the education system in Sindh, but it is not being used properly.”[117] In Khyber Pakhtunkhwa, a teacher said that a biometric system for monitoring teacher attendance had been implemented and had significantly improved teacher attendance.[118]

Experts and families also had concerns about teachers’ qualifications and motivation. “There are a lot of challenges,” the principal of a government school in Karachi said. “Illiterate teachers with only a matric are being appointed as teachers. They don’t know how to learn and teach. We face this a lot.” He said that on paper the government requires primary school teachers to have completed a one-year post-matric training course, but in recent years people without this qualification were being appointed. “The main problem was politicians,” he said. “Politicians appoint their family and party workers as teachers…. The politician thinks about his voter and his own benefit. He has to reward the people who support him.”[119]

“Teachers in government school just eat sweets while the children play outside—they don’t focus on the kids,” said Maryan, 36, explaining why she and her husband sent their children to private school. When Maryan’s husband lost his job as an electrician in Saudi Arabia, they could no longer afford the cost of private school, and the children stopped studying.[120]

Overcrowding

Government schools often suffer from unmanageable class sizes. Class sizes in government schools are meant to be limited—in some areas, for example, to 35 students.[121] But children and experts said classes are often much larger—50 to 80 students, and sometimes more.[122] “In government schools, there are very few teachers,” a worker at a youth center in Karachi said. “There will be one teacher who is supposed to be teaching two sections. One section is supposed to be 35 kids but usually it is more—45, 50—so you have one teacher for 90 to 100 kids.”[123]

A teacher in Peshawar said she struggled to teach high school subjects to classes of sometimes over 60 students.[124] Another government teacher, in Peshawar, said she had 120 students: “too many.” She also complained of a grueling schedule: “One teacher can’t teach eight classes in a row,” she said.[125]

Overcrowding drives children out of government schools. “At the government college and government school it’s so crowded it’s chaotic and you can’t focus mentally,” said Marzia, who helps run an informal school in her family’s home in Karachi.[126]

Maryam has worked at a private school for nine years. She attended government school for her own education, and said that overcrowding has grown worse:

This is recent. In the past, before 2000, government schools were seen as very good, but the reputation of government schools has gone down because there are so many students in one class. How can teachers focus on this many kids?... I went to government school and was really happy. My sister is 14 years younger. She found it a different place, not good. When I was learning … if I had a question I could ask as many times as I want. Now, if you learn, fine. If you don’t, the teacher won’t explain again.[127]

Overcrowding can lead to government schools turning children away. A headmaster of a private school in Punjab said the government school in his area refuses to enroll new students. If they didn’t, he said, “I wouldn’t have to run a private school.”[128]

Because of overcrowding, many schools have several shifts a day. This shortens the school day, typically to only four hours, making it impossible to cover a full curriculum.[129]

Water, Sanitation, and Facilities

If there are teachers, there are no classrooms. If there are classrooms, there are no teachers.
—Government teacher in Peshawar, August 2017

Government schools are often in poor physical condition, unable to offer a safe learning environment. “The education policy is not implemented,” the head of an NGO working with out of school children said. He described specific rules about the number of rooms and chairs schools should have but said these are not followed. “The laws and policies are there, but they are not implemented because there are no resources,” he added. “We are not in a position to upgrade our education system.”[130]

“There is not enough money for buildings, toilets, washrooms, furniture,” the headmaster of a government primary school in Karachi, who has worked in the government education system for 25 years, said. “Every government school faces these problems.”

He had recently been assigned to a different school where the situation was worse than at his previous school. “There are no windows or doors—just a ceiling and walls. No chairs—we are trying to arrange chairs. Kids sit on the floor. There is no water at the school—kids go home to have water. There are no washrooms or toilets—they go back home [if they need the toilet].… Naturally it does affect our ability to teach.”[131]

An education expert pointed out that poor infrastructure, particularly lack of toilets, creates greater difficulties for girls than for boys. “Schools in rural areas are not built for girls’ needs,” he said. “There is no toilet, no water, no boundary walls, no security.”[132]

Thirty-seven percent of schools do not have basic sanitation or toilet facilities.[133] Girls who have started menstruation are particularly affected by poor toilet facilities. Without private gender-segregated toilets with running water, they face difficulties managing menstrual hygiene at school and are likely to stay home during menstruation, leading to gaps in their attendance that undermine academic achievement, and increase the risk of them dropping out of school entirely.[134]

“There is an issue with drinking water in the school,” said Zafira, 15, a ninth-grade student in government school. “Generally, in this area there are water shortages, so sometimes for a week there is no drinking water at school.” Zafira said students bring their own water or go without.[135]

Poor facilities also affect school staff. Shazia, 24, is a private school teacher. “I have friends who are government teachers,” she said. “They said I should work for the government.” Shazia decided not to apply. “There are none of the facilities that I get here—electricity, a generator, furniture. The salaries are high, but the infrastructure is very bad,” she said. “In so many schools there are no toilets and no clean water. These are the reasons that I didn’t want to work there, and my in-laws didn’t want me to work there.”[136]

 

Quality Concerns in Private Schools

Experts and educators raised concerns about the quality of education in some low-cost private schools. One expert said, “My real concern is low-cost private schools.... Kids spend six or ten years in these schools and learn nothing.”[137]

Teacher Qualifications, Training, and Salaries

Private schools often maximize profits by paying teachers as little as possible, which results in them hiring teachers with few qualifications.

“In private schools, teachers get very low salaries,” the head of a community-based organization told Human Rights Watch, adding that in the area where his organization works private school teachers earn 1,500 to 3,000 rupees a month ($14-28). “Minimum wage [for government teachers] is 15,000 [$143] so they are getting one tenth or one fifth as much.” He said that the private school teachers are usually required only to have completed 10th grade, and most are women.[138]

A government teacher in Balochistan contrasted her terms of employment—18,000 rupees per month salary ($171) with an annual raise, pension, health benefits, annual and parental leave, and annual training—with that of private school teachers she knew, who she said earned 4,000 to 5,000 rupees per month ($38-48) with no benefits.[139] A government headmaster said that while physical conditions are generally better in private schools, he wouldn’t work in one due to low salaries and lack of benefits.[140]

Experts said conditions of employment are similar for teachers in NGO schools: “You have one teacher with 20 students in one room. The teacher earns 5,000 rupees [$48] a month…. [I]nformal school teachers should have proper training and higher salaries.”[141]

Lack of Government Regulation of Private Education

Private schools are obliged to register with and obtain a certification from the relevant government authority. But oversight, both through and after the registration process, is sparse. “They are registered with government but not standardized,” the head of an NGO said.[142] An education expert pointed to the role of some government officials as owners of companies operating private schools as a barrier to monitoring, citing examples where these politicians had intervened to block government from more closely regulating private schools in ways that might reduce profits.[143]

Government officials inspect private schools periodically, but inspections are often cursory. The headmaster of a private school in Punjab said the government inspects his school, “But they are not effective. They come, but they are not doing a good job.”[144]

“Once or twice a year they come, unannounced,” another private school principal said. “They come for a half hour. They want tea and to be entertained. You have to please them or they will say that your school is not good. Once I made the inspector wait and he got mad and left and said, ‘I will write a bad report.’ My colleague went to his house and gave him 25,000 rupees [$238] and we got a good report.”[145]

Private schools are free to choose their own curriculum, though some use the government curriculum. “We set the curriculum—no one tells us what to teach,” a headmaster of a private school explained.[146] “There is no monitoring of the curriculum,” the head of an NGO said.[147] As they prepare students for government exams after sixth grade, some private schools become more likely to use the government curriculum.[148]

Because private schools are so unregulated, they can vary dramatically in terms of not only teaching quality but also the adequacy and safety of the facilities, with some low-cost private schools in very poor facilities.

There also exists an entire world of private tutoring, often providing additional help for children in school, but sometimes the last resort for children unable to access schools. Tutoring often consists simply of a teacher—usually a woman or girl—setting up classes in her home. While some tutors are motivated by philanthropy, other are businesses, and such tuition is often entirely unregulated. Private tuition does not provide children with a path for transitioning into a school or obtaining educational qualifications. Parents who are uneducated likely have difficulty assessing the quality of private tuition and are vulnerable to exaggerated claims by tutors. 

Because there is such unmet demand for education, and the sector is so unregulated, establishing a school has become a business option for educated girls and women. Gulrukh, who left school after eighth grade, started her own tutoring business. “I take 50 rupees [$0.48] per month per child and five or six children come to me,” she said. She helps those in school with their homework and teaches the Urdu alphabet to those not in school.[149]

Basma, 12, left government school after class two or three because of abusive behavior by teachers and violence among pupils. She moved to a private school but left after class five when the family could no longer afford the fees. At the time of the interview she was attending private tuition, paying 500 rupees ($4.76) per month for classes from 8 to 11 a.m. every day. Basma’s mother supports the family as a tailor; she wants Basma to become a doctor.[150]

Rukhsana, 30, and her 17-year-old daughter, neither of whom ever studied, are employed together in a private home as domestic workers. They moved to Karachi from a village in Punjab seeking work. In their village, the local school charged 1,000 rupees a month ($9.52), which the family could not afford, so none of Rukhsana’s three children studied. In Karachi, Rukhsana was approached by a woman providing private tuition. “This lady is in the area—she said send your kids and I’ll teach them,” Rukhsana said. She decided to send her 7-year-old son—the first time one of her children has studied—but struggles to pay fees of 500 rupees ($4.76) per month. She worries about the quality of the instruction and is frustrated that the teacher sometimes cancels classes.[151]

Corporal Punishment and Other Abusive Behavior by Teachers

Use of corporal punishment and other types of abusive behavior by teachers is widespread. It seems to be a greater problem in government school but also occurs in private schools. “Once they hit me so hard the stick broke,” said Hakimah, 17, about her government primary school. “They also force us into the chicken position.” Her sister Atifa described the “chicken position”, which she had also experienced: “You have to put your arms under your knees while sitting, and then put your hands on your cheeks. You sit like this for a long time—like a half hour.” Hakimah added, “We were hit three or four times a week—if we would get to school a little late they would hit us for that.”[152]

Corporal punishment drives many children out of school. Somia, 12, was 11 years old and in class three in a government school when she quit. “My father told me to leave, because the teacher used to hit me a lot, with a steel rod on my hands.” She said that she was hit every day, whenever she made a mistake on her lesson. “In first grade, I had a different teacher who wasn’t angry, but in second grade the teacher was very angry and started hitting me,” Somia said. “Everyone got hit. She has a temper. She was hitting every kid every day.… The principal didn’t know she was hitting—no one told him. If anyone said anything, they would have been beaten by the teacher.” Somia now studies in a madrasa but is frustrated that her dreams of becoming a doctor ended when she left school.[153]

Although private school teachers are under pressure not to drive students away, due the financial interests of their employers, private schools also use corporal punishment. “It was a very good school, but they used to hit us,” said Aliya, age 10 or 12, describing the private school she attended up to second grade. “They made us go in the chicken position…. The teacher used to pull our hair. She used to hit me every day.”[154]

“The teacher used to beat us up, hit us with a stick,” said Shaheen, 16. She went to both government and private schools, and was beaten in both. She said she was beaten when there were fights between students and when the principal told her to cut her hair and she resisted. She saw other students beaten after missing class, so when her family went away to a festival and she missed school she was afraid to go back and quit.[155]

Students also reported abuse in schools run by NGOs. Atifa, 17, said that her 9-year-old brother dropped out of a school funded by the United Nations Children's Fund (UNICEF) because he was being hit by the teacher. “He wants to go but every time he goes back to this class he gets hit again,” she said.[156]

Some teachers forced children to do chores for them. “I didn’t like school because the teacher would make me do chores outside, like go get her fruit,” said Noor, 15, describing her government village school. “We would come in the morning and she would send up off to do some chores. Even in school holidays she would make us do work…. We would go to her house—she lived far away. We would go and do the shopping for her and then go to school.” Noor said the teacher slapped her once when she tried to refuse to do chores.[157]

Asifa, 20, said at age 13 and 14 she was forced to clean the house of her teacher at a village government school, and students were also forced to do agricultural work in a teacher’s fields. “There was no one to complain to,” she said. “As a child you can’t understand. The teacher would threaten that, ‘If you go home and complain to someone I’ll remove you from school…. Village people think there’s no point in sending a child to government school—when you see examples like this, parents aren’t going to send kids.”[158]

Basma, 12, left government school because of fighting in her school. “The teachers would not stop fights. They were always on the phone,” she said. During inspections of the school, Basma said the teachers would behave well. But after inspectors left, “the teachers would go back to being themselves. There was no discipline. They were even rude to parents.”[159] Her mother added: “[T]hey are like this with all the children. Teachers insult children. They say things like, ‘Don’t sit with this child—he is dumb.’”[160]

Students struggling academically are sometimes targeted for abuse. “Teachers used to create hurdles for some students, if they didn’t like some, regardless of whether the student was good or not,” said Tamana, 15, who dropped out at age 13: “My teacher would call my mother, saying I shouldn’t be in school…. So then my mother took me out. She said I wasn’t doing well in my studies, but I got 90 out of 100.” Tamana said the teacher singled out her and a friend of hers who also dropped out as a result. Tamana’s mother complained to the school principal, but the principal sided with the teacher. She thought perhaps she was targeted because she is short. “The teacher kept saying I should be in a lower section [because I’m small].”[161]

Children are sometimes afraid to complain of abuse because it may lead to their parents removing them from school. “My mother said if she [the teacher] is hitting you, just leave,” said Aliya, age 10 or 12.[162]

Noor, 15, said her teacher slapped her after she tried to refuse to do chores such as food shopping for the teacher’s family. “But I told my parents I was slapped for not doing my work,” Noor said. “I lied because if I told them the truth [that I was spending part of the school day doing chores for my teacher] they wouldn’t send me to school anymore.”[163]

Administrative Barriers at Government School

Families sometimes face administrative barriers to registering children in school, including requirements for birth certificates, national identification cards, age restrictions, and demands for certificates from previous schools. These barriers can be difficult to overcome, particularly for families that are poor, that move frequently from one location to another, or where parents are not literate. Requirements to register in school can vary from one place to another and be applied with varying levels of strictness.

Children are sometimes required to provide birth certificates to register for school. Malaika, 45, registered her older children in government school without birth certificates, but when she went to register her youngest son the school had a new requirement for a birth certificate, which she did not have. Instead she sent him to an NGO school funded by UNICEF, which did not require a birth certificate.[164]

Farzana, age 25 to 30, mother of six, moved from a village to Karachi two months earlier. She is determined that her children, who were in school in the village, study again, but has been told she cannot register them in government school in Karachi without birth certificates, so she is waiting for their father to get birth certificates from the village.[165]

Other schools require that children provide national identification cards. Salma, 12, never went to school because her father doesn’t have a national ID card (known as a CNIC) and that means she can’t get one—and identification is necessary to register in school.[166]

Some groups face barriers to obtaining identification. “We don’t have CNICs in this area,” said Samra, 11, explaining why she has not studied.[167] The neighborhood consists largely of people who migrated from Bangladesh during the war between Bangladesh and Pakistan in 1971, and many are unable to obtain identification cards due to difficulties proving that they are citizens of Pakistan. This means their children are barred from government school, and prevents individuals from working in the fishing industry, a common occupation in the area. The fear of problems with law enforcement further restricts their movement, making education even more inaccessible. “Sometimes rangers just pick up people from this neighborhood for identification, for random checks,” said Samra’s mother.[168]

Gulrukh, 20, studied through eighth grade, but was unable to continue. “To give exams for ninth and 10th grade, you need a B form,” she said. “I can’t get it because my mother doesn’t have a CNIC.” Gulrukh said her mother migrated to Pakistan from Bangladesh in 1971 and, because she applied several times for a CNIC at different offices, she has been blacklisted from obtaining a card. Her father also came from Bangladesh, but earlier, and his parents were able to get him an ID card before the war.[169]

Some schools place age restrictions on who can study, which create barriers for girls who started school late or had disrupted schooling, putting them in a class behind where they should normally be for their age. Many children, especially girls, start school late, and need to be able to access education behind the regular schedule. “Fifteen and sixteen-year-old girls want admission for sixth grade,” a teacher in Peshawar said.[170]

“When I wanted to get admission, I tried to go to fifth grade, but I was 14,” said Khadijah, 14. “They said, ‘If you are 13 you can go, but you are too old.’ What does it have to do with age? It should have to do with ability.”[171]

“If you are over 16, you need special permission to sit for the ninth and 10th grade exams,” the head of a youth center told Human Rights Watch.[172]

Many poor families interviewed for this report move frequently, seeking work or struggling with insecure housing. Administrative barriers can contribute to children in these families falling out of school. Sara, 16, had completed fifth grade when her family moved from Khyber Pakhtunkhwa to Karachi. The family stayed temporarily in an area with a school nearby, and Sara attempted to enroll, but was turned away, first because she did not have a certificate from her previous school, and then because exams were taking place. She was told to come back later, but before she was supposed to return, the family moved again. “When we moved to another area, there was no government school nearby, and my father couldn’t afford private school,” Sara said. The nearby private school costs 350 rupees ($3) per month. Sara’s father is a security guard at a garment factory.[173]

 

III.    Barriers to Girls’ Education Outside the School System

Poverty, housework, purdah.
—Gulrukh, 20, listing reasons girls in her poor neighborhood in Karachi do not go to school, Karachi, July 2017.

Poverty, child labor, gender discrimination and harmful social norms, and insecurity and dangers on the way to school create barriers to girls’ education. Many families are too poor to afford even the costs associated with attending a government school, let alone paying for private education. Poverty drives many families to put their children to work, which often keeps them out of school.

Other girls are kept home to do housework. Restrictions on girls’ freedom of movement due to harmful gender norms push many girls out of school, as does child marriage. Families short on resources often decide to educate sons and not daughters.

An insecure environment, where sexual harassment is a regular experience for many girls, fear of kidnapping and other crime is pervasive and well-founded, and conflict and attacks on education pose very real threats, prompts many parents to keep their girls home from school. Fear of violence and harassment may make what would otherwise be feasible walks to school seem too far.

 A teacher in a government school in Balochistan summed up these challenges and said: “This happens every year: we have a high number of admissions in the beginning and little by little the girls drop out. By fifth grade, there are only four girls left.”[174]

Poverty

We’re poor people, we don’t go to school.
—Neda, 17, Karachi, July 2017.

Whatever money we get, we feed ourselves.
—Akifah, 28, mother of three out-of-school children, Karachi, July 2017.

For many families, the most fundamental barrier to education is financial. “In this area, about half of girls go to school and about half don’t,” said Aqiba, 18, who left school at age 12 in Lahore. “For the ones who don’t go, it’s always because they can’t afford it.”[175]

“If there was no poverty, parents would be able to send their daughters to school,” said Mariam, formerly a private school teacher, who now runs a free tuition center in her Karachi home.[176]

“I was the sole breadwinner then, because my husband has a heart condition and couldn’t work,” said Pariza, 44, a mother of eight, explaining why most of her older children studied to grade 10 or 12, but her youngest daughter had to drop out of 5th grade. “I was the only one earning, so I needed help. I was working in a garment factory, so my daughter had to cook.” The family moved from their village to Lahore—where Pariza had more opportunities to find work—after family in the village tired of helping them financially. In Lahore, however, unlike the village, they had to pay rent, and Pariza had just received an electricity bill for 30,000 rupees (US$286). “I never went to school—I understand the value of education,” said Pariza. But she felt overwhelmed by financial difficulties. “There is no hope for poor people in Pakistan. I don’t see any hope for my situation.”[177]

“I wanted my daughters to get educated, but I couldn’t because of poverty,” said Halima, 38, mother of five daughters, ages 13 to 19, none of whom studied more than a year or two. Her husband works in a chewing gum factory. “My husband’s salary is 12,000 rupees [$114] a month. At the end of the month, we are always out [of money] and wonder what to do—it is all gone. I want a school for girls who belong to poor families.”[178]

Bad luck, failed crops, illness or a death can easily put education out of reach. Muskaan was in seventh grade when her father, a construction worker, fell from a mosque building site and died. Her mother struggles to support her seven daughters and three sons. An uncle helping the family financially refused to pay for the girls to study. “He said, ‘You’re a girl, and girls should just cook.’”[179]

“My father passed away and I had to be the breadwinner,” said Talween, 20. She and her two siblings attended a private school where the fees were 1,800-1,900 rupees per month per child ($17-18). Talween was among the top three students until her father’s death—and the loss of his income as an employee of the government’s water board—forced her out of eighth grade. She trained as a beautician and became the family’s sole wage earner. “As long as my father was there he was taking care of everything, but since he’s been gone I’ve been taking care of everything and running the household,” Talween, whose mother has a disability and cannot work, said. “Parents should have enough so that girls can complete their education.”[180]

As children get older, they are sometimes obliged to pay their own school fees if they wish to continue studying. Asima, 16, has an 18-year-old brother who works full-time, pays his own school fees, and is in 12th grade. Asima just completed 10th grade and wants to become a doctor. Her father said, “She can study as much as she wants if she pays herself.” But finding employment can be more difficult for girls than boys, due to harmful gender norms, discrimination, and restrictions on their freedom of movement. Asima’s father said the only job he would allow her to do that would permit her to pay school fees is a position as a receptionist at the school she attends. “I want to study further,” she said. “But because of the financial situation in my house I think I won’t be able to.”[181]

Lack of future employment opportunities discourages some families from educating girls. “We do want our daughter to get an education,” said Aisha, about her 14-year-old daughter, Bushrah. “But even boys don’t get jobs after college, and we’re poor. So, it doesn’t make sense. Boys can’t get jobs, so how will girls?” She said in her neighborhood, there are only two young women who studied as far as 10th grade, and neither have jobs.[182]

Many poor families move between urban and rural areas as a survival strategy. Families living in rural areas sometimes travel to the cities where work may be more plentiful. Families settled in the cities often return to the village where they have roots for weddings, funerals, and other visits. Movement back and forth often disrupts children’s access to education, especially for girls.

“I was late starting school because of all the back and forth,” said Noor, 15, whose family has moved every two or three years between Karachi and their home village her whole life. Noor said the frequent moves happened because the family wanted to live in the village but were repeatedly forced back to the city by lack of work in the village. Her father paints houses; in the city her mother finds work as a maid. Noor began school at ages 3, 10, and 13, but only reached second grade, because of disruption. At the age of 14, when the family moved to Karachi again, she gave up.[183]

Families living between two locations may be able to access schools in one place, but not the other. Sheherbano is 15 and just finishing fifth grade. She was behind in her studies because she left school for several years when her family returned from Karachi to their village. “We went to Punjab for two to three years and I didn’t study at all there,” she said. “We didn’t know much about school there.”[184]

Children switching schools are sometimes obliged to repeat grades. Rania, 14, moved between Karachi and her family’s village several times, as her parents sought work in the city but were pulled back to the village by family ties. She completed first grade in Karachi, but when her family returned to the village had to redo first grade. The family moved back to Karachi again one year before Human Rights Watch interviewed Rania. This time Rania did not go back to school because the family viewed the stay as temporary and rent in Karachi was too high to leave money for education costs. She hopes to attend second grade after the family returns to the village.[185]

Child Labor

Many children, girls and boys, are out of school because they are working. Sometimes they are engaged in paid work, which for girls often consists of home-based industries, such as sewing, embroidery, or assembling small items. Other children—almost always girls—are kept home to do housework in the family home.

Some NGOs run specialized schools designed to accommodate children’s work schedules, with books and school supplies provided for free, and incentives such as a free meal for students. “We have given recommendations to the government, we said from 5 to 9 p.m. you should have a shift of school for kids who can’t go earlier. They are done with their work and housework and are relaxed then,” an NGO worker said. She also urged outreach to children and families, bringing the message, “You can work and study at the same time.”[186]

Housework in the Family Home

My mother had to go to work and my siblings were young.
—Taslima, 18, explaining why she left school after second grade, Karachi, July 2017.

The pressure to take on housework drives many girls out of school, especially when their mother works outside of the home. “I do housework—all the housework,” said Basooma, 16. “I am the only one doing the work in this house.” Her mother is one of her father’s two wives, both of whom are domestic workers in private homes, leaving Basooma responsible for the tasks in the family home. Basooma has three siblings, two brothers and a younger sister. All her siblings studied, but Basooma was told she was needed for housework. “I really want to study,” she said.[187]

“When we were young, we went to school, but now because our mother works, we can’t go,” said Azwa, 16, describing her situation and that of her 18-year-old sister. Their mother works as a maid. Azwa’s older sister married at age 11, so Azwa, at age ten, left school to take over housework for the family which includes their father and two brothers. “There was no one to take care of the house—I can’t leave the house alone.”[188]

Often one girl in the family sees her education sacrificed to housework, while others study. Nadia and her sister Sahar Gul went to a government school together in Karachi and did the family’s housework together after school. When Nadia was 17 and in ninth grade, however, a death in the family prompted a visit to their village. While there, Sahar Gul liked the village school, and their parents agreed for her to stay with extended family and study. Left to do the housework alone back in Karachi, Nadia could no longer manage both that and studying. “My sister missed a lot of days of school to do housework after I stayed in Punjab,” Sahar Gul explained. “So, then the school threw her out.” A year later Sahar Gul was still studying and hoped to become an engineer. Their parents sent Nadia to seamstress training, and she continued to do all the housework.[189]

Eldest daughters often bear the brunt of housework.[190] Rabia, 16, lives with her father, three brothers, and two younger sisters—her mother died eleven years ago. Her younger siblings are all studying, and her older brother completed 10th grade, but Rabia quit fourth grade. “I’m the eldest daughter and I have to take care of the home,” she said. “My father’s health is not that great. I have to take care of all the younger siblings and the house.”[191]

“I give food to my younger siblings—my mother goes to work,” said Aynoor, 13, the oldest of five children. Aynoor’s eight-year-old sister is in school, but Aynoor left school after second grade when the family moved from a village to Karachi and her mother found employment as a domestic worker. “I do these things because I am the oldest sister.”[192]

When older daughters marry, the responsibility for housework often shifts from them to a younger sister, in turn pushing her out of school. “When my sisters were unmarried, I used to go to school,” said Parween, 17, whose mother has impaired vision and physical limitations because of diabetes and other illnesses. Parween attended school from age 10 to 13, completing second grade before she was forced to drop out and take on household work after her three older sisters married at ages 17 or 18. “I felt bad [about leaving school],” she added. “My father stopped me from going because there was no one to work at home.” Her older sisters had studied briefly but were also forced to leave school to take on domestic work at home. Parween described her daily routine of cleaning the house, washing clothes, and preparing meals for her parents and her two brothers.[193]

Paid Labor

I used to try to study, but I couldn’t remember anything and the financial situation at home was such that I had to work. And then I would come home so tired I would just eat and go to sleep.
—Aziza, 23, works making spices, Karachi, July 2017.

Child labor remains widespread in Pakistan, though exact figures are hard to come by. The International Labour Organization cites estimates that almost 13 percent of children aged 10 to 14 years are in employment, rising to 33 percent among children ages 15 to 17.[194] The US Department of Labor says that in Punjab 12.4 percent of 5 to 14-year-olds are working, and in Sindh that figure is 31.5 percent.[195] An NGO staff member working in poor areas of Lahore estimated that 70 percent of children in those neighborhoods are in paid employment, much of it home-based.[196]

Experts pointed to lack of effort by the government to end harmful child labor. “Poverty has gone down slightly, according to figures, but we don’t see change regarding child labor,” a labor rights expert said:

The government is not enforcing laws against child labor. For example, the government passed a law banning children under 14 from working at brick kilns, but it has not done anything to raise the parents’ income. So, this new law means some kids moved from brick making to other sectors, but they may be less safe now because they are isolated and not with their parents. So, we don’t see these measures as helpful. You have to address poverty and really implement labor laws, especially enforcing the minimum wage—and the minimum wage is too low. You need a living wage, and you need to make people follow it…. It’s not a priority for government. When steps are taken, it’s because of international pressure.[197]

Children in families interviewed for this report worked in occupations including home-based industries such as sewing, embroidery, jewelry making, making furniture (string beds), as domestic workers in other families’ homes, at brick kilns, and fishing, and working children were rarely in school. “Those children who are out of school, it’s because they are involved in some kind of economic activity,” the head of a community-based organization. “They are engaged in some work, so they don’t have the time [to study].[198]

“In poor households both parents work and there are four or five children,” a school headmaster in a poor area of Karachi explained. “Child labor is prevalent throughout Pakistan, but it is more prevalent in places like this.” He explained that children typically start work at age eight to ten, helping with their parents’ work. “A child that is working with the mother or father, to leave his earning that the family needs—how is this possible? If the government supported the family, then the child could go to school.”[199]

Home-based industries account for much child labor by girls. This labor is largely invisible and unregulated, as it takes place in private, is often itinerant, and has no fixed hours. Children are particularly likely to work with their parents when the parents are employed in the home, an NGO worker said: “In one house, all the kids and their parents work.”[200]

“More than 75 percent of workers are in the informal economy,” a labor rights expert told Human Rights Watch. “Home-based industry is the biggest sector in Pakistan. The implementation of labor laws is very weak even in factories, and production is moving from bigger factories to smaller factories to home. More and more things are being made at home. The reasons for this include cost saving, but also avoiding labor rights laws. These workers are not covered by Pakistan’s labor laws. And it is mostly girls working at home with their mothers—this is very common.”[201]

In some areas, boys are more vulnerable to missing education due to child labor than girls. For example, in a fishing community, an activist explained that more girls study than boys, because boys often join their fathers on fishing boats from age 12 or 13 or even younger, and long days offshore make it impossible to attend school regularly.[202]

Some children manage to combine work and school.[203] But many other are kept or taken out of education so that they can work. Barriers to accessing school, and concerns about the quality of schools, encourage poor parents to opt for children to work instead. “The parents send the kids off to work at young ages because they think what’s the use of studying, because the school is poor quality,” a teacher explained. She went on to talk about the daughters of domestic workers: “Their mothers take them to work with them starting at young ages if there is extra work, such as guests visiting.”[204]

“The situation in my house was not such that I could study,” said Samika, 13. “My brothers don’t do anything, so I started working at age 10.” Samika learned embroidery from her mother and older sisters. She earns 100 rupees ($0.95) per piece of embroidery; one piece takes her two days. “I work throughout the day, from morning until 2 p.m., then I do housework until 4, then zari [embroidery] again until 8 or 9 p.m. Then I’m tired,” she said. “I try to make my parents understand [that I want to study] but my father says, ‘We’re not in a financial position to send you.’” Samika said the nearest government school charges 250 rupees ($2.38) a month and is an hour-long walk away. “I wish to tell the government that however they can do it, please make a school here so that I can go to school.”[205]

Sometimes all the children in a family work. Azeeba, 11, does embroidery with her three sisters, ages 9, 12, and 15, and her brother, aged 13. The children work 9 a.m. to 2 p.m., earning 400 rupees ($3.81) each per day. “I give some of the money to my mother and father and for the rent,” Azeeba said. The family’s rent is 5,000 rupees ($48) a month, and both parents have health problems. Azeeba’s father has intermittent work as a metal polisher, and her mother does not do paid work. Azeeba’s brother and youngest sister both study and work, but the family can’t afford education for the others.[206]

Efforts to make it easier for children who are working to study are few and poorly funded. Mahvish, 13, and three of her siblings studied for the first time three years earlier, when an NGO opened a school for working children in their area of Lahore providing all supplies for free plus free lunch. The family managed to allow them to stop working and focus on their studies. The NGO had recently run out of money, however, and the school closed. Mahvish was back at work, with her 11-year-old sister and brothers, ages 8 and 15. The children make necklaces, and the family earns 10 rupees ($0.10) per dozen. Mahvish said she can make six dozen a day, earning 60 rupees ($0.57). Their mother makes necklaces with them and does embroidery, while their father irons laundry. Although there is a government school nearby, Mahvish says the children cannot study there. “I would have to buy the books myself,” she said. “There’s no money for books.”[207]

Girls with mothers employed as domestic workers often help. Tamana, 15, an oldest daughter, left school at 13, in ninth grade. “I had to work with my mother,” she said. “I go with her and work in houses cleaning and doing dishes…. My mother keeps telling me to go back to ninth grade, but I say no. My mother is alone, and she needs my help. My father has a problem with his leg and he’s in pain and I don’t want him to work.” Tamana’s younger sister, 13, is studying and hopes to be a doctor.[208]

Child Labor in the Brick Industry

A particularly abusive form of child labor in Pakistan is brickmaking. While the government has made some efforts in recent years to prohibit child labor in brick kilns, the extreme poverty of families employed in the industry and lack of enforcement of labor laws continues to put many children at risk.[209] Despite laws aimed at ending bonded labor, families signing up to work at a brick kiln—who are often in desperate straits—are regularly given an advance of up to 100,000 to 200,000 rupees ($952-1,905) which they must repay through their labor. “The family is paid, not the individual,” an NGO worker assisting brick workers explained, saying families are paid weekly, earning seven to eight rupees ($0.7 to $0.8) per brick. He estimated that hundreds of thousands of children under the age of fourteen are making bricks in Punjab alone, where much of the industry is based, starting work as early as age four or five.[210]

Children grow up at the kilns, and often continue as adults. “They don’t have anything else—because they don’t have the opportunity to study or to learn new skills, this passes on from generation to generation,” the NGO worker said. “Government schools are very far from the kilns … and these children of brick workers won’t be accepted there. Teachers will treat them badly.” He said there are government funds to help children from brick kilns study, but estimated this assistance reaches five out of every 100 eligible children.[211]

Neither Yasmina, her mother, or her grandmother—who still works at the kiln at age 62, one of four generations of brick workers—nor any of Yasmina’s children ever went to school. Yasmina thinks she is about 32—she knows that she married at 14. She shares a one-room hut owned by the brick company, about 9 by 15 feet, with her husband and their nine children, ages 15, 12, 11, 9, 8, 7, 5, 3, and 2. “There are too many expenses in the school—I can’t make ends meet,” Yasmina said. Her eldest daughters, 15 and 12, are domestic workers, while the younger children stay at the kiln. “They do small work—they get me water, they help clean the bricks,” Yasmina said. “They’re not making bricks—they’re too small. But they clean the mud away, they pile the finished bricks.” Her husband added: “We put the kids to work so it gets done quickly.” The family makes about 1,000 bricks a day, earning around 900 rupees ($8.57), but receive half of that; the owner keeps the rest as rent and to recoup money he advanced them. One of Yasmina’s brothers, age 10, was the only child in the family to study, walking two kilometers to government school. But after school fees increased from 40 rupees ($0.38) to 200-300 rupees ($1.90-2.86) a month, the family could no longer afford it and he quit.[212]

Gender Discrimination and Harmful Social Norms

Patriarchy is the main problem.
—NGO gender expert, Lahore, July 2017.

Why don’t they let us study? They let the boys study, so they should let us study.
—Bina, 15, forced to leave school after fifth grade, Karachi, July 2017.

Some families do not believe that girls should study or believe that girls should not continue school beyond a certain age. In data comparing responses across 15 countries to the statement, “A university education is more important for men than for women,” Pakistan had the unhappy distinction of being the country in which there was the greatest increase in the number of people agreeing with that statement, in a comparison of data from 2001 and 2012.[213]

A teacher in Peshawar said after poverty, the most common reason for children dropping out of school was: “religious and cultural issues with sending girls out.” She explained: “After eighth grade, a lot of girls get married.… There are some girls who are so good in their studies and have so much potential that I feel very sad when they’re taken out.”[214]

“There’s a view that there’s no need to educate girls because they will be married,” an NGO gender expert said. “These views are changing, but it is taking a lot of time. Parents say boys and girls are equal, but in practice they don’t do this.”[215]

Humaira, 17, studied for only one year and her four sisters are similarly uneducated. Humaira said they were prevented from attending school by their grandfather. “He liked to say, ‘Education is not for girls,’” Humaira said. “My father wanted us to go to school, but my grandfather ruled this house, so my father couldn’t ask for us to go.”[216]

Attitudes regarding how desirable or acceptable it is for girls to study, especially as they grow older, vary significantly across different communities in Pakistan, and there is a range of attitudes in every community. In some areas, however, families violating cultural norms prohibiting girls from studying face pressure and hostility. “People talk,” Asiya, a mother of seven daughters explained. “The girls would cry to let them go to school, but their father says he can’t keep arguing with other people.”[217]

Farkhunda, 40, and her husband are Afghan immigrants living in Peshawar. They have six daughters and two sons. “It’s considered disgraceful to send girls to school,” in their community, Farkhunda explained. She said that if the family had the means to pay for education, they would permit their daughters to study until age 10, but no further.[218]

For some families, their willingness to send girls to school, especially as they grow older, hinges at least in part of whether girls study separately from boys and are taught by female teachers. Many schools are segregated by gender, through separate schools, separate shifts, or separate sections of the building. As students get older, schools are more likely to be segregated.[219]

When families violate norms in their community against girls’ education, the girls may face stigma. “When a girl steps out of the house, she doesn’t get proposal,” said Amina, about age 30, explaining that if her daughters attended school and as a result were seen walking in the neighborhood, it would harm their ability to get married. Amina’s daughter had a job as a domestic worker, but when she began menstruating her father decided that it was no longer permissible for her to do this work.[220]

Girls also face restrictions on their freedom of movement that undermine their access to education. “There is less mobility for girls—boys are allowed to go outside,” a gender expert with an NGO working with out of school children said.[221]

“I don’t have permission from the people in the house—my father,” Sima, 15, said, explaining why she left her studies after passing her grade 10 exams. Her mother explained, “In my in-laws’ household, they say if a girl studies more she gets ruined.” Sima attended school through eighth grade but was barred from continuing by her father. Her mother brought her textbooks for ninth and 10th grade, and she studied on her own, at home, so successfully that she took and passed the 10th grade matric exam. Her father has now put an end to her studies.[222]

Some girls are permitted to study only within strict limits. Batool, 13, was the first girl in her family to study and completed fifth grade. But when it was time for her to sit the exam for sixth grade, the exam center was at a different location than her primary school. “I could not sit my exam because my father did not give me permission to go to the center,” she said, “even though the school had made arrangements to take the girls there.” Batool said that her school headmistress asked to meet her father to try to convince him to let Batool sit the exam, but Batool’s father never went for the meeting.[223]

Girls are often removed from school as they approach or reach puberty. “My father said I was too big and then he asked me to leave,” said Salma, 15, who left school at age 13, during third grade. “People gossip among each other and say, ‘That girl is grown up now.’… My father said no, he said ‘Don’t study—girls aren’t supposed to study.’”[224]

Families taking girls out of school sometimes fear that girls will engage in romantic relationships. “Why are you educating your daughters?” Muskaan, who left school after seventh grade said her uncle demanded of her mother. “It corrupts them—they get bad.” Muskaan explained, “In his mindset a girl is going to have affairs if she studies and then will marry whoever she wants.” Muskaan said her uncle fought often with her mother about Muskaan and her sisters going to school. “Do you want your daughters to be westernized?” she said he demanded.[225]

Azra, 40, a mother of 11 children, including seven daughters, said girls in her family are not permitted to study beyond fifth grade. “Otherwise they talk to boys,” she said. “Then the sons and fathers argue with you, saying, ‘Look at what your daughter is up to.’… One can’t pick fights all the time—it’s not worth it.”[226]

Harmful gender norms create economic reasons for prioritizing boys’ education. Daughters who marry typically go to live with, and contribute to, their husband’s family, while sons are expected to remain with their parents—so sending sons to school is seen as a better investment in the family’s economic future. “If [parents] have land to inherit, it’s for the boy,” an NGO gender expert explained. “Girls don’t support their parents. They cost dowry and go to their in-laws. Parents think a boy should have land.”[227]

“He is a son, so he studies, and he can work,” said Zainab, 32, mother of four, explaining why she and her husband prioritized education for their oldest son. “If the daughter doesn’t work it’s not that important. We’re in a strained situation and we have to give priority to our son, so he gets the right kind of job.”[228]

Girls are also perceived as unlikely to find work, even if they are educated. “It’s stressful having so many daughters, because they don’t generate income,” said Anisa, who has seven living daughters and one son. “It would have been better to have more sons.”[229]

Some girls go to extraordinary lengths to seek education, over family objection. “My uncle said no, and I hide from him to come here,” said Aliya, who is 10 or 12 years old, who had started attending a free tuition center one or two months earlier, after she quit second grade. “I say I’m going to get something and then I take my notebook and come here. My mother and brother make up stories to send me out of the house. My uncle says: ‘Work at home, wash the clothes.’ He thinks girls shouldn’t study.”[230]

Afsha was 16 before she had a chance to study for the first time, when she learned about a free tuition center in a neighbor’s home. Afsha’s father has left the family; her brother stood in the way of her studying. “My brother said don’t go, and he still says don’t go but I come anyway…. In our household, girls don’t go to study. That’s just the way it is.”[231]

Sometimes views, or decision-makers, about girls’ education change within a family, affecting girls’ ability to study. For example, Mumtaz, 20, told Human Rights Watch that when she was young her uncles, who lived next door, said she shouldn’t study, but her father permitted her to go to school anyway. Now, however, several of her brothers are in their late teens, and they are becoming angry about their sisters studying and putting pressure on their parents to take the girls out of school.[232]

Zarafshan’s older sister was able to study through 10th grade, but by the time Zarafshan was 12, her uncle, who previously worked elsewhere, had opened a cycle shop next to their house. “He sits there, and whenever he sees anyone’s daughter going to school, he gets aggressive,” Zarafshan, 18, said. “My uncle stopped me going to school—he said I should stay home and do housework…. My father has to listen to him because he says, ‘If your daughter goes to school, so many boys will follow her, and people will talk about her and no one will marry her.’”[233]

Restrictions on the movement of women and girls are sometimes so severe that when girls leave school they become essentially homebound. “My eldest sister really wanted to study, but she was not allowed to, and now she doesn’t even leave the house,” Baheerah, age 12, told Human Rights Watch.[234]

Instead of studying, Azrah, 12, helped at home, including food shopping in the bazaar, but four months before Human Rights Watch interviewed her, she gave up that task. “Once we get bigger, we don’t go to the bazaar without a burqa, so I had to stop going,” she said. “Now I just sit at home all day. There’s no permission to go out at all now.”[235]

Some girls and parents called for more female teachers and more girls-only schools as a measure to make it possible for more girls to study. “The government should open all-girls’ schools close by with no men, not even male teachers or any staff,” said Zaneerah, 16, who left school at age 11 or 12, explaining what would have permitted her to continue studying. “Only the chowkidar [guard] outside can be a man.”[236]

Yasmina, 13, said she left school three or four years earlier, when she was in third grade, after the school closed because there was no female teacher. When the school re-opened after a year, with female teachers, Yasmina’s father said she was now too old to study.[237]

Negative perceptions about girls’ education may even affect where girls’ schools are established. Lily, 45, lives in a poor area of Lahore. Her daughter was in her second year of university at the time of the interview. When she was younger she had to travel by rickshaw to a private school every day as there is no government school nearby. “The government promised to make a school here—they even bought a plot of land,” Lily said. “But landowners in the area said that schools being set up had a negative foreign influence and would corrupt the girls.” Lily said her own in-laws were among those fighting to block to creation of the school. “They didn’t allow the school to be made. [The government] made it in a neighboring area instead.”[238]

Child Marriage

The educated daughter of today will become the mother of tomorrow.
—Beena, aunt of a 20-year-old in 11th grade, Karachi, July 2017.

Child marriage is both a cause and a consequence of girls not attending school. In Pakistan, 21 percent of girls are married before age 18, and 3 percent marry before age 15.

Early marriage, in particular marrying younger than 18 can cause severe harm. Married children are more likely to leave school, live in poverty, and experience health problems. Girls who marry as children are more likely to experience domestic violence than women who marry later.[239]

Girls are sometimes seen as ready for marriage as soon as they mature physically. Ayesha arranged for her daughters to be engaged, at the same time, to two brothers who are their relatives, when the girls were ages 17 and 13. “Sixteen or 15 is a good age to get engaged,” said Ayesha. “This is the age when girls have their periods and are mature.”[240]

In some communities, child marriage is expected. “When daughters are not married, people start talking about them, so there’s that pressure,” said Saira, 30, who never attended school and married at age 17. Two of her three sisters married even younger.[241]

Aisha plans to get her 12-year-old daughter Bushrah engaged soon. Aisha married as a teen herself; she is about 30 years old and has six children, ages two to 15. Her oldest sons are now in ninth and seventh grade, but Bushrah left third grade when she was nine years old. Aisha told Human Rights Watch that it is normal for girls to marry at about age 15 in the area where the family lives, and that if girls wait later it becomes difficult for them to marry. Early marriage is a reason for parents to prioritize educating sons. “She belongs to someone else, will live in someone else’s house,” Aisha said about Bushrah, but sons, “will bring money home.”[242]

Some parents see child marriage as a chance to lighten their load. “If a girl goes to her own home [with her in-laws] it’s good, because then a burden is lifted off the parents,” said Faiza, mother of a son, 17, and a daughter, 20. Faiza’s daughter began studying at age 13, at a tuition center. After Faiza arranged a marriage for her at age 15 or 16, her in-laws forced her to stop studying.[243]

Marjan, who does not know her age, and is a mother of six children, would like her 15-year-old daughter to marry: “One less daughter is one less mouth to feed.”[244]

Child marriage is sometimes seen as preventing girls from engaging in romantic or sexual relationships outside marriage. “If she’s good to me I’ll get her married after age 20,” said Saira, 30, who married at age 17, about her eight-year-old daughter. “But if she rebels and sees men and has flings, I’m going to get her married quickly. In my area there is a government college. If she’s good, I’ll put her there and she can study higher.”[245]

Girls often have little or no say in the timing of their marriage, or the choice of spouse. Tamima, age 14, has been engaged to a cousin since she was 12; her mother is planning the wedding for when she is 15. When asked her daughter’s view about the marriage, Tamima’s mother Raheebah replied, “What is she going to say? What does she know?” Tamima began studying at age 13 in a tuition center, but this will end once she marries. “That’s our decision what she does now, but after she marries it’s her in-laws’ decision,” explained Raheebah. “If girls work there’s no one to take care of the house and the children…. All five fingers are not equal.”[246]

Dinah was engaged at age 15 and married at age 17. She grew up in a compound where seven related families lived. Some girls in the compound studied until age 10 or 12, but the girls in Dinah’s family did not study because they were poorer, as their father had intermittent work as a day laborer. About her marriage, she said: “We had no part in that decision. My mother and grandmother wanted it. We have no decision power—neither girls nor boys.”[247]

Staying in school longer can protect girls from marrying young. “They get married after they are done with schooling,” said Sumbul, 25, the aunt of two teenage girls struggling to stay in school. “Someone in school wants to complete their schooling and then marry.”[248]

Zarmina, 20, married at 16, and has two children. She said she would have married later had she not been forced out of school when her father became blind and could not work. “If you’re studying, you keep going,” she said. “You have to finish your studies and you don’t marry.” Instead, when her father’s disability worsened her mother went to work as a maid, but the family faced pressure to marry their daughters off:

My mother arranged our marriages because people started telling her, ‘You should get them married.’ My parents felt sad that they had to get me married at such a young age, but they had to so people wouldn’t say things. I felt sad, and I felt weird to be married at such a young age. But people in this area gossip and raise suspicions. My father said, ‘I can’t see so I can’t protect you, so I should get my daughters married quickly.’ He didn’t want his daughters to be harassed.[249]

Some in-laws prefer a young daughter-in-law. “My mother-in-law hurried it up—I was 11 when I married,” said Ayesha, 18, who married a cousin. “I was engaged one week and married the next week.” Ayesha never studied; her younger sister was studying, she was forced to drop out and take over the housework when Ayesha married. Three years later, Ayesha fled back to her parents. “It wasn’t a nice place—there was constant bickering and fighting,” she said. “I liked the boy—he is a hard worker—but the mother-in-law is the one creating problems.” Ayesha longed to study, but her in-laws didn’t allow her to leave the house at all. After leaving her husband, she at last found a way to study, in a madrasa, studying the Quran and Urdu. “I’m not going back [to my husband] ever,” Ayesha said.[250]

After marriage, girls often leave school. Some future in-laws agree to allow girls to continue studying, but such promises are often broken. “I would have kept studying if this engagement hadn’t come,” said Saba, married at 16. She had completed 10th grade when she married. Saba said before she married her in-laws agreed she could continue studying: “They said you can do whatever you want.” But as soon as she married both they and her husband forbid her from attending school.[251]

Kanwal, 24, had just taken her tenth-grade exam and was about 16 years old when her parents married her to her cousin. She agreed to marry because her parents and in-laws promised that she could continue studying. When she received her exam results she found that she had passed everything except math and planned to retake the math exam—but at that point her in-laws said they wouldn’t allow her to study any more. She argued with them, but to no avail. “And then I got pregnant,” said Kanwal, who now has three daughters. She said her husband gambles and rarely works, leaving her financially dependent on her parents. He also began beating her as soon as they married, and one beating was so severe that she was hospitalized for brain damage. “I felt bad—I wanted to study, to write,” Kanwal said. “I would have a job—I would be of use and feel useful. I could work in a bank…. Sometimes I feel women aren’t treated well in this society.”[252]

Boys are also sometimes forced into child marriage. Layla, 50, said her oldest son drowned six months after marrying, when he and his wife were in their early 20s. Layla’s second son had died of a fever as a child. Her third son was 15 or 16 years old at the time and had recently left school. The family decided that he should marry his brother’s widow. After marrying, the couple had five daughters, ages three to 14 at the time of the interview, none of whom study because their father is unemployed due to substance abuse. “He said he started doing drugs because he didn’t want to get married,” Layla said.[253]

It is common in many communities for there to be a payment from one family to the other at the time of a marriage. Both dowry (payment by the bride’s family to the groom’s family) and bride price (payment by the groom’s family to the bride’s family) are practiced, in different communities.[254] These payments can consist of jewelry, clothing, household goods, and cars or motorcycles, as well as cash. The cost of a dowry or bride price is often a crippling expense for poor families already struggling to get by.[255] The financial pressure of trying to reduce or avoid dowry or needing to receive bride price can induce families to accept a marriage proposal that comes earlier than they would have chosen.

Some mothers who married young fight to delay their daughters’ marriages. Zunaisha, 35, a mother of nine, married at age 12. Her older daughters were 16 and 15 years old when Human Rights Watch interviewed Zunaisha and were not engaged or married. Zunaisha hopes to delay their marriages until they are 20. “I want them to enjoy their lives and spend as much time with their parents as they can,” she said.[256] 

“I’m going to be very careful in selecting a husband for my daughter,” said Shaista, 32, who left school during 8th grade and married at age 14, after her grandparents, who she lived with and cared for became too ill to support her. “For me a mistake was made. I got stuck and I drowned. But I won’t let that happen to her.” Shaista’s daughter has passed her 10th grade exam, but her father has said she may not study further.[257]

Insecurity on the Way to and in Schools

There’s a lot of fear in parents’ minds of sending their daughters outside.
—Baheerah, 12, who never attended school, Karachi, July 30, 2017.

Many families and girls cited security problems as barriers to girls studying, including sexual harassment, kidnapping, crime, conflict, and attacks on education. Insecurity has a disproportionate impact on girls because girls are often targeted and parents are often less willing to have girls leave the home or make long journeys to school in insecure conditions than boys.[258] Widespread impunity for violence against women and girls heightens parents’ fears.

Some parents and children said insecurity in their communities had worsened in recent years, meaning younger children had less access to education than their older siblings. “These are bad times,” said Shaista, 32, mother of four daughters and three sons, ages three to 18, who lives in a poor area of Karachi. “Before, 20 years ago, things were nice, but the environment now is such that I don’t even want to let my small girl out of the house. There is drug addiction and alcoholism and then when your daughter steps out boys will whistle at her. So, to protect your honor you won’t send your daughter out.”[259]

Families worry about terrorist attacks, but they also worry about busy roads, and the long distance many girls must travel to school can increase risks. Hafsa, 16, thinks she was five or six years old on the day she fell into an open sewage ditch on her way to her school which was an hour-long walk away. That was her last day of school. “After my fall, I just didn’t feel like going back,” she said. “But it wasn’t just that—the distance was just too much. Many years later I regretted leaving, but I was too old to start all over.”[260]

“We can’t walk alone because of boys selling drugs and big trucks going by,” said Layla, 50, explaining why the school 30 to 40-minute walk away is not accessible to her family.[261]

Conflict and Attacks on Education

Life and death is in God’s hands. Of course, people here feel some fear. Anyone would be afraid. We can take precautions, but if it’s fate, it’s fate.
—Zulekha, mother of seven, living in an area of Quetta known for insecurity, Quetta, January 2018.

Many parts of Pakistan are facing escalating levels of violence related to insurgency, and ethnic and religious conflict. In the areas most affected, this is having a devastating impact of girls’ access to education. Fawzia, 34, in Peshawar, is a mother of four girls and one boy. She said she is afraid for her children when they go to school. “Why would there not be fear?” she said. “Fear is present 24/7. From the time the child steps out of the house till they return home, the fear is persistent.” Fawzia said if she could, she would teach her children at home. She described a bombing in the family’s church, and other attacks that followed. “Children died in that blast, and nothing changed.”[262]

Parveen sends four of her daughters to a madrasa to study, because it is more affordable than schools. She said there were two bomb blasts near the madrasa three or four years earlier, but no one was killed or injured. “We do worry, but we still send them,” she said.[263]

Insecurity has long-term consequences. “There was a lot of shooting—for a whole week, constant firing,” said Fazeelah, 35, explaining why she took her oldest child, a son, out of school, and kept her other six children, including four daughters, home. The worst of the violence took place about 10 years earlier, but after missing school during that period, the children were never able to go to school.”[264]

Layla, 50, said the government school near her home closed permanently after 10 to 12 bodies were found there during ethnic conflict in the neighborhood in 2005. Layla said ethnic tensions have eased, but the area remains insecure, especially for women. “The situation is better, and that ethnic fear is gone, but there is still fear of harassment by boys, and that’s worse now,” she said. “Before people hid this harassment more—now they do it more openly.” She said lingering ethnic tension makes it harder to fight back against harassment. “The school is a mix of Pakhtuns and Muhajirs so we’re afraid if anyone says anything to one of the boys another ethnic conflict could start depending on who he is, so it’s better just not to send girls—and studies there aren’t very good anyway.”[265]

A teacher in Balochistan said that many of her students manage to finish high school, but to continue to university they must travel through areas seen as unsafe for people from their ethnic group, which deters many from continuing.[266]

Ethnic conflict often spills into schools. Basma, 12, was moved by her parents from government school to private school, even though they struggled to afford private fees, in part because of fighting in the government school between Hindu and Muslim students. Basma’s foot was fractured during one eruption of violence. “I feel very hurt that they hurt my daughter,” Basma’s mother Najma, said.[267]

Attacks on Education and Government Responses

The government is nothing. They just fill their own stomachs. There are bomb blasts in schools—children die all the time. If they can’t take care of schools, what can they do?
Farzana, age 25-30, mother of five daughters and one son, Karachi, July 29, 2017.

One aspect of insecurity in Pakistan has been targeted attacks against students, teachers, and schools.[268] The most lethal attack on education in recent years in Pakistan was the December 16, 2014, attack by armed militants on the Army Public School in Peshawar city, killing 145 people, almost all of them children.[269]

This attack was far from isolated, however. The Global Coalition to Protect Education from Attack (GCPEA) describes Pakistan as a country heavily affected by attacks on education.[270] According to GCPEA, between 2013 and 2017, “armed non-state groups and unknown parties” reportedly attacked hundreds of schools, across every province, typically using explosive devices, killing several hundred students and teachers, and damaging and destroying infrastructure.[271] One-third of these attacks targeted girls and women and were “aimed at repressing or stopping the learning or teaching of girls and women.”[272] In August 2018, alleged militants attacked and burned down at least 12 schools in Diamer district of Gilgit-Baltistan.[273] At least half were girls’ schools.[274]

The Army Public School attack had ripple effects as many parents became more concerned about security. Abda, 51, lives with her husband, four of her six children, two daughters-in-law and five grandchildren, in Peshawar. She said that after the Army Public School attack, the children in the family were afraid to go to school and her husband wanted to take all the children out of school for safety reasons, but Abda insisted on keeping them in school.[275]

Zunaisha, 35, a mother of nine in Peshawar said when she discussed the possibility of several daughters going to school they said they were afraid of bomb blasts. At the time of the interview, all her children were out of education or studying in a madrasa.[276]

Naira worries about her teenage daughter, a college student in Quetta. Naira described their lives in Quetta as being like a prison, saying targeted attacks against members of the Hazara community are so pervasive that girls from other ethnic groups sometimes beg Hazara girls not travel with them or stand close to them on public transportation.[277]

An activist in Balochistan said he believed driving Hazara students out of education was an objective for sectarian groups. “They targeted us because we were progressing—in the military, in sports, education,” he said. “We always achieved the highest marks at Balochistan’s various universities. Now there are only a handful of [Hazara] children who go to Balochistan University. This was a concentrated campaign to keep us down.”[278]

“There should be security for girls, so parents are not afraid of sending girls to school,” said Marzia, who helps run an informal school in her family’s home. “There should be security outside the school. I went to an army school, and I felt safe because no one could go inside without a CNIC [national identification card]. There was a checkpoint. But this doesn’t exist at government schools.”[279]

After the Army Public School attack, Prime Minister Nawaz Sharif announced a 20-point National Action Plan to address the threat from terrorism, but none of the 20 points pertained to protection of educational institutions.[280] Instead, in most cases, the responsibility for enhancing and maintaining security has been passed to school authorities. This has sometimes led to increased hardship and chaos. Some schools organized traumatic security drills, while others armed teachers and students.[281]

Sexual Harassment

Many girls encountered sexual harassment on the way to school. “In this place, it’s not the type of area [where you can go to school]. It’s not a good area. When you walk out, the boys stare at you and tease you…. I can’t go to school because of the environment outside,” said Azeeba, 11, who studied for the first time when an NGO opened a school near her home. When it closed due to lack of funds two years later, her education was over. She was not allowed to go to the nearby government school as men are gambling in that area. “If someone small goes out, no one looks at them. But if you’re a little grown people stare, and boys tease you,” Azeeba said.[282]

Some girls said men and boys harass them outside their school. “Lots of girls from this area go to the government school,” said Paveena, 13. “But men hang around the there…. They speak crudely, curse, sometimes they throw stones at you. I took my cousin to school once, and this man started cursing me. This is just how it is in Quetta—it happens to all girls.” Paveena said that dressing modestly, in a chaddar [concealing robe and head covering], did nothing to help.[283]

“They walk you halfway home,” said Mumtaz, 20, about the boys at a nearby school, complaining that they follow girls and harass them.[284]

When the distance to school is long, it intensifies fears of sexual harassment. “It takes one hour to walk to the nearest school, and it’s not a nice area,” said Samika, 12. “You know what boys can be like. They bother you. It’s not nice for girls to be walking alone.”[285]

Sidra was 13 and in fifth grade when her family returned from Karachi to Quetta. In Quetta, Sidra tried to re-enroll in in the nearest government girls’ school, a long walk from her home. “I went one day with a group of girls,” she explained. “The men stare, they say things to you. Sometimes they hurl abusive words at you—bad words.” That was two years earlier, and she decided never to go back. “If there’s a school made close by, I’ll go.” She works instead, earning 150 rupees each ($1.43) for stitching suits of clothing.[286]

“In private schools we try to stop it,” a private school headmaster said, explaining that sexual harassment would hurt his school’s business. “I make complaints to the police regarding specific boys. Since then no one bothered my female students in this street. Before boys used to hang out in this street.”[287]

Other said police demonstrate little willingness to intervene to try to end harassment of girls. “In front of our house is a store owner who has a drinking problem and beats his wife and harasses my 13-year-old sister and says he’s going to marry her,” said Tamana, 15. “The whole village [neighborhood] is very upset about him. We complained to the police, but he paid them off.” Tamana, who left school at 13, said that their mother wants her younger sister to leave school because of the harassment by the neighbor.[288]

Girls face security risks on the way to school, but they also, too often, face insecurity at school. Interviewees described this as primarily a problem at government schools; private schools have a greater incentive to fix any conditions that could lead to them losing students. Insecurity for girls often takes the form of sexual harassment by male students.

“I studied to eighth grade, but then I stopped because my brothers told me to because there were these boys who were very lewd to me,” said Rabiya, 23. She left government school at around age 11 and missed several years of school before her mother managed to pay for private school. She still lives near the government school, and says over the intervening years, it became worse. “The girls are afraid,” she said. “Girls are on one side of the school and boys on the other, but there is one gate. These boys sit outside and bother them. The boys throw their phone numbers at the girls.” Rabiya said another concern was that low walls at the school failed to protect girls from boys in the neighborhood seeking to harass them. She described the private school she later attended as feeling much more secure, with parents required to pick up their children, ID cards required for entering, and separate shifts for boys and girls.[289]

Parents sometimes have a lower tolerance for harassment than their daughters. Salima, 13, had quit school a few days earlier. “The boys in the school used to bother me—they would throw rulers and pencils at me,” she said. “My mother told me to leave because of the boys bothering me. I want to study but my mother won’t let me.”[290]

When security measures are in place, they are often ineffective. “The school guard is old and doesn’t have any teeth—what can he do?” said Rabiya, 23, about the government school she left. “He lives at the school, so he is scared for himself…. He won’t say anything to the boys, who are much stronger.”[291]

Others echoed the view that security measures are better at private schools. Fawzia, 34, recently removed her 16-year-old daughter from government school and now plans to send her to private school. “They have cameras and keep a check on all the students who come and enter and leave the premises. They take responsibility for the children.”[292]

Pakistan’s ethnic and religious tensions sometimes result in children feeling unsafe at school. Basma, 12, left government school because of fighting between Muslim and Hindu students.[293] Priya, 17, left school after eighth grade, after three years of bullying by other girls. “In the entire school, I was the only Hindu,” she said. “They just wanted me out—like, ‘Why is this Hindu girl here?’ I think [I was bullied] because I was alone.”[294]

Harmful gender norms about older girls being seen in public can create heightened sensitivity to harassment. Samah, 19, was forced by her four brothers to leave school after class 10, because they wouldn’t permit her to travel further to a government college. “None of my brothers are okay with me studying,” she said:

Harassment happens—you know what our society is like. What my brothers are saying is you can study privately with a tutor who comes over [to our house], but a girl can’t walk alone because things are bad. Men look at you funny, they stare. Sometimes they hoot or whistle. My brothers are afraid men would do something—or just my being seen is a problem. They don’t like other men looking at their sister. It does bother me that men are like this, but I would still study [if I could]. I really want to study—I wanted to be a doctor.

Samah said her brothers would only permit her to study if her mother escorted her to and from school, but there is no government college close enough to their home to make that feasible. She has also been unable to find tutors that will come to her home. She is now working as a tailor instead. Even paying for a rickshaw or car with her wages would not allow her to go back to school, she said. “My brothers still have an issue if I’m in a car or a rickshaw…. Even though we wear the veil [niqab—face covering] there is still that insecurity.”[295]

Harmful gender norms mean that when girls are sexually harassed, the consequence is often that their movement is restricted, pushing them out of school. “If a girl is being sexually harassed on the way to school, often she won’t tell her parents, because they will take her out of school if they know,” a researcher on education said. “Kids, especially girls, are afraid of their parents—afraid that if anything happens to them, even if it’s not their fault, then they’ll be taken out of school.”[296]

Girls, and their families, are sometimes seen as at fault when they are the target of harassment. “My father doesn’t allow us, because we’re girls, to go out to school, because boys will harass us, and people will see and will say, ‘They were harassed on the street,’” said Humaira, 17, one of five sisters. “It’s about our honor—even though we wear abayas [long figure concealing garments]. We’ve been living here for so many years, so every boy knows what girls live in this house.” Humaira said since she finished studying at madrasa three years earlier, she leaves the house only for specific reasons—such as a doctor’s appointment or a visit to a relative—every month or two.[297]

Just the fear of harassment sometimes leads to families keeping girls home. Aisha, a mother of one daughter and five sons said that one reason the family removed her daughter from school after third grade was concern about “what people will say if, for example, she’s seen in a ‘non-respectable’ place.” When asked what “non-respectable” places are, she said her husband raised this concern and she does not know as she does not go outside herself. Aisha’s husband Mubashir said he had heard of an incident of a girl being harassed near the local madrasa, and that: “There are private schools here where boys just hang outside and throw their phone numbers at girls.”[298]

Harassers also sometimes target teachers. A teacher in Balochistan said that when she was posted to a new school at first her husband dropped her off every day on his motorcycle. But he and she encountered harassment from young men from the community who did not like a strange man coming to their area. She began taking shared transport instead, which ended the harassment, but created a financial burden, costing 4,000 rupees a month ($38) which was over 20 percent of her salary.[299]

Crime

I used to be interested in studying, but that interest died.
—Mahmuda, 22, left school in fifth grade due to gang violence in her neighborhood, Karachi, July 2017.

When violence happens in a school or in a neighborhood, it has long term consequences for girls’ education. Parizad, 12, said one reason she left school in Karachi was because several children at that school, including a girl in her class, were abducted from the school and murdered. Parizad and her brother left school, in part because of fear of being murdered. “We used to feel very scared,” she said.[300]

Anisa’s oldest son was killed in a local dispute in the family’s village a year before Human Rights Watch interviewed her. Fearing that their remaining son might also be targeted, the family abruptly left the village. Anisa’s five youngest daughters can no longer study as there is no nearby school in their new neighborhood, and the family feels unsafe there.[301]

Several families in a Karachi neighborhood said the area had experienced such high levels of gang violence several years earlier that many girls’ education was disrupted, and some families had fled the area. “We left school because the environment wasn’t good, the times weren’t good,” said Mahmuda, 22, explaining why she quit school after fifth grade. “It was the time of gang violence, so it was difficult to go back and forth to school…. We used to feel scared…. Now everything is fine and there’s no fear, but that age to study is gone. What would we learn now?... Imagine if it had been fine before—we could have studied and had different jobs.” Mahmuda, her mother, and her younger sister are domestic workers.[302]

Rabiya, 23, said a classmate of hers disappeared and her body was found two days later at their government school. “We saw it with our own eyes,” she said. “We saw bruises all over her arms.” Rabiya was around 11 at the time. “My brothers said, ‘These are uncertain times,’ so they took me out,” she said. Over ten years later, the family refuses to send children to that school. In the home where Rabiya and her extended family live, there are ten children. Some study at private school—if their parents can pay the fees; the rest do not study. The oldest child is a 14-year-old girl who left school after fifth grade. Rabiya said the girl has no one to pay fees since her mother died and her father left to work in Malaysia and was never heard from again. “We can’t send her to the government school and we can’t afford the private school. We’re still scared of that government school.”[303]

Layla, 50, lives nearby. She described the same murder and said several of her children quit school afterwards, including her oldest living son. “He said he didn’t feel safe,” she said. The family removed their daughter who was studying there: “They said girls in this school disappear,” Layla explained. Another son wanted to stay at the school. “We let him study at the government school in spite of the murder because he was a boy.”[304]

Fear of Kidnapping

Because the area was so desolate, if someone were to kidnap or assault me, no one would be able to find me.
—Zaneerah, 16, describing the walk to the school she dropped out of, Peshawar, August 2017.

Families in particularly fear kidnapping, especially when girls face long walks to school. It is difficult to know the exact number of kidnappings each year, due to inconsistencies in how figures are collected, but media reports suggest a significant and growing problem, and fuel fears.[305]

Alishba, 29, a mother of seven, said that she and her husband took their oldest daughters out of school at ages seven and eight because the walk to school took the girls past a field where drug users congregated, and they feared someone would “take them away.” Alishba said if they could have afforded a rickshaw they would have let them continue, but the cost was prohibitive. The girls now study part-time at a madrasa closer to their home.[306]

This fear is heightened when girls are older and seen as at greater risk of sexual assault. Kamila is a mother of six children, including four adolescent girls. She said that the reason her daughters cannot attend school is because Kamila’s husband, the girls’ father, “is afraid someone will steal them if they step out of the house.”[307]

The distinction between fear of girls being kidnapped and them engaging in a romantic relationship are sometimes blurred. “They’re pretty, so we’re afraid they will be taken,” said Asiya, a mother of eight, using a term that can mean both kidnapped and wooed, explaining why her older daughters left school, at ages 16 and 12. “If someone dishonors one of my daughters, it’s a matter of dishonor for my remaining daughters as well.” She said one daughter studied until 16 while the other had to leave at 12 because the 12-year-old had physically developed early. Asiya said that her next two daughters, ages 12 and 13, would leave school soon for the same reason.[308]

 

IV. Pakistan’s Obligations under Domestic and International Law

The right to non-discrimination and equality between men and women are enshrined in numerous human rights treaties and Pakistan domestic law. Non-discrimination is essential for ensuring that all children, including girls, have full access to education.

Right to Education

Education is a basic right enshrined in various international treaties ratified by Pakistan, including the Convention on the Rights of the Child (CRC), and the International Covenant on Economic, Social and Cultural Rights (ICESCR).[309]

The Constitution of Pakistan, when adopted in 1973, contained a section under the non-enforceable “principles of state policy” that provided, “The State shall … remove illiteracy and provide free and compulsory secondary education within [the] minimum possible period.”[310]

In 2010 the 18th Amendment introduced article 25-A in the section containing judicially enforceable “fundamental rights,” which states that “The State shall provide free and compulsory education to all children of the age of five to sixteen years in such manner as may be determined by law.”[311]

Article 25-A has been transposed into the local laws of different federal units of Pakistan via the Right to Free and 2012 Compulsory Education Act (for Islamabad), the 2013 Sindh Right of Children to Free and Compulsory Education Act, the 2014 Punjab Free and Compulsory Education Act, and the 2014 Balochistan Compulsory Education Act. However, requisite legislation for KP, Federally Administered Tribal Areas, Gilgit-Baltistan, and Azad Kashmir has yet to be drafted.

Pakistan became a party to the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), which includes an obligation to ensure women equal rights with men, including in the field of education.[312]

The right to education entails state obligations of both an immediate and progressive kind. According to the UN Committee on Economic, Social and Cultural Rights, the expert body that interprets the ICESCR and provides guidance to states in their efforts to implement it, governments should take steps towards fulfilling the rights in the ICESCR that are “deliberate, concrete and targeted as clearly as possible towards meeting the obligations.” The committee has also stressed that the ICESCR imposes an obligation to “move as expeditiously and effectively as possible towards that goal.”[313]

Under international human rights law, everyone has a right to free, compulsory, primary education, free from discrimination.[314] The Committee on Economic, Social and Cultural Rights has stated that the right to fundamental education extends to all those who have not yet satisfied their “basic learning needs.”[315]

International law also provides that secondary education shall be generally available and accessible to all without discrimination. The right to secondary education includes “the completion of basic education and consolidation of the foundations for life-long learning and human development.”[316] It also includes the right to vocational and technical training.[317]

Human Rights Watch believes governments should take immediate measures to ensure that secondary education is available and accessible to all free of charge. They should also encourage and intensify “fundamental education” for those persons who have not received or completed the whole period of primary (or basic) education.[318]

In implementing their obligations on education, governments should be guided by four essential criteria: availability, accessibility, acceptability, and adaptability. Education should be available throughout the country, including by guaranteeing adequate and quality school infrastructure, and accessible to everyone on an equal basis. Moreover, the form and substance of education should be of acceptable quality and meet minimum educational standards, and the education provided should adapt to the needs of students with diverse social and cultural settings.[319]

Governments should ensure that functioning educational institutions and programs are sufficiently available within their jurisdiction. Functioning education institutions should include buildings, sanitation facilities for both sexes, safe drinking water, trained teachers receiving domestically competitive salaries, teaching materials, and, where possible, facilities such as a library, computer facilities and information technology.[320]

Non-Discrimination in Education

Governments should guarantee equality in access to education as well as education free from discrimination. According to the Committee on Economic, Social and Cultural Rights, discrimination constitutes “any distinction, exclusion, restriction or preference or other differential treatment that is directly or indirectly based on the prohibited grounds of discrimination and which has the intention or effect of nullifying or impairing the recognition, enjoyment or exercise [of rights] on an equal footing.”[321]

In addition to removing any forms of direct discrimination against students, governments should also ensure indirect discrimination does not occur because of laws, policies, or practices that may have the effect of disproportionately impacting on the right to education of children who require further accommodation, or whose circumstances may not be the same as those of the majority school population.[322]

CEDAW addresses the right to non-discrimination in all spheres. Article 1 of CEDAW defines "discrimination against women" as any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women.[323]

Governments also have a positive obligation to remedy abuses that emanate from social and cultural practices. CEDAW requires that states “take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs, and practices which constitute discrimination against women.”[324] It obligates states to “refrain from engaging in any act or practice of discrimination against women and to ensure that public authorities and institutions shall act in conformity with this obligation,” and to “take all appropriate measures to eliminate discrimination against women by any person, organization or enterprise.” CEDAW requires governments: 

To modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes or on stereotyped roles for men and women.[325]

International human rights law also calls upon governments address the legal and social subordination women and girls face in their families, provisions violated by Pakistan’s tolerance of a disproportionate number of girls being excluded from school.

Quality of Education

It is widely acknowledged that any meaningful effort to realize the right to education should make the quality of such education a core priority. The Committee on Economic, Social and Cultural Rights has maintained that beyond their access obligations, governments need to ensure that the form and substance of education, including curricula and teaching methods, are “acceptable” to students. The committee stated that acceptability hinges on a range of different factors, including the notion that education should be of “good quality.”[326] The aim is to ensure that “no child leaves school without being equipped to face the challenges that he or she can expect to be confronted with in life.”[327] According to the Committee on the Rights of the Child, an education of good quality “requires a focus on the quality of the learning environment, of teaching and learning processes and materials, and of learning outputs.”[328]

The state must provide education “on the basis of equal opportunity,” “without discrimination of any kind irrespective of the child's race, colour, sex, language, religion, political or other opinion, national ethnic or social origin, property, disability, birth or other status.”[329] In addition, the guarantees of equality before the law and the equal protection of law prevent a government from arbitrarily making distinctions among classes of persons in promulgating and enforcing its laws. A state will violate the prohibition on discrimination in education both with direct action, such as introducing or failing to repeal discriminatory laws, as well as when it fails to take measures “which address de facto educational discrimination.”[330] States must ensure that their domestic legal systems provide “appropriate means of redress, or remedies … to any aggrieved individual or groups,” including judicial remedies.[331]

The Committee on Economic, Social and Cultural Rights has stated: “The prohibition against discrimination enshrined in article 2 (2) of the [International Covenant on Economic, Social and Cultural Rights] is subject to neither progressive realization nor the availability of resources; it applies fully and immediately to all aspects of education and encompasses all internationally prohibited grounds of discrimination.”[332]

Protection from Child Marriage and Child Labor

Child marriage—a major barrier to education for girls in Pakistan—is recognized under international law as a human rights violation. Since the vast majority of those subjected to child marriage are girls, it is considered a form of gender-based discrimination, and it violates other human rights principles. The CRC does not explicitly address child marriage. However, child marriage is viewed as incompatible with a number of the articles in the convention. CEDAW states explicitly that the marriage or betrothal of a child should have no legal effect.[333]

There is an evolving consensus in international law that 18 should be the minimum age for marriage, and Human Rights Watch calls on all governments to set the minimum age for marriage at 18. The committees that interpret the CRC and CEDAW have each recommended that 18 be the minimum age for marriage for boys and girls, regardless of parental consent.[334] The Committee on the Rights of the Child has taken a clear position on 18 as the minimum age for marriage, regardless of parental consent, and repeatedly addressed the need for countries to establish a definition of a child in all domestic legislation that is consistent with the provisions of the CRC.[335] These committees have pointed to the importance of delaying marriage to protect young girls from the negative health implications of early marriage such as early pregnancy and childbirth and to ensure that girls complete their education.[336] The CEDAW committee has noted that child marriage and early pregnancy impede girls’ rights to education, and are a primary cause of school drop-out for girls.[337]

In Pakistan, laws regarding the minimum age of marriage vary from province to province. Some provinces have reformed their legislation to reduce child marriage, but in 2017, the Senate rejected national legislation that would have raised the minimum age of marriage from 16 to 18.[338]

The CRC also obligates governments to protect children from economic exploitation, and from performing work that is hazardous, interferes with a child’s education, or is harmful to the child’s health or physical, mental, spiritual, moral, or social development.[339] The International Labour Organization’s (ILO) Minimum Age Convention and the Worst Forms of Child Labor Convention describe what types of work amount to child labor, depending on the child’s age, the type and hours of work performed, the impact on education, and other factors.[340]

Pakistan’s constitution states: “No child below the age of fourteen years shall be engaged in any factory or mine or any other hazardous employment.”[341]

Protection from Violence, including Corporal Punishment and Cruel and Degrading Forms of Punishment

Under international law, governments should take all appropriate legislative, administrative, social, and educational measures to protect children from all forms of physical and mental violence, injury or abuse, neglect or negligent treatment, and maltreatment.[342] The CRC obligates governments to “take all appropriate measures to ensure that school discipline is administered in a manner consistent with the child’s human dignity.”[343] The Committee on the Rights of the Child has defined corporal or physical punishment as “any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.”[344]

The international prohibition of torture and other cruel, inhuman or degrading treatment or punishment, relates not only to acts that cause physical pain but also to acts that cause mental suffering to the victim.[345] Children and pupils in teaching institutions should be protected from corporal punishment, “including excessive chastisement ordered as … an educative or disciplinary measure.”[346]

 

Recommendations

To the Federal Government of Pakistan

  • Increase expenditure on and resources available for education to bring the level of education funding up to standards recommended by UNESCO to enable Pakistan to fulfill its obligations on education.
  • Monitor expenditure of education funds at the provincial level and ensure full use of funds.
  • Strengthen the federal government’s role in assisting and advising provincial governments in their provision of education, with the goal of removing disparities between provinces, ensuring universal access to free primary and secondary education across all parts of the country, and removing gender disparities in all provinces.
  • Work with provincial governments to improve the quality of government schools and to strengthen quality assurance of private schools.
  • Assist provinces to reform the curriculum in all parts of the country based on international best practices and through a consultative process with education experts and national stakeholders.
  • Ensure that the curriculum is gender-sensitive and includes comprehensive sexuality education.
  • Once high-quality curricula are in place, private schools and madrasas teaching non-religious subjects should be required to use the government curriculum.
  • Encourage continued international donor assistance for education from foreign donors, and work with donors to ensure that aid to the education sector goes where it is most needed.
  • Support efforts to develop sustainable solutions to increase girls’ participation in education, including by developing strategies to develop and expand innovative models such as community-based classes in remote areas, schools targeting disadvantaged populations, and schools designed for children who combine education and work.
  • Ensure anti-corruption efforts include a strong focus on fighting corruption within the education sector.
  • Strengthen oversight of provincial education systems specifically regarding their progress toward ensuring that all girls complete primary and secondary education, by taking steps to ensure that provinces provide accurate data on girls’ education, monitoring enrolment and attendance by girls, and setting specific targets in each province toward achieving parity between girls and boys and universal primary and secondary education for girls and boys.
  • Work with provincial governments to increase enforcement of laws prohibiting child labor.
  • Raise the national minimum age of marriage to 18 with no exceptions and develop and implement a national action plan to end child marriage, with the goal of ending all child marriage by 2030, as per Sustainable Development Goal target 5.3.
  • Ensure that students deprived of their schools because of hostilities or threats, their schools need to be repaired or reconstructed, or the use of their school for military purposes, are promptly provided access to alternative educational facilities in their vicinity.
  • Endorse the Safe Schools Declaration, committing to take concrete measures to deter the military use of schools by armed forces and armed groups, and to use as a minimum standard the Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict.
  • Develop a comprehensive policy for protecting students, teachers, schools, and universities from attack and military use.
  • Address and remedy the disproportionate harm to girls’ access to education because of hostilities and military use of schools. The government should adopt measures to assist girls who have been denied or risk losing access to education.
  • In any negotiations with insurgent groups, make it a priority to negotiate for access to education for all children, including girls, in insurgent-controlled and contested areas of the country.

To Provincial Governments

  • Direct the provincial education authority to make girls’ education a priority within the education budget, in regard to construction and rehabilitation of schools, training and recruitment of female teachers, and provision of supplies, to address the imbalance between the participation of girls and boys in education.
  • Monitor expenditure of education funds and ensure that all funds are used.
  • Strengthen enforcement of anti-child labour laws.
  • Instruct police officials at the provincial and district level to ensure that police at the community level work with schools to ensure the safety of students, including monitoring potential threats to schools, students and teachers, and working to prevent harassment and abuse of students, especially girls.
  • Work with education authorities to collect reliable data on military use of schools by both government security forces and non-government armed groups. Data should include the names and locations of the educational institutions being used; the purpose for which they are being used; the duration of the use; the specific security force unit or armed group making use of the school; the enrollment prior to use and attendance during use; impact on students unable to attend school; actions taken by the authorities to end military use of the school; and the damages sustained during the military use of the school. Where relevant data should be disaggregated by gender to capture any disproportionate impact on girls.

To Provincial Education Authorities

Increase the Availability of Government Schools

  • Rehabilitate, build, and establish new schools, especially for girls.
  • Until government schools are universally available, develop a program for providing scholarships to good-quality private schools for girls living in areas not served by government schools.
  • In consultation with school officials, students, communities, and relevant local government officials, provide free or affordable transport for students who would need to travel long distances or through difficult environments to get to a government school.
  • Introduce a partial or fully subsidized transport program for students in urban areas to travel to government schools.

Increase Girls’ Participation in Education

  • Ensure universal access to free primary and secondary education, in accordance with Sustainable Development Goal 4, including by:
    • Abolishing all tuition, registration and exam fees at government schools;
    • Providing all needed school supplies to all students, including notebooks, pens, pencils, and a book bag;
    • Abolishing uniform requirements, or providing uniforms at no cost to students;
    • Reforming the system for providing textbooks, to ensure that every student receives free use of a full set of textbooks in a timely manner each school year.
  • Instruct all principals to work with school staff to do outreach in the catchment area for each school, identifying out-of-school children and working with families to convince them to send their children to school.
  • Develop and ensure compliance with guidelines that prohibit schools from excluding students based on their lack of identification or birth certificate.
  • Require schools to permit children to enroll at any point in the school year.
  • Ensure that every school has an active school management committee, and that the staff of the school are working with the committee to identify and reach out-of-school children in the community.
  • Explore options for increasing attendance by girls from poor families through scholarships, food distribution or meal programs at girls’ schools.
  • Develop and implement a plan to increase access to alternative forms of education for children and adults who have been unable to study during their school-age years.

Improve Retention of Girls in School

  • Adopt mechanisms to ensure all schools regularly monitor students who are out of school for prolonged periods of time or drop out of school altogether and reach out to determine the reasons for non-attendance and seek to re-engage the student in school.
  • Instruct each principal of a school for girls to work with police in the area to identify locations where girls walking to school face harassment or threats and enlist police and community leaders in preventing such threats to their safety and taking quick action when girls encounter them.
  • Take steps to help ensure cases of harassment and threats are reported to appropriate enforcement authorities, including police, and that cases are duly investigated and appropriately prosecuted.
  • Require each school to develop a security plan in consultation with students and parents, with each plan for a mixed or girls’ school giving special attention to security issues of concern to girls including sexual harassment.
  • Develop guidelines for teachers and principals on monitoring the student body for girls at risk of child marriage. When girls are identified as being at risk, school staff should reach out to the family to discourage the marriage and to keep the girl in school.
  • When female students marry, school staff should advocate with the girl’s family and in-laws to convince them to allow her to continue her studies. Married girls should be both permitted and encouraged to continue their studies, including during pregnancy and if they have children, and schools should where possible provide childcare assistance.
  • Develop a plan to expand access to middle and high school for girls through the government education system, including establishment of new schools and colleges and, where possible, adding additional grades to existing schools.

Improve the Quality of Education

  • Strengthen the system for monitoring and quality assurance of all schools, not only for government schools but also private schools and madrasas.
  • Hire and deploy more qualified teachers as needed.
  • Ensure adequate qualification requirements are in place and applied for teachers, and provided domestically competitive salaries, commensurate with their roles, and where necessary provide financial incentives to encourage teachers, especially female teachers, to work in under-served areas of the country.
  • Strengthen measures to monitor quality of instruction and teacher attendance.
  • Publicly prohibit all school staff from using any form of corporal punishment and take appropriate disciplinary action against any employee violating this rule.
  • Include mandatory training on alternative forms of class management and teacher discipline in all teacher trainings. Ensure teachers are adequately trained in positive forms of class management, and ensure teachers are provided with sufficient materials and tools to adequately manage large classrooms.
  • Ensure that all newly constructed schools have adequate boundary walls, safe and private toilets with hygiene facilities, and access to safe drinking water. Work promptly to install boundary walls, toilets with hygiene facilities and a safe drinking water source in existing schools that do not have them, with the goal of all schools having these facilities.

Improve Transparency and Accountability

  • Strengthen anti-corruption anti-nepotism mechanisms to ensure that anyone who encounters corruption or nepotism by government education officials has access to effective and responsive complaint mechanisms. Strengthen internal monitoring and evaluation mechanisms to assess the performance of ministry efforts at the local, district, provincial and national levels, and make findings public.
  • Include in all job announcements and recruitment materials statements explaining that it is an offense for anyone to demand a bribe at any stage in the recruitment process for teachers and include information on how applicants can confidentially report any such demands. Appropriately sanction or seek prosecution of any official found to have demanded bribes.

Enforce Compulsory Education

  • Develop a phased plan to achieve Sustainable Development Goal target 4.1, by 2030 ensuring that all girls and boys complete free, equitable and quality primary and secondary education. Gradually roll out compulsory education across the country, including through public awareness strategies, plans for engaging community leaders, and systems for identifying and engaging out-of-school children and their families.
  • Develop, and ensure compliance with, guidelines that require government schools to ensure that all children of compulsory school age enrol and complete at least lower secondary school.

To Non-State Armed Groups in Pakistan

  • Respect the right of girls and boys to education in all areas that are contested or under the influence or control of anti-government forces. Issue clear orders to all commanders and fighters forbidding them from attacking or threatening schools, teachers, students, and families of students.
  • Immediately cease all attacks against schools that are not lawful military objectives. Take appropriate disciplinary action against individuals who are responsible for unlawful attacks on schools.
  • Take appropriate disciplinary action against individuals responsible for attacks or threats against girls’ education. Order commanders and fighters not to interfere with the operation of schools.
  • Order commanders to avoid use of schools and school property for camps, barracks, deployment, or as depots for weapons, ammunition, and materiel in accordance with the Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict.
  • Immediately cease the use of inherently indiscriminate weapons such as improvised explosive devices near schools as well as other populated areas.

To International Donors and Agencies Supporting Pakistan

  • Urge the government of Pakistan to comply with international and domestic laws and policies supporting girls’ right to education, including through implementation of the recommendations above.
  • Continue to fund girls’ education at current or higher levels until the government can devote sufficient government revenue to education to maintain the current system and expand it in order to meet the goal of universal access to primary and secondary education.
  • Ensure new construction of schools are funded, designed and constructed to include water and sanitation facilities. Provide funding and support to construct water and sanitation facilities in schools previously constructed that do not have adequate water and sanitation facilities.
  • Improve coordination among donors at the local level to ensure appropriate distribution across the country of donor-funded education services.
  • Work with the Pakistan government to discourage the military use of schools, encourage security forces to vacate occupied schools, and promote security force policies and practices that better protect schools.

 

Acknowledgments

This report was written by a Human Rights Watch researcher, based on research by that researcher and by an independent consultant. Elin Martinez, children’s rights researcher, contributed additional research.

The report was edited and reviewed by: Liesl Gerntholtz, director of women’s rights; Tom Porteous, deputy program director; Saroop Ijaz, Pakistan researcher; Zama Neff, children’s rights director; and Aisling Reidy, senior legal advisor.

Production assistance was provided by Agnieszka Bielecka, associate in the Women’s Rights Division; Fitzroy Hepkins, administrative manager; and Jose Martinez, senior administration coordinator. 

Human Rights Watch would like to thank all the experts, activists, teachers, principals, and community leaders who kindly agreed to speak with us. We regret that the environment in Pakistan toward NGOs makes it unwise to thank them here by name. We acknowledge the important work Pakistani organizations are doing to push for, and achieve, education reform and to educate some of the children falling through the cracks in the existing system. Our greatest gratitude is, of course, for the girls and young women and their families who welcomed us into their homes and shared their stories with us.

 

 

[1] Rabea Malik and Pauline Rose, “Financing Education in Pakistan: Opportunities for Action,” Oslo Summit on Education for Development, 2015, https://reliefweb.int/sites/reliefweb.int/files/resources/pakista.pdf (accessed September 12, 2018), p. 3.

[2] Pakistan Tehreek-e-Insaf, “The road to Naya Pakistan: PTI Manifesto 2018,” 2018, http://insaf.pk/public/insafpk/content/manifesto (accessed September 12, 2018), p. 44.

[3] United Nations Children's Fund (UNICEF), “State of the World’s Children data,” December 2017, https://data.unicef.org/resources/state-worlds-children-2017-statistical-tables/ (accessed September 12, 2018).

[4] According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), as of 2016 4,901,479 children were out of school. 3,040,280 of these were girls, and 1,861,199 were boys. UNESCO Institute for Statistics, “Pakistan,” http://uis.unesco.org/country/PK (accessed September 12, 2018).

[5] Ibid.

[6] Baela Raza Jamil, “Pakistan: all girls and boys in school for 12 years – a critical pathway to progress,” post to “World Education Blog,” (blog), Global Education Monitoring Report, 15 February 2016, https://gemreportunesco.wordpress.com/2016/02/15/pakistan-all-girls-and-boys-in-school-for-12-years-a-critical-pathway-to-progress/ (accessed September 12, 2018).

[7] UNESCO, “Accountability in education: Meeting Our Commitments. Global Education Monitoring Report,” 2017/18, http://unesdoc.unesco.org/images/0025/002593/259338e.pdf (accessed September 12, 2018), p. 362.

[8] Ibid.

[9] Ibid, p. 363.

[10] Several education experts interviewed for this reported also expressed concern that the curricula used in government schools reflect some of the tensions in broader society. The curricula vary at the provincial level. UNESCO International Bureau of Education, “Pakistan: Curriculum Design and Development,” undated, www.ibe.unesco.org/curriculum/Asia%20Networkpdf/ndreppk.pdf (accessed September 12, 2018). Echoing concerns consistently expressed by experts, one interviewee described the curriculum in her province as “indoctrination,” saying it taught no critical thinking, and was riddled with religious bias and harmful stereotypical representations of other provinces and ethnic groups, and contained messages encouraging extremism and even violence. “Radicalization doesn’t result from no education—it results from the wrong education,” she said. Human Rights Watch telephone interview with education expert (name withheld), September 15, 2018. UNESCO has raised similar concerns. UNESCO, “Accountability in education: Meeting Our Commitments. Global Education Monitoring Report,” 2017/18, http://unesdoc.unesco.org/images/0025/002593/259338e.pdf (accessed September 12, 2018), pp. 220-221.

[11] Government of Pakistan Statistics Division, “Pakistan Social and Living Standards Measurement Survey 2014-15,” March 2016, http://www.pbs.gov.pk/sites/default/files//pslm/publications/PSLM_2014-15_National-Provincial-District_report.pdf (accessed September 12, 2018), pp. 17-24.

[12] “Maternal mortality ratio (modeled estimate, per 100,000 live births),” World Bank, https://data.worldbank.org/indicator/SH.STA.MMRT (accessed September 12, 2018).

[13] In October 2016, following public protests after Qandeel Baloch, a Pakistani model, was killed by her brother, parliament passed an anti-honor killing law. The new law included harsher punishments and partially closed a loophole allowing legal heirs to pardon perpetrators who are usually also a relative. After the law was passed, however, high numbers of so-called “honor killings” continue, raising questions about the willingness of law enforcement officials to investigate and prosecute these cases, and to protect women and girls at risk. Saroop Ijaz, “‘Honor’ killings continue in Pakistan despite new law,” commentary, Human Rights Watch Dispatch, September 25, 2017, https://www.hrw.org/news/2017/09/25/honor-killings-continue-pakistan-despite-new-law.

[14] E.g. Human Rights Watch interview with Basila, Karachi, July 31, 2017.

[15] Institute of Social and Policy Sciences, “Private Sector Education in Pakistan: Mapping and Musing,” 2010, i-saps.org/upload/report_publications/docs/1401025704.pdf (accessed September 12, 2018).

[16] Ibid.

[17] “All Pakistan Private Schools’ Federation,” http://www.pakistanprivateschools.com/ (accessed September 12, 2018).

[18] E.g. Sabrina Tavernise, “Pakistan’s Religious School Fill Void, but Fuel Militancy,” New York Times, May 3, 2009, https://www.nytimes.com/2009/05/04/world/asia/04schools.html (accessed September 12, 2018).

[19] “About Us,” Citizens’ Foundation, undated, http://www.tcf.org.pk/#about (accessed September 12, 2018).

[20] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[21] Human Rights Watch interview with nongovernmental organization (NGO) worker (name withheld), Lahore, July 21, 2017.

[22] Human Rights Watch interview with Fakhunda, Peshawar, August 6, 2017. Sometimes discrimination is built in to the provision of education; for example, one mother told Human Rights Watch about a school in Peshawar for Afghans which provides primary and secondary education for boys, but only primary education for girls.

[23] Human Rights Watch interview with Sana, Karachi, July 30, 2017.

[24] Human Rights Watch interview with Mariam and Tehreem, Karachi, July 31, 2017.

[25] Human Rights Watch interview with government primary school teacher (name withheld), Karachi, July 26, 2017.

[26] Human Rights Watch interview with Fazeelah, Karachi, July 27, 2017.

[27] Nadia Siddiqui and Stephen Gorard, “Comparing government and private schools in Pakistan: The way forward for universal education,” International Journal of al Journal of Educational Research, 82 (2017), pp. 159-169. https://doi.org/10.1016/j.ijer.2017.01.007 (accessed September 12, 2018).

[28] Ibid.

[29] See, e.g.: Education and Literacy Department, Government of Sindh, “Sindh Education Sector Plan, 2014-2018,” 2014, https://www.globalpartnership.org/content/education-sector-plan-2014-2018-sindh-province-pakistan (accessed September 12, 2018); School Education Department, Government of Punjab, “Punjab School Education Sector Plan 2013-2017,” June 2013, http://aserpakistan.org/document/learning_resources/2014/Sector_Plans/Punjab%20Sector%20Plan%202013-2017.pdf (accessed September 12, 2018); Department of Elementary and Secondary Education, Government of Khyber Pakhtunkhwa, “Education Sector Plan 2010-2015,” April 2012, http://www.aserpakistan.org/document/learning_resources/2014/Sector_Plans/KP%20Sector%20Plan%202010-2015.pdf (accessed September 12, 2018); Policy Planning and Implementation Unit (PPIU), Education Department, Government of Balochistan, “Balochistan Education Sector Plan 2013-2018,” 2014, http://planipolis.iiep.unesco.org/sites/planipolis/files/ressources/pakistan_balochistan_education_sector_plan.pdf (accessed September 12, 2018).

[30] Human Rights Watch interview with Aziza, Karachi, July 26, 2017.

[31] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[32] In Pakistan, 11th and 12th grade are taught in what are called “intermediate colleges,” often referred to as just college.

[33] Human Rights Watch interview with Alima, Karachi, July 27, 2017.

[34] Human Rights Watch interview with worker from a community-based organization (name withheld), Karachi, July 27, 2017.

[35] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[36] Human Rights Watch interview with Razia, Karachi, July 29, 2017.

[37] Annababette Wils, “Reaching education targets in low and lower-middle income countries: Costs and finance gaps to 2030, Paper commissioned for the “EFA Global Monitoring Report 2015, Education for All 2000-2015: Achievements and Challenges,” 2015, http://unesdoc.unesco.org/images/0023/002325/232560e.pdf (accessed September 12, 2018), p. 12.

[38] United Nations Educational, Scientific and Cultural Organization (UNESCO) et al., “Education 2030: Framework for Action,” December 2015, art. 105. http://unesdoc.unesco.org/images/0024/002456/245656e.pdf (accessed September 12, 2018).

[39] UNESCO, “Accountability in education: Meeting Our Commitments. Global Education Monitoring Report,” 2017/18, http://unesdoc.unesco.org/images/0025/002593/259338e.pdf (accessed September 12, 2018), p. 265; UNESCO, “Education for All 2000-2015: Achievements and Challenges,” http://unesdoc.unesco.org/images/0023/002322/232205e.pdf (accessed September 12, 2018), p. 243.

[40] “Expenditure on education as a % of total expenditure: Pakistan,” World Bank, https://data.worldbank.org/indicator/SE.XPD.TOTL.GB.ZS?locations=PK (accessed September 12, 2018); “Government expenditure on education, total (% of GDP): Pakistan,” World Bank, https://data.worldbank.org/indicator/SE.XPD.TOTL.GD.ZS?locations=PK (accessed September 12, 2018).

[41] Andreas Benz, “The Crisis of School Education in Pakistan: Of Government’s Failure and New Hopes in the Growing Private Education Sector,” Internationales Asienforum, 43 (2012), No.3–4, http://crossasia-journals.ub.uni-heidelberg.de/index.php/iaf/article/viewFile/186/181 (accessed September 12, 2018), pp. 225-226.

[42] Ministry of Federal Education and Professional Training Government of Pakistan, “National Education Policy 2017,” 2017, http://www.moent.gov.pk/userfiles1/file/National%20Educaiton%20Policy%202017.pdf (accessed September 12, 2018), p. 160.

[43] Human Rights Watch telephone interview with education expert (name withheld), September 15, 2018.

[44] Human Rights Watch interview with head of a nongovernmental organization (NGO) (name withheld), Punjab, July 20, 2017.

[45] Human Rights Watch telephone interview with education expert (name withheld), September 15, 2018; Human Rights Watch interview with education expert (name withheld), UK, September 8, 2018.

[46] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.  

[47] Constitution of Islamic Republic of Pakistan, 1973, http://na.gov.pk/uploads/documents/1431341153_169.pdf (accessed September 13, 2018), article 25A.

[48] Human Rights Watch interviews with Hafsa and Zunaisha, Peshawar, August 8, 2017.

[49] Human Rights Watch interview with Safina, Karachi, July 26, 2017.

[50] Human Rights Watch interview with Kaarima, Karachi, July 25, 2017.

[51] Human Rights Watch interview with Sahar, Karachi, July 25, 2017.

[52] Human Rights Watch interview with Saira, Karachi, July 26, 2017.

[53] Human Rights Watch interview with Palwashay, Peshawar, August 5, 2017.

[54] Human Rights Watch interview with head of an NGO (name withheld), Punjab, July 20, 2017.

[55] Human Rights Watch interview with local counselor (name withheld), Peshawar, August 7, 2017.

[56] E.g. Human Rights Watch interview with Mumtaz, Peshawar, August 7, 2017.

[57] E.g. Human Rights Watch interview with teacher at a government school (name withheld), Peshawar, August 8, 2017.

[58] Government of Pakistan Bureau of Statistics, “Social indicators of Pakistan 2016,” http://www.pbs.gov.pk/sites/default/files//SOCIAL%20INDICATORS%202016%20%20(FINAL)%20%20COLOUR%201.pdf (accessed September 12, 2018), pp. 56-57.

[59] Ibid., p. 58.

[60] 9,399 boys’ schools, versus 3,880 for girls. “Detail of Government Schools in Balochistan,” Government of Balochistan, http://emis.gob.pk/Uploads/DETAIL%20OF%20GOVERNMENT%20SCHOOLS%20IN%20BALOCHISTAN.pdf (accessed September 12, 2018).

[61] Human Rights Watch telephone interview with education expert (name withheld), September 15, 2018.

[62] Human Rights Watch interview with education expert, UK, 2018.

[63] Human Rights Watch interview with Aisha, Peshawar, August 6, 2017.

[64] Human Rights Watch interview with Akifah, Karachi, July 28, 2017.

[65] Education Department, Government of Balochistan, “Balochistan Education Sector Plan 2013-2018,” 2014), p. 53.

[66] Human Rights Watch interview with Beenish, Balochistan, January 18, 2018.

[67] Human Rights Watch interview with Ghazal, Karachi, July 30, 2017.

[68] Human Rights Watch interview with principal of a private school (name withheld), Lahore, July 19, 2017.

[69] Human Rights Watch interviews with Asima and her parents, Lahore, July 18, 2017.

[70] E.g. Human Rights Watch interview with Bina, Karachi, July 30, 2017.

[71] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[72] Human Rights Watch interview with Asifa, Punjab, July 19, 2017.

[73] Human Rights Watch interview with Mina, Punjab, July 19, 2017.

[74] Transparency International, “Corruption Perception Index 2017,” https://www.transparency.org/news/feature/corruption_perceptions_index_2017 (accessed September 12, 2018).

[75] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[76] Human Rights Watch interview with headmaster of a government primary school (name withheld), Karachi, July 26, 2017.

[77] Human Rights Watch interview with education expert, UK, 2018.

[78] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[79] UNESCO, “Accountability in education: Meeting Our Commitments. Global Education Monitoring Report,” 2017/18, http://unesdoc.unesco.org/images/0025/002593/259338e.pdf (accessed September 12, 2018), p. 269.

[80] Human Rights Watch interview with private school staff member (name withheld), Lahore, July 19, 2017.

[81] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[82] Human Rights Watch interview with Beena and Alima, Karachi, July 27, 2017.

[83] Ibid.

[84] Ibid.

[85] Human Rights Watch interview with Fazila, Lahore, July 18, 2017.

[86] Human Rights Watch interview with government middle school teacher (name withheld), Balochistan, January 2018.

87 Ibid.

 

[88] Mubarak Zeb Khan, “New poverty line makes a third of Pakistanis poor,” Dawn, April 8, 2016, https://www.dawn.com/news/1250694 (accessed September 12, 2018).

[89] Human Rights Watch interview with Pariza, Lahore, July 17, 2017.

[90] E.g. Human Rights Watch interview with Benazir, Peshawar, August 7, 2017.

[91] Human Rights Watch interview with Zarifah, Balochistan, January 18, 2018.

[92] Human Rights Watch interview with Aqiba, Lahore, July 21, 2017.

[93] Human Rights Watch interviews with Azwa, Ayesha, and Sidra, Karachi, July 31, 2017, Fazila, Lahore, July 18, 2017, and Bisharah, Lahore, July 18, 2017.

[94] Human Rights Watch interview with Aqiba, Lahore, July 21, 2017.

[95] Human Rights Watch interviews with Pariza, Lahore, July 17, 2017, Fazila, Lahore, July 19, 2017, and Aqiba, Lahore, July 21, 2017.

[96] Human Rights Watch interviews with Bisharah, Lahore, July 18, 2017, and Aqiba, Lahore, July 21, 2017.

[97] E.g. Human Rights Watch interview with Benazir, Peshawar, August 7, 2017.

[98] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[99] Human Rights Watch interview with Aqiba, Lahore, July 21, 2017.

[100] Human Rights Watch interview with Paveena, Quetta, January 17, 2018.

[101] Human Rights Watch interview with Muskaan, Lahore, July 18, 2017.

[102] Human Rights Watch interview with Ann, Lahore, July 18, 2017.

[103] Human Rights Watch interview with Alima, Karachi, July 27, 2017.

[104] E.g. Human Rights Watch interview with Nazneen, Karachi, July 29, 2017.

[105] E.g. Human Rights Watch interview with Eva, Peshawar, August 7, 2017.

[106] Human Rights Watch interview with Shumila, Quetta, January 17, 2018.

[107] Human Rights Watch interview with Asadah, Balochistan, January 18, 2018.

[108] Human Rights Watch interview with Najiba, Quetta, January 17, 2018.

[109] Human Rights Watch interview with Sahar, Karachi, July 25, 2017.

[110] Human Rights Watch interview with Busrah, Karachi, July 26, 2017.

[111] Education Department, Government of Balochistan, “Balochistan Education Sector Plan 2013-2018,” 2014, p. 10.

[112] Human Rights Watch interview with Mariam and Tehreem, Karachi, July 31, 2017.

[113] Human Rights Watch interview with Atifa, Hakimah, and Zafra, Karachi, July 26, 2017.

[114] Human Rights Watch interview with Layla, Karachi, July 27, 2017.

[115] Human Rights Watch interview with head of an NGO (name withheld), Punjab, July 20, 2017.

[116] Human Rights Watch interviews with government primary school teacher (name withheld), Karachi, July 26, 2017, and government high school teacher (name withheld), Peshawar, August 8, 2017.

[117] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[118] Human Rights Watch interview with government high school teacher (name withheld), Peshawar, August 8, 2017.

[119] Human Rights Watch interview with government school principal (name withheld), Karachi, July 30, 2017.

[120] Human Rights Watch interview with Maryan, Peshawar, August 6, 2017.

[121] Human Rights Watch interview with the head of a youth center (name withheld), Karachi, July 30, 2017.

[122] E.g. Human Rights Watch interviews with private school teacher, Lahore, July 19, 2017, and headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[123] Human Rights Watch interview with staff of a youth center (names withheld), Karachi, July 30, 2017.

[124] Human Rights Watch interview with government high school teacher (name withheld), Peshawar, August 8, 2017.

[125] Human Rights Watch interview with government school teacher (name withheld), Peshawar, August 8, 2017.

[126] Human Rights Watch interview with Marzia, Karachi, July 30, 2017.

[127] Human Rights Watch interview with Maryam, Lahore, July 19, 2017.

[128] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[129] E.g. Human Rights Watch interview with Anusha and Zafira, Karachi, July 31, 2017.

[130] Human Rights Watch interview with director of an NGO (name withheld), Punjab, July 20, 2017.

[131] Human Rights Watch interview with headmaster at government primary school (name withheld), Karachi, July 26, 2017.

[132] Human Rights Watch interview with education expert (name withheld), UK, 2017.

[133] UNESCO, “Accountability in education: Meeting Our Commitment. Global Education Monitoring Report,” 2017/18, p. 356.

[134] E.g. Caitlin Gruer, “Menstruation matters: That’s the bottom line,” Global Partnership for Education, March 9, 2017, https://www.globalpartnership.org/blog/menstruation-matters-thats-bottom-line (accessed September 13, 2018).

[135] Human Rights Watch interview with Anusha and Zafira, Karachi, July 31, 2017.

[136] Human Rights Watch interview with Shazia, Lahore, July 19, 2017.

[137] Human Rights Watch interview with education expert (name withheld), UK, 2017.

[138] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[139] Human Rights Watch interview with government primary school teacher (name withheld), Balochistan, January 18, 2018.

[140] Human Rights Watch interview with headmaster of government primary school (name withheld), Karachi, July 26, 2017.

[141] Human Rights Watch interview with NGO worker (name withheld), Lahore, July 21, 2017.

[142] Human Rights Watch interview with head of an NGO (name withheld), Punjab, July 20, 2017.

[143] Human Rights Watch telephone interview with education expert (name withheld), UK, September 15, 2018.

[144] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[145] Human Rights Watch interview with a private school principal (name and location withheld), July 2017.

[146] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[147] Human Rights Watch interview with head of an NGO (name withheld), Punjab, July 20, 2017.

[148] Human Rights Watch interview with principal of a private school (name withheld), Lahore, July 19, 2017.

[149] Human Rights Watch interview with Gulrukh, Karachi, July 31, 2017.

[150] Human Rights Watch interviews with Basma and Najma, Peshawar, August 5, 2017.

[151] Human Rights Watch interview with Rukhsana, Karachi, July 29, 2017.

[152] Human Rights Watch interview with Atifa, Hakimah, and Zafra, Karachi, July 26, 2017.

[153] Human Rights Watch interview with Somia, Karachi, July 30, 2017.

[154] Human Rights Watch interview with Aliya, Karachi, July 31, 2017.

[155] Human Rights Watch interview with Shaheen, Lahore, July 21, 2017.

[156] Human Rights Watch interview with Atifa, Hakimah, and Zafra, Karachi, July 26, 2017.

[157] Human Rights Watch interview with Noor, Karachi, July 31, 2017.

[158] Human Rights Watch interview with Asifa, Punjab, July 19, 2017.

[159] Human Rights Watch interview with Basma, Peshawar, August 5, 2017.

[160] Human Rights Watch interview with Najma, Peshawar, August 5, 2017.

[161] Human Rights Watch interview with Tamana, Lahore, July 17, 2017.

[162] Human Rights Watch interview with Aliya, Karachi, July 31, 2017.

[163] Human Rights Watch interview with Noor, Karachi, July 31, 2017.

[164] Human Rights Watch interview with Malaika, Karachi, July 26, 2017.

[165] Human Rights Watch interview with Farzana, Karachi, July 29, 2017.

[166] Human Rights Watch interview with Salma, Karachi, July 31, 2017.

[167] A CNIC is a “Computerized National Identification Card,” a card issued by the Pakistan government to adult Pakistan citizens, which citizens living in the country are required to register for. A CNIC is required for many actions such as voting, obtaining a passport or driver’s license, or booking a plane ticket. It is also often required from a parent wishing to register their child in government school, although this rule seems to be not always present, and not always enforced. It is less likely to be an issue outside of the government school system. Some parents may have lost CNICs, never obtained them in the first place, or faced barriers obtaining them because of issues like difficulties proving citizenship.

[168] Human Rights Watch interview with Samra and her mother, Karachi, July 31, 2017.

[169] Human Rights Watch interview with Gulrukh, Karachi, July 31, 2017.

[170] Human Rights Watch interview with government school teacher (name withheld), Peshawar, August 8, 2017.

[171] Human Rights Watch interview with Khadijah, Karachi, July 30, 2017.

[172] Human Rights Watch interview with the head of a youth center (name withheld), Karachi, July 30, 2017.

[173] Human Rights Watch interview with Ayesha, Parveen, and Sara, Karachi, July 25, 2017.

[174] Human Rights Watch interview with government primary school teacher (name withheld), Balochistan, January 18, 2018.

[175] Human Rights Watch interview with Aqiba, Lahore, July 21, 2017.

[176] Human Rights Watch interview with Mariam and Tehreem, Karachi, July 31, 2017.

[177] Human Rights Watch interview with Pariza, Lahore, July 17, 2017.

[178] Human Rights Watch interview with Halima, Karachi, July 25, 2017.

[179] Human Rights Watch interview with Muskaan, Lahore, July 18, 2017.

[180] Human Rights Watch interview with Talween, Karachi, July 26, 2017.

[181] Human Rights Watch interviews with Shakila, Asima, and Asima’s father, Lahore, July 18, 2017.

[182] Human Rights Watch interview with Aisha, Peshawar, August 6, 2017.

[183] Human Rights Watch interview with Noor, Karachi, July 31, 2017.

[184] Human Rights Watch interview with Sheherbano, Karachi, July 26, 2017.

[185] Human Rights Watch interview with Rania, Karachi, July 30, 2017.

[186] Human Rights Watch interview with NGO worker (name withheld), Lahore, July 21, 2017.

[187] Human Rights Watch interview with Basooma, Karachi, July 27, 2017.

[188] Human Rights Watch interview with Azwa, Ayesha, and Sidra, Karachi, July 31, 2017.

[189] Human Rights Watch interviews with Nadia and Sahar Gul, Karachi, July 26, 2017.

[190] Conversely, families sometimes made a special effort to educate the youngest child or children in the family, often aided by earnings of eldest children who were already working. E.g. Human Rights Watch interview with Muskaan, Lahore, July 18, 2017.

[191] Human Rights Watch interview with Rabia, Karachi, July 31, 2017.

[192] Human Rights Watch interview with Aynoor, Karachi, July 31, 2017.

[193] Human Rights Watch interview with Parween, Karachi, July 26, 2017.

[194]“The Elimination of Child Labour and Promotion of Decent Work in the Stora Enso Value Chain, with a Focus on Pakistan,” International Labour Organization (ILO), undated but the project duration is 2015-2017, http://www.ilo.org/islamabad/whatwedo/projects/WCMS_427005/lang--en/index.htm (accessed September 13, 2018).

[195] US Department of Labor—Department of International Labor Affairs, “Child Labor and Forced Labor Reports—Pakistan,” 2016, https://www.dol.gov/agencies/ilab/resources/reports/child-labor/pakistan#_ENREF_5 (accessed September 13, 2018).

[196] Human Rights Watch interview with NGO worker (name withheld), Lahore, July 21, 2017.

[197] Human Rights Watch interview with labor rights expert (name withheld), Punjab, July 20, 2017.

[198] Human Rights Watch interview with director of a community-based organization (name withheld), Karachi, July 27, 2017.

[199] Human Rights Watch interview with headmaster of government primary school (name withheld), Karachi, July 26, 2017.

[200] Human Rights Watch interview with NGO worker (name withheld), Lahore, July 21, 2017.

[201] Human Rights Watch interview with labor rights expert (name withheld), Punjab, July 20, 2017.

[202] Human Rights Watch interviews with local activist (name withheld), Karachi, July 26, 2017, and Busrah, Karachi, July 26, 2017.

[203] Human Rights Watch interview with NGO worker (name withheld), Lahore, July 21, 2017.

[204] Human Rights Watch interview with Mariam and Tehreem, Karachi, July 31, 2017.

[205] Human Rights Watch interview with Samika, Lahore, July 21, 2017.

[206] Human Rights Watch interview with Azeeba, Lahore, July 21, 2017.

[207] Human Rights Watch interview with Mahvish, Lahore, July 21, 2017.

[208] Human Rights Watch interview with Tamana, Lahore, July 17, 2017.

[209] E.g. Iftikhar Khan, “Child labour: Lack of coherent reforms in Pakistan, News Tribune, July 1, 2017, https://tribune.com.pk/story/1447383/child-labour-lack-coherent-reforms-pakistan/ (accessed September 13, 2018).

[210] Human Rights Watch interview with NGO worker assisting brick workers (name withheld), Punjab, July 20, 2017.

[211] Ibid.

[212] Human Rights Watch interview with Yasmina and her family, Punjab, July 20, 2017.

[213] UNESCO, “Education for All 2000-2015: Achievements and Challenges,” p. 124.

[214] Human Rights Watch interview with teacher at government school (name withheld), Peshawar, August 8, 2017.

[215] Human Rights Watch interview with NGO gender expert (name withheld), Lahore, July 20, 2017.

[216] Human Rights Watch interview with Humaira, Karachi, July 25, 2017.

[217] Human Rights Watch interview with Asiya, Peshawar, August 7, 2017.

[218] Human Rights Watch interview with Farkhunda, Peshawar, August 6, 2017.

[219] Human Rights Watch interview with government school teacher (name withheld), Peshawar, August 8, 2017.

[220] Human Rights Watch interview with Amina and Fatima, Peshawar, August 6, 2017.

[221] Human Rights Watch interview with NGO gender expert (name withheld), Punjab, July 20, 2017.

[222] Human Rights Watch interview with Sima, Karachi, July 30, 2017.

[223] Human Rights Watch interview with Batool, Balochistan, January 18, 2018.

[224] Human Rights Watch interview with Salma, Karachi, July 30, 2017.

[225] Human Rights Watch interview with Muskaan, Lahore, July 18, 2017.

[226] Human Rights Watch interview with Azra, Peshawar, August 6, 2017.

[227] Human Rights Watch interview with NGO gender expert (name withheld), Lahore, July 20, 2017.

[228] Human Rights Watch interview with Zainab, Karachi, July 29, 2017.

[229] Human Rights Watch interview with Anisa, Peshawar, August 6, 2017.

[230] Human Rights Watch interview with Aliya, Karachi, July 31, 2017.

[231] Human Rights Watch interview with Afsha, Karachi, July 31, 2017.

[232] Human Rights Watch interview with Mumtaz, Peshawar, August 7, 2017.

[233] Human Rights Watch interview with Zarafshan, Karachi, July 30, 2017.

[234] Human Rights Watch interview with Baheerah, Karachi, July 30, 2017.

[235] Human Rights Watch interview with Azrah, Karachi, July 31, 2017.

[236] Human Rights Watch interview with Zaneerah, Peshawar, August 7, 2017.

[237] Human Rights Watch interview with Yasmina, Balochistan, January 18, 2018.

[238] Human Rights Watch interview with Lily, Lahore, July 17, 2017.

[239] United Nations Population Fund (UNFPA), “Marrying Too Young: End Child Marriage,” 2002, http://aidsdatahub.org/sites/default/files/publication/UNFPA_2012_Marrying_too_young.pdf (accessed September 13, 2018).

[240] Human Rights Watch interview with Ayesha, Parveen, and Sara, Karachi, July 25, 2017.

[241] Human Rights Watch interview with Saira, Karachi, July 26, 2017.

[242] Human Rights Watch interview with Aisha, Peshawar, August 6, 2017.

[243] Human Rights Watch interview with Faiza, Karachi, July 31, 2017.

[244] Human Rights Watch interview with Marjan, Lahore, July 17, 2017. 

[245] Human Rights Watch interview with Saira, Karachi, July 26, 2017.

[246] Human Rights Watch interview with Raheebah and Tamima, Karachi, July 31, 2017.

[247] Human Rights Watch interview with Dinah, Karachi, July 30, 2017.

[248] Human Rights Watch interview with Sumbul and Aziza, Karachi, July 31, 2017.

[249] Human Rights Watch interview with Zarmina, Lahore, July 18, 2017.

[250] Human Rights Watch interview with Azwa, Ayesha, and Sidra, Karachi, July 31, 2017.

[251] Human Rights Watch interview with Saba, Lahore, July 18, 2017.

[252] Human Rights Watch interview with Kanwal, Lahore, July 18, 2017.

[253] Human Rights Watch interview with Layla, Karachi, July 27, 2017.

[254] E.g. Human Rights Watch interview with Mumtaz, Peshawar, August 7, 2017.

[255] E.g. Human Rights Watch interview with Rukhsana, Karachi, July 29, 2017.

[256] Human Rights Watch interview with Zunaisha, Peshawar, August 8, 2017.

[257] Human Rights Watch interview with Shaista, Karachi, July 30, 2017.

[258] Human Rights Watch interview with education expert (name withheld), UK, 2017.

[259] Human Rights Watch interview with Shaista, Karachi, July 30, 2017.

[260] Human Rights Watch interview with Hafsa, Peshawar, August 8, 2017.

[261] Human Rights Watch interview with Layla, Karachi, July 27, 2017.

[262] Human Rights Watch interview with Fawzia, Peshawar, August 5, 2017.

[263] Human Rights Watch interview with Parveen, Peshawar, August 7, 2017.

[264] Human Rights Watch interview with Fazeelah, Karachi, July 27, 2017.

[265] Human Rights Watch interview with Layla, Karachi, July 27, 2017.

[266] Human Rights Watch interview with government middle school teacher (name withheld), Balochistan, January 2018.

[267] Human Rights Watch interview with Basma and Najma, Peshawar, August 5, 2017.

[268] Human Rights Watch, Dreams Turned into Nightmares: Attacks on Students, Teachers and Schools in Pakistan, March 2017, https://www.hrw.org/report/2017/03/27/dreams-turned-nightmares/attacks-students-teachers-and-schools-pakistan.

[269] Ibid.

[270] Global Coalition to Protect Education from Attack (GCPEA), “Education Under Attack 2018: Country Profiles: Pakistan,” May 2018, http://protectingeducation.org/sites/default/files/documents/eua2018_pakistan.pdf (accessed September 13, 2018), p. 1.

[271] GCPEA, “Education Under Attack 2018,” May 2018, http://eua2018.protectingeducation.org/ (accessed September 13, 2018), p. 33.

[272] Ibid., p. 49.

[273] “Pakistan: Surge in Militant Attacks on Schools,” Human Rights Watch news release, August 3, 2018, https://www.hrw.org/news/2018/08/03/pakistan-surge-militant-attacks-schools.

[274] Ibid.

[275] Human Rights Watch interview with Abda and Zarghona, Peshawar, August 6, 2017.

[276] Human Rights Watch interview with Zunaisha, Peshawar, August 8, 2017.

[277] Human Rights Watch interview with Naira, Quetta, January 2018.

[278] Human Rights Watch interview with activist (name withheld), Quetta, January 2018.

[279] Human Rights Watch interview with Marzia, Karachi, July 30, 2017.

[280] National Counter Terrorism Authority Pakistan, “20 Points of The National Actions Plan,” http://www.satp.org/satporgtp/countries/pakistan/document/papers/Nationa... (accessed September 13, 2018).

[281] Human Rights Watch, Dreams Turned into Nightmares: Attacks on Students, Teachers and Schools in Pakistan, March 2017, https://www.hrw.org/report/2017/03/27/dreams-turned-nightmares/attacks-students-teachers-and-schools-pakistan.

[282] Human Rights Watch interview with Azeeba, Lahore, July 21, 2017.

[283] Human Rights Watch interview with Paveena, Quetta, January 17, 2018.

[284] Human Rights Watch interview with Mumtaz, Peshawar, August 7, 2017.

[285] Human Rights Watch interview with Samika, Lahore, July 21, 2017.

[286] Human Rights Watch interview with Sidra, Quetta, January 17, 2018.

[287] Human Rights Watch interview with headmaster of private school in a small town (name withheld), Punjab, July 19, 2017.

[288] Human Rights Watch interview with Tamana, Lahore, July 17, 2017.

[289] Human Rights Watch interview with Rabiya and Zahida, Karachi, July 27, 2017.

[290] Human Rights Watch interview with Salima, Punjab, July 19, 2017.

[291] Human Rights Watch interview with Rabiya and Zahida, Karachi, July 27, 2017.

[292] Human Rights Watch interview with Fawzia, Peshawar, August 5, 2017.

[293] Human Rights Watch interview with Basma, Peshawar, August 5, 2017.

[294] Human Rights Watch interview with Priya, Peshawar, August 5, 2017.

[295] Human Rights Watch interview with Samah, Lahore, July 18, 2017.

[296] Human Rights Watch interview with a researcher on education (name withheld), Lahore, July 19, 2017.

[297] Human Rights Watch interview with Humaira, Karachi, July 25, 2017.

[298] Human Rights Watch interviews with Aisha, Bushrah, and Mubashir, Peshawar, August 6, 2017.

[299] Human Rights Watch interview with government primary school teacher (name withheld), Balochistan, January 18, 2018.

[300] Human Rights Watch interview with Parizad, Karachi, July 31, 2017.

[301] Human Rights Watch interview with Anisa, Peshawar, August 6, 2017.

[302] Human Rights Watch interview with Taslima, Samina, and Mahmuda, Karachi, July 31, 2017.

[303] Human Rights Watch interview with Rabiya and Zahida, Karachi, July 27, 2017.

[304] Human Rights Watch interview with Layla, Karachi, July 27, 2017.

[305] E.g. Asif Chaudry and Fahad Naveed, “Why are so many of our children going missing?” Dawn, August 15, 2016, https://www.dawn.com/news/1276916 (accessed September 13, 2018).

[306] Human Rights Watch interview with Alishba, Peshawar, August 6, 2017.

[307] Human Rights Watch interview with Kamila, Balochistan, January 18, 2018.

[308] Human Rights Watch interviews with Asiya and Zaneerah, Peshawar, August 7, 2017.

[309] Convention on the Rights of the Child (CRC), adopted November 20, 1989, G.A. Res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989), entered into force September 2, 1990., art. 6. Pakistan ratified the CRC in November 1990. International Covenant on Economic, Social and Cultural Rights (ICESCR), adopted December 16, 1966, G.A.Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 49, U.N. Doc A/6316 (1966), 993 U.N.T.S. 3, entered into force January 3, 1976. Pakistan ratified the ICESCR in April 2008.

[310] Constitution of Islamic Republic of Pakistan, 1973, art. 37(b).

[311] Ibid., art. 25-A.

[312] Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted December 18, 1979, G.A. res. 34/180, 34 U.N. GAOR Supp. (No. 46) at 193, U.N. Doc. A/34/46, entered into force September 3, 1981. Pakistan acceded to CEDAW in March 1996.

[313] UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment 3, The nature of States parties' obligations (Fifth session, 1990), U.N. Doc. E/1991/23, paras. 2 and 9.

[314] ICESCR, arts. 13 and 2; see also UN Economic and Social Council, Preliminary report of the Special Rapporteur on the right to education, Ms. Katarina Tomasevski, submitted in accordance with Commission on Human Rights resolution 1998/33, E/CN.4/1999/49, January 13, 1999, http://repository.un.org/bitstream/handle/11176/223172/E_CN.4_1999_49-EN... (accessed September 13, 2018).

[315] CESCR, General Comment No. 13, The Right to Education (Art. 13 of the Covenant), U.N. Doc. E/C.12/1999/10 (1999), para. 23.

[316] Ibid., paras. 11–12.

[317] Universal Declaration of Human Rights (UDHR), adopted December 10, 1948, G.A. Res. 217A(III), U.N. Doc. A/810 at 71 (1948), art. 26; ICESCR, art. 13(2)(b); CRC, art. 28. Technical and vocational education and training refers to all forms and levels of the educational process involving, in addition to general knowledge, the study of technologies and related sciences and the acquisition of practical skills, know-how, attitudes and understanding relating to occupations in the various sectors of economic and social life. Convention on Technical and Vocational Education 1989, adopted November 10, 1989, No. 28352, art. 1(a). For further information, see also Convention on Technical and Vocational Education, November 10, 1989, art. 3. http://portal.unesco.org/en/ev.php-URL_ID=13059&URL_DO=DO_TOPIC&URL_SECTION=201.html (accessed September 13. 2018).

[318] ICESCR, art. 13(d). According to the 1990 World Declaration on Education for All, “sound basic education is fundamental to the strengthening of higher levels of education and of scientific and technological literacy and capacity and thus to self-reliant development.” Basic education “should be provided to all children, youth and adults … [and] should be expanded and consistent measures must be taken to reduce disparities.” World Conference on Education for All, World Declaration on Education For All and Framework for Action to Meet Basic Learning Needs, Jomtien, Thailand, March 1990, http://unesdoc.unesco.org/images/0012/001275/127583e.pdf (accessed September 13, 2018), art. 3(1)-(2).

[319] CESCR, General Comment No. 13, “The Right to Education (Art. 13), para. 6 (a)–(d).

[320] Ibid.

[321] CESCR, “Non-discrimination in economic, social and cultural rights (art. 2, para. 2, of the International Covenant on Economic, Social and Cultural Rights),” General Comment No. 20, E/C.12/GC/20 (2009), http://www.refworld.org/docid/4a60961f2.html (accessed September 13, 2018), para. 10 (b).

[322] Ibid.

[323] CEDAW, art. 1.

[324] CEDAW, art. 2.

[325] CEDAW, art. 5(a).

[326] CESCR, General Comment No. 13, “The Right to Education (Art. 13),” para. 6(c).

[327] UN Committee on the Rights of the Child, “The Aims of Education (article 29),” General Comment No. 1, CRC/GC/2001/1 (2001), http://www2.ohchr.org/english/bodies/crc/docs/GC1_en.doc (accessed September 13, 2018).

[328] Ibid., para. 22.

[329] CRC, arts. 28(1) and 2(1).

[330] CESCR, General Comment No. 13, “The Right to Education (Art. 13),” para. 59.

[331] CESCR, General Comment 9, The Domestic Application of the Covenant, E/C.12/1998/24, http://www.refworld.org/docid/47a7079d6.html (accessed September 13, 2018), paras. 2, 9. See also, CESCR, General Comment 3, The Nature of States Parties Obligations, E/1991/23, http://www.refworld.org/docid/4538838e10.html (accessed September 13, 2018), para. 5.

[332] CESCR, General Comment No. 13, “The Right to Education (Art. 13),”, para. 31. See also, CESCR, General Comment 11, Plans of Action for Primary Education, U.N. Doc. E/C.12/1999/4 (May 10, 1999), para. 10; and CESCR, General Comment 3,, para. 2 (stating that the obligation to guarantee the exercise of rights in the International Covenant on Economic, Social and Cultural Rights without discrimination is "of immediate effect").

[333] CEDAW, art.16 (2).

[334] CEDAW Committee, General Recommendation No. 21, Equality in Marriage and Family Relations, (Thirteenth Session, 1994), para. 36; UN Committee on the Rights of the Child, General Comment No. 4, Adolescent Health and Development in the Context of the Convention on the Rights of the Child, (Thirty-third session, 2003), para. 20.

[335] Committee on the Rights of the Child, General Comment No. 4, Adolescent Health and Development in the Context of the Convention on the Rights of Child, CRC/GC/2003/4, (2003), http://www.ohchr.org/Documents/Issues/Women/WRGS/Health/GC4.pdf (accessed September 13, 2018), paras. 16, 20, and 35 (g).

[336] CEDAW Committee, General Recommendation No. 21, Equality in Marriage and Family Relations, (Thirteenth Session, 1994), para. 36; UN Committee on the Rights of the Child, “General Comment No. 4, Adolescent Health and Development in the Context of the Convention on the Rights of the Child,” (Thirty-third session, 2003), para. 20.

[337] See, for example, CEDAW Committee, “Concluding Observations of the Committee to End All Forms of Discrimination against Women, Uganda,” October 22, 2010, para.31, http://www2.ohchr.org/english/bodies/cedaw/docs/co/CEDAW-C-UGA-CO-7.pdf (accessed September 13, 2018).

[338] Saroop Ijaz, “Pakistan Should End Child Marriage,” commentary, Human Rights Watch Dispatch, October 12, 2017, https://www.hrw.org/news/2017/10/12/pakistan-should-end-child-marriage.

[339] CRC, art. 32.

[340] C138 - Minimum Age Convention, 1973 (No. 138), Convention concerning Minimum Age for Admission to Employment (Entry into force: June 19, 1976), ratified by Pakistan on July 6, 2006 stating a minimum age of 14; C182 - Worst Forms of Child Labour Convention, 1999 (No. 182), Convention concerning the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour (Entered into force November 19, 2000), ratified by Pakistan on October 11, 2001.

[341] Constitution of the Islamic Republic of Pakistan, 1973, article 11(3).

[342] CRC, art. 19(1). See Global Initiative to End All Corporal Punishment of Children and Save The Children, “Towards non-violent schools: prohibiting all corporal punishment, Global report 2015,” May 2015, https://endcorporalpunishment.org/resources/thematic-publications/school... (accessed September 13, 2018), pp. 4–5.

[343] CRC, art. 28(2).

[344] UN Committee on the Rights of the Child, “General Comment No. 8 (2006): The right of the child to protection from corporal punishment and other cruel or degrading forms of punishment (arts.19; 28, para. 2; and 37, inter alia),” CRC/C/GC/8 (2007), http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?sy... (accessed September 13, 2018), para. 11.

[345] UN Human Rights Committee, “General Comment No. 20: Article 7 (Prohibition of torture or other cruel, inhuman or degrading treatment or punishment),” A/44/40, (1992), http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?sy... (accessed September 13, 2018), para. 5.

[346] Ibid., para. 5.

Posted: January 1, 1970, 12:00 am

People hold a candlelight vigil in Bengaluru, India, to protest the rape of an 8-year-old girl in Kathua and a teenager in Unnao, April 13, 2018.

© 2018 Reuters
India is witnessing the latest advance in women’s fight for workplace equality and dignity. Women in India have furiously taken to social media using the #MeToo hashtag to publicize accounts of workplace sexual harassment. Some of these have been bottled up for decades.

These brave women are breaching a huge wall of silence and stigma. From Bollywood celebrities to prominent journalists and authors to leaders of nongovernmental organizations, it’s been a cathartic outpouring of women’s grievances.

What’s remarkable about this new wave of naming and shaming is that critics cannot easily brush them aside. Most of the grievances shared publicly provide excruciatingly painful detail about what women endured.

Yet, as we have already seen in the U.S. and in other countries where #MeToo has taken hold, whether those implicated will be held accountable — and how — is the big question. The laws, and how the authorities enforce them, can make a big difference in whether powerful men who use their power to harass women can also use legal intimidation tactics to fend off their accusers.

The Process Is the Punishment

These issues have been central in the case of M.J. Akbar, the minister of state for external affairs in the Narendra Modi government.

Akbar was long revered for his astute journalism. But in early October, he was publicly pilloried with complaints about workplace sexual misconduct from his journalism years. Within days, 14 women wrote about their experiences involving Akbar.

Akbar denied the allegations and contended that they were malicious. He made no offer to cooperate with any investigations or inquiries.

People hold a candlelight vigil in Bengaluru, India, to protest the rape of an 8-year-old girl in Kathua and a teenager in Unnao, April 13, 2018.

© 2018 Reuters
Instead, he adopted a chilling legal strategy, filing a criminal defamation case against Priya Ramani, a prominent woman journalist who first wrote about him. A relic of the British colonial period, India’s criminal defamation law carries up to two years in prison and a fine. With the backing of one of India’s top law firms, Akbar brought a criminal investigation to bear against Ramani. This is different from a civil defamation suit, which provides damages for harm suffered.

Indian journalists and women’s rights activists have banded together with an outpouring of support to make sure Ramani has the resources she’ll need to take on the legal battle. In India, cases of criminal defamation can be arduous, long, and expensive. The court hearings can drag on. The process itself is the punishment.

Women journalists petitioned the president of India to intervene and ensure that Akbar would step down and that the Indian government would initiate an independent investigation. But despite its public pledges to protect the rights of women and girls, when faced with allegations against one of its ministers, the government has not spoken publicly on the case.

Akbar’s criminal defamation case helps explain why many women don’t speak up sooner or never bring cases at all.

Defanging Defamation Laws

Breaking down the architecture of legal intimidation is central to the success of laws governing sexual harassment.

India has had Supreme Court Guidelines (known as Vishaka Guidelines) to prevent workplace sexual harassment from as far back as 1997. Subsequently, the Indian women’s rights movement championed a strong law governing workplace sexual harassment in 2013. But the law has been enforced in a woefully inadequate way.

The reasons are many, including the lack of a monitoring system. But dismantling the ability of the accused to retaliate against complainants is key to the enforcement of any credible regime.

If policymakers want to truly empower women to speak fearlessly and bring complaints against workplace sexual harassment, criminal defamation should have no place in a country’s laws. India is not alone in the world in allowing people to bring criminal defamation cases to harass and intimidate victims who write about them. Many countries have these laws.

As the UN expert on freedom of expression and others have recommended, these laws should be repealed, and replaced with civil defamation laws. And until criminal defamation laws are repealed, courts should not allow them to be used as a legal response to complaints of sexual harassment.

But civil defamation cases can also be used for intimidation. Ramani is not the only woman facing a defamation case. Other men accused of workplace sexual harassment in India have slapped women complainants with civil defamation cases. Civil lawsuits may not carry the threat of criminal sanctions, but they still retain their power to intimidate.

Legal systems should ensure that civil defamation actions cannot be misused as tools to intimidate critics of powerful people into silence. These should be appropriately tailored to weigh the public interest in seeing important allegations brought to light. The UN expert on freedom of expression has stated that defamation suits should be limited to the reputational harm wrongly suffered — and that given the high bar for restricting criticism of government officials, they should not be able to bring defamation suits at all. Financial sanctions should not be so large as to have a chilling effect on speech.

In the United States, 27 states have introduced additional protections, commonly known as “Anti-SLAPP” laws. These are legal measures that guard against Strategic Litigation Against Public Participation (SLAPP) — civil lawsuits brought largely for the purpose of burying activists and others in costly litigation. They help the targets of these suits to have the cases easily thrown out of court without being dragged into a lengthy litigation. There is a growing demand in the European Union to introduce anti-SLAPP legislation.

“We’ll See You at the Barricades”

Ramani is fortunate in that she has the backing of hundreds of journalists across India and widespread support of the women’s rights movement. Ramani and the other women refused to back down and have, for now, prevailed. After Akbar accused Ramani of making false and politically motivated allegations, many more journalists came out to bolster her claims against him. One of them, Tushita Patel, wrote, “[E]nough with the legal intimidation — we can see you in court too…. You know who we are. You’ll recognize us when you see us at the barricades.”

Akbar resigned from his position on October 17. Even though the government has taken no public action in the case, it is hard to know to what extent politics played a role behind the scenes in his departure. But he is not dropping his criminal defamation case.

Governments around the world should throw their weight behind the women saying #MeToo and painfully recounting workplace sexual harassment. They should strike down criminal defamation laws and press ahead with protections that make it easier to hold powerful men accountable and harder to retaliate against courageous women who come forward to confront them. India can, and should, lead the way.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

It happened when I was 17 — not the first such incident but it remains most seared in my memory. It was early autumn, so I was wearing a sweater or light jacket – not that it matters, except that women and girls have been taught to believe that what we are wearing does matter, and to dress in response.

As I walked by some construction scaffolding on my way to class, I heard a man yell: “Nice rack!” I think he snickered, or maybe that was the humiliation echoing in my head. I was mortified. I felt like the world’s eyes were on me – on my body, and its most private parts. Did my classmates hear? The shop owners on the street I walked every day? Decades later, every time it comes to mind I feel my body curling in on itself, my shoulders rounding, my arms crossing like protective armor.

Almost every woman and girl has her version of this story. They — we — have been dismissed for far too long.

In October, a United Kingdom House of Commons special committee, the Women and Equalities Committee, issued a report revealing that for women and girls incidents of sexual harassment in public are “relentless, everyday experiences.”

Young women in Osh, Kyrgyzstan. Nearly one-third of women in Kyrgyzstan experience abuse by a spouse or partner. 

© 2015 Hillary Margolis / Human Rights Watch
Plan International recently reported that two out of three girls in the U.K. had experienced public harassment — including more than one in three while wearing school uniforms. The problem doesn’t end on the street but can even be seen in legislative settings: an independent report in October cited sexual harassment against female House of Commons staff that, along with other abuses, had long been “long been tolerated and concealed.”

The Women and Equalities Committee report notes, “The damage is far-reaching. Experienced at a young age, sexual harassment becomes ‘normalized’ as girls move through life.” What are often discounted as “jokes” or “compliments” can have consequences for years, sometimes even a lifetime. Growing up with our bodies as constant fodder for public comment affects the way we carry ourselves, the way we dress, and the way we navigate our place in the world. It affects our rights to dignity, privacy and autonomy as human beings.

That catcall at age 17, and the ones before and after, turned me into something I did not want and was not ready to be: an object of sexual desire to be gawked at and talked about. I wanted to disappear, and literally tried to, starving myself until I was dizzy with hunger. It wasn’t the only reason I lingered for a couple of years on the edge of an eating disorder. But remembering how dirty and violated it made me feel reinforced my drive to be skinny: if I just get thin enough, I thought, I will be invisible. I won’t be a target anymore.

It never occurred to me to tell anyone that a sense of shame and disgust was eating me from the inside out. I was too embarrassed — as though my body had betrayed me and brought this on itself. And who would I have told? What could they have done? Girls saw women everywhere ignoring catcalls and moving on. We thought that was our lot in life, too.
Street harassment cannot necessarily be legislated out of existence considering the challenges in monitoring, policing, and prosecuting it, and the risk of laws being used inordinately against particular groups.

Harassment of women and girls is a global problem. But in the U.K., there are efforts to do something about it. The Women and Equalities Committee inquiry is important. So are U.K. government moves like mandatory Relationships Education in primary schools and Relationships and Sex Education in secondary schools by September 2019. Yet the WEC report says the government has not done enough to meet its pledge to eliminate sexual harassment by 2030, and efforts have focused only on workplace harassment. But the Home Office reportedly said tackling street harassment is now a “key priority.”

The government should implement recommendations to address street harassment in its Violence against Women and Girls Strategy and strengthen policies and training to prevent harassment on public transit. It should develop media and public education initiatives to change attitudes and behaviors. And change often starts at the top. Elected representatives should demonstrate intolerance for sexual harassment and ensure effective reporting systems and appropriate sanctions for cases within government institutions.

It took me years to stop hiding my body at every turn. Still, when men whistle from car windows or jeer as I run to the bus stop, it is infuriating and degrading. As it takes me back to my 17-year-old self, I think of all the girls and women forced to reckon with feeling like public property.

I want to be able to tell them that they do not have to stand for it, and that we are working to change it. Individually, we can do more to call out such behavior, to intervene and not let it happen to others, especially girls. But governments need also take action so that girls don’t grow up thinking street harassment is “normal,” and hiding themselves as they live silently with the consequences.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am