115 Volume 22, Number 3, September 1996 fore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed [about] and to have access to safe, effective, affordable and acceptable methods of family plan- ning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appro- priate health-care services that will en- able women to go safely through preg- nancy and childbirth and provide couples with the best chance of having a healthy infant [para. 7.2]. The Declaration and Platform for Ac- tion adopted by 187 UN member states in Beijing 3 reaffirm the Cairo Programme’s definition of reproductive health [para. 94], but advance women’s wider interests: The human rights of women include their right to have control over and de- cide freely and responsibly on matters related to their sexuality, including sex- ual and reproductive health, free of co- ercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared re- sponsibility for sexual behaviour and its consequences [para. 96]. The Cairo Programme and the Beijing Platform are points of advancement in identifying particular steps that countries have agreed to take to achieve reproduc- tive rights within specified time periods. The Beijing Platform explains that “re- productive rights embrace certain human rights that are already recognized in na- tional laws, international human rights documents and other consensus docu- ments” [paras. 95 and 223]. However, both Rebecca J. Cook is professor of law on the faculty of law, on the faculty of medicine and with the Centre for Boethics, University of Toronto, Canada. Mahmoud F. Fathalla is president of the International Federation of Gynecology and Obstetrics, London, is senior advisor for biomedical and reproductive health research, The Rockefeller Foun- dation, New York, and is professor of obstetrics and gy- necology at Assiut University, Assiut, Egypt. Advancing Reproductive Rights Beyond Cairo and Beijing By Rebecca J. Cook and Mahmoud F. Fathalla The International Federation of Gynecol- ogy and Obstetrics’ 1994 World Report on Women’s Health concluded that improve- ments in women’s health need more than better science and health care—they require state action to correct injustices to women. 1 Women’s health is often compromised not by lack of medical knowledge, but by in- fringements on women’s human rights. The use of human rights to advance re- productive health and self-determination has gained momentum through recent United Nations (UN) conferences, partic- ularly the 1994 International Conference on Population and Development, held in Cairo, and the 1995 Fourth World Confer- ence on Women, held in Beijing. The Programme of Action adopted by 184 UN member states in Cairo recognizes the importance of human rights in pro- tecting and promoting reproductive health. 2 The Cairo Programme strongly endorses a new strategy for addressing population issues, focused on meeting the needs of individual women and men rather than on achieving demographic tar- gets. A key to this approach is empower- ing women and protecting their human rights, particularly those relevant to re- productive health. Building on the World Health Organization’s definition of health, the Cairo Programme explains that re- productive health is: a state of complete physical, mental and social well-being and…not mere- ly the absence of disease or infirmity, in all matters relating to the reproduc- tive system and to its functions and processes. Reproductive health there- documents lack mechanisms for holding governments legally accountable; such mechanisms generally exist in national laws and constitutions and in regional and international human rights treaties, though, which establish general legal obligations that can be applied to the quest for reproductive health and self-determi- nation (see Table 1, p. 116). National and international human rights law has yet to be adequately applied to reproductive health matters. In this article, we explain how nation- al constitutions and international human rights law can be applied to hold govern- ments accountable for neglecting or vio- lating these rights, how the Cairo Pro- gramme and the Beijing Platform can be used to add specific detail to reproductive rights and how programs have been de- veloped to protect and promote repro- ductive rights beyond Cairo and Beijing. Holding States Accountable Most states commit themselves to pro- mote and protect the human rights of women through national constitutions and by membership in regional and in- ternational human rights conventions. For example, as of July 1, 1996, 153 states have ratified the Convention on the Elimination of All Forms of Discrimination Against Women (the Women’s Convention) and are thus obligated “...to ensure the full de- velopment and advancement of women, for the purpose of guaranteeing them the exercise and enjoyment of human rights and fundamental freedoms on a basis of equality with men” [Women’s Conven- tion, Article 3]. 4 Ratifying countries are to report regu- larly on what they have done “...to ensure the full development and advancement of women.” They report to the Committee on the Elimination of Discrimination Against Women (CEDAW), which was es- tablished under the Women’s Convention COMMENT