Women of the world : laws and policies affecting their reproductive lives, East and Southeast Asia

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WOMEN OF THE WORLD:

WOMEN OF THE WORLD: LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

Published by: The Center for Reproductive Rights 120 Wall Street New York, NY 10005 U.S.A. ©2005 All rights reserved ©2005 Center for Reproductive Rights and Asian-Pacific Resource and Research Centre for Women (ARROW). Any part of this report may be copied, translated or adapted with permission from the authors, provided that the parts copied are distributed free or at cost (not for profit) and the Center for Reproductive Rights and the co-authoring organization of a particular country chapter are acknowledged as the authors. Any commercial reproduction requires prior permission from the Center. The Center would appreciate receiving a copy of any materials in which information from the publication is used. ISBN 1-890671-29-0

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

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Acknowledgments The Center for Reproductive Rights would like to thank its partners in East and Southeast Asia for making this report possible. This report is a product of the hard work and commitment of many wonderful individuals associated with the Asian-Pacific Resource & Research Centre for Women (ARROW), the Population Research Institute at Renmin University of China, the Institute for Social Studies and Action (ISSA), the Women’s Health Advocacy Foundation (WHAF), and the Research Centre for Gender, Family, and Development (CGFED). Many others, too many to name, have guided and assisted us and our partners during the challenging process of gathering information about national laws and policies in the countries surveyed. We are incredibly grateful for their cooperation and support. This report could not have been completed without the leadership and guidance of ARROW, Malaysia, which functioned as the regional coordinator of the project. ARROW guided the Center in the selection of partners for the project and convened two regional meetings to facilitate the research. We would like to express our deepest thanks to the entire ARROW team for the many roles that they played during this project: regional coordinator, primary drafter of the Malaysia chapter, and contributor to the overview of the report. This team of people includes Rashidah Abdullah, Syirin Junisya, Saira Shameem, Nalini Keshavraj, Rathi Ramanathan, Nandita Solomon, Augustha Khew, Sai Jyothi Racherla Uma Tiruvengadam, Shanta Anna, Norlela Shahrani, Khatijah Mohd, Baki, Rosnani Hitam, and Mae Tan Siew Man. We would like to acknowledge the invaluable contributions made by our partner organizations in China, Malaysia, the Philippines, Thailand, and Vietnam that coordinated project research at the national level, undertook the difficult task of gathering information about laws and policies from their governments, drafted chapters, and translated local sources into English. In China, we would like to thank the Population Research Institute at the Renmin University of China, in particular Zheng Xiaoying and Pang Lihua, who were the primary contributors, and Dr. Mu Guangzong, who was a peer reviewer of the draft. In Malaysia, we extend our thanks and appreciation to ARROW, especially Syrin Junisiya, Rashidah Abdullah, and Sai Jyoti for their work on the country chapter. We would also like to thank Datuk Dr. Narimah Awin, director, family health development, Ministry of Health; Nik Noriani Nik Badlishah, research manager, Sisters in Islam; Nik Fahmee

Nik Hussin, executive director, Malaysian AIDS Council; Dr. Ang Eng Suan, executive director, Federation of Family Planning Association Malaysia; Marlina Iskandar, Tenaganita; Florida Sandanasamy, Tenaganita; Wong Shook Foong, law reform officer, Women’s Aid Organisation; Dr. Wong Yut Lin, associate professor, University Malaya; Tashia Peterson, project coordinator, National Council of Women’s Organisations (NCWO); Shanthi Thambiah, Gender Studies Unit, University Malaya; Chee Heng Leng; Tan Beng Hui, program officer, International Women’s Rights Action Watch-Asia Pacific; and Dr. Radhakrishnan for the guidance and support they provided to the primary drafters. In the Philippines, we would like to thank the ISSA and the following members in particular, who devoted considerable time and energy to this report: Rodelyn D. Marte, former coordinator for action research and documentation and also primary drafter of the country chapter; Vincent M. Abrigo, program coordinator; and Mel E. Advincula, officer-incharge. We would also like to thank Dr. Junice Melgar, executive director of Likaan, and attorney Beth Pangalangan of the UP College of Law for their support as peer reviewers. In Thailand, we would like to thank the Women’s Health Advocacy Foundation, especially Nattaya Boonpakdee, coordinator for the Women’s Health Advocacy Foundation (WHAF), for her extended role in drafting the country chapter. We would like to thank the following researchers: Dusita Phuengsamran, ex-coordinator for Research and Dissemination Desk, WHAF; Sumalee Tokthong, program staff, WHAF; Uthaiwan Jamsuthee, state attorney, Office of the Attorney General of Thailand; and Dr. Kritaya Archavanitkul, consultant, deputy director, Institute for Population and Social Research, Mahidol University. We would like to thank Dr. Chalida Kespradit, technical expert, Reproductive Health Division, Department of Health, Ministry of Public Health, and Vacharin Patjekvinyusakul, justice of the court, Court of Appeal Region 1 of Thailand for being peer reviewers. In Vietnam, we would like to thank the Research Centre for Gender, Family, and Environment in Development (CGFED), especially Dr. Le Thi Nham Tuyet, director of research; Hoang Ba Thinh, assistant director of research; Pham Kim Ngoc and Nguyen Kim Thuy, vice-directors; Nguyen Thi Hiep; Pham Thi Minh Hang; and Dang Kim Anh. We would also like to thank the following people for serving as peer reviewers: Dao Xuan Dung, an expert in Reproductive Health and Sexual Health; and Nguyen Thi Hue, ex-

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WOMEN OF THE WORLD:

chairwoman for the External Department, Vietnam Radio Broadcasting, who also translated numerous local sources into English. Credit is also due to many of the Center’s dedicated staff. This project was coordinated by Melissa Upreti, who is also supervising editor of the report. Legal Advisers Lilian Sepúlveda and Pardiss Kebriaei both researched and edited various chapters of the report. Legal Assistants Nile Park and Rachel Gore provided invaluable administrative and editorial assistance. Luisa Cabal, international program director, provided input and guidance during the final stages of the project. We are also grateful to Legal Fellows Aya FujimuraFanselow and Elisa Slattery; Senior Editor/Writer Dara Mayers; Legal Assistant Morgan Stoffregen; and Guan Lan Ying, accountant at the Center. We would also like to thank these individuals who are no longer with the Center but who contributed to portions of the report during their time working with us: Julia Zajkowski, former consulting legal adviser for global projects; Claire Rita Padilla, Dina Bogecho and Sarah Wells, former legal fellows; Melissa Brown, Ritu Gambhir, Rochelle Sparko, Deepah Varma, Lea Bishop, Angelina Fisher, Serena Longley, Jennifer Curran, Camille Mackler, Meghan Rhoad, Jenifer Rajkumar, and Devon Quasha; former legal assistant Ghazal Keshavarzian; former administrative intern Rachel Myer; and, former International Program Director Kathy Hall-Martinez. We are grateful to Neesha Harnam, Vanda Asapahu, and Natalie Nguyen, students at the Yale School of Public Health, for their invaluable assistance in researching foreign sources and fact-checking the Malaysia, Thailand, and Vietnam chapters. We would particularly like to acknowledge the contribution of Bonnie Wong, who volunteered her time and contributed to several chapters of the report. We would also like to thank Xiaonan Liu at the Center for Human Rights, University of Shanghai, for her generous help. We would like to thank members of our communications department who offered guidance on the layout and design of the report, especially Deborah Dudley and Shauna Cagan. We would like to thank former Center Managing Editor Anaga Dalal for her editing and suggestions, particularly on the Overview. We are thankful to Lisa Remez and Sara Shay for copyediting the report. We would also like to express our thanks to Michael Voon in Malaysia for the layout design and imprint services for the printing of the report.

We are grateful for the pro-bono assistance provided by attorneys at Shearman & Sterling LLP; Cleary, Gottlieb, Steen & Hamilton LLP; and Wilmer Cutler Pickering Hale & Dorr LLP. The Center for Reproductive Rights would like to thank the following foundations for their generous support of this report: The Ford Foundation The Wallace Alexander Gerbode Foundation The William and Flora Hewlett Foundation The John D. and Catherine T. MacArthur Foundation The Sigrid Rausing Trust

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

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Table of Contents

D. Divorce Parental rights E. Economic and Social Rights

ACKNOWLEDGMENTS

3

FOREWORD

9

OVERVIEW

10

Ownership of property and inheritance

27

56 56 56

Labor and employment

57

Access to credit

58

Education

58

F. Protections Against Physical and Sexual Violence 1. CHINA

54

61

Rape

61

Incest

61

Domestic violence

61

Framework of China

30

Sexual harassment

62

A. The Structure of National Government

30

Commercial sex work and sex-trafficking

62

Executive branch

30

Sexual offenses against minors

63

Legislative branch

31

I. Setting the Stage: The Legal and Political

B. The Structure of Local Governments

31

Executive branch

31

Legislative branch

32

Judicial branch

32

C. The Role of Civil Society and Nongovernmental Organizations (NGOs) D. Sources of Law and Policy Domestic sources International sources II. Examining Reproductive Health and Rights A. General Health Laws and Policies

2. MALAYSIA

81

I. Setting the Stage: The Legal and Political Framework of Malaysia

84

A. The Structure of National Government

84

33

Executive branch

84

34

Legislative branch

85

34 34 34 34

Objectives

35

Infrastructure of health-care services

35

Financing and cost of health-care services

36

Regulation of drugs and medical equipment

37

Regulation of health-care providers

37

Judicial branch

85

B. The Structure of Local Governments

86

C. The Role of Civil Society and Nongovernmental

86

Organizations (NGOs) D. Sources of Law and Policy

86

Domestic sources

86

International sources

87

II. Examining Reproductive Health and Rights

A. General Health Laws and Policies

87

88

39

Objectives

39

Infrastructure of health-care services

89

Regulation of reproductive health technologies

39

Financing and cost of health-care services

90

Family planning

40

Regulation of drugs and medical equipment

91

Maternal health

43

Regulation of health-care providers

91

Delivery of Services

44

Patients’ rights

92

Safe abortion

45

Patients’ rights B. Reproductive Health Laws and Policies

Regulation of reproductive health technologies

HIV/AIDS and other sexually transmissible infections (STIs) Adolescent reproductive health C. Population III. Legal Status of Women and Girls A. Rights to Equality and Nondiscrimination Formal institutions and policies

B. Reproductive Health Laws and Policies

88

92 93

46

Family planning

93

49

Maternal health

94

50

Safe abortion

96

52

HIV/AIDS and other sexually transmissible

52

infections (STIs)

53

Adolescent reproductive health

B. Citizenship

53

C. Marriage

53

C. Population

97 98 99

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WOMEN OF THE WORLD:

III. Legal Status of Women and Girls

A. Rights to Equality and Nondiscrimination Formal institutions and policies

100

HIV/AIDS and other sexually transmissible

100

infections (STIs)

101

B. Citizenship

101

C. Marriage

101

D. Divorce Parental rights E. Economic and Social Rights

103 104

Adolescent reproductive health C. Population III. Legal Status of Women and Girls A. Rights to Equality and Nondiscrimination Formal institutions and policies

140 142 144 145 145 146

105

B. Citizenship

147

105

C. Marriage

147

Labor and employment

105

D. Divorce

148

Access to credit

106

Education

106

Ownership of property and inheritance

F. Protections Against Physical and Sexual Violence

Parental rights E. Economic and Social Rights

150 150

108

Ownership of property and inheritance

150

108

Labor and employment

151

Incest

108

Access to credit

152

Domestic violence

109

Education

152

Sexual harassment

110

Commercial sex work and sex-trafficking

110

Rape

153

Customary forms of violence

111

Domestic violence

154

Sexual offenses against minors

111

Sexual harassment

155

Commercial sex work and sex-trafficking

155

Sexual offenses against minors

156

Rape

3. PHILIPPINES

123

I. Setting the Stage: The Legal and Political Framework of the Philippines

126

A. The Structure of National Government

126

F. Protections Against Physical and Sexual Violence

4. THAILAND

153

169

I. Setting the Stage: The Legal and Political

Executive branch

127

Framework of Thailand

172

Legislative branch

127

A. The Structure of National Government

172

Judicial branch

127

Executive branch

172

128

Legislative branch

173

Judicial branch

173

B. The Structure of Local Governments C. The Role of Civil Society and Nongovernmental Organizations (NGOs)

129

B. The Structure of Local Governments

D. Sources of Law and Policy

130

C. The Role of Civil Society and Nongovernmental

174

Domestic sources

130

Organizations (NGOs)

174

International sources

130

D. Sources of Law and Policy

174

II. Examining Reproductive Health and Rights A. General Health Laws and Policies

131 131

Domestic sources

174

International sources

174

Objectives

131

Infrastructure of health-care services

132

Financing and cost of health-care services

133

Objectives

Regulation of drugs and medical equipment

133

Infrastructure of health-care services

175

Regulation of health-care providers

133

Financing and cost of health-care services

177

Patients’ rights

134

Regulation of health-care providers

178

Patients’ rights

179

B. Reproductive Health Laws and Policies

135

II. Examining Reproductive Health and Rights A. General Health Laws and Policies

175 175 175

Regulation of reproductive health technologies

135

Family planning

136

Regulation of reproductive health technologies

181

Maternal health

138

Family planning

181

Safe abortion

139

Maternal health

183

B. Reproductive Health Laws and Policies

179

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

Safe abortion

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184

HIV/AIDS and other sexually transmissible

Regulation of reproductive health technologies

216

Family planning

217

infections (STIs)

185

Maternal health

218

Adolescent reproductive health

186

Safe abortion

219

187

HIV/AIDS and other sexually transmissible

C. Population III. Legal Status of Women and Girls A. Rights to Equality and Nondiscrimination Formal institutions and policies B. Citizenship

188 188 189 190

C. Marriage

190

D. Divorce

191

Parental rights E. Economic and Social Rights Ownership of property and inheritance

infections (STIs)

219

Adolescent Reproductive Health

220

C. Population III. Legal Status of Women and Girls

A. Rights to Equality and Nondiscrimination Formal institutions and policies

220 221

222 222

191

B. Citizenship

223

192

C. Marriage

223

192

D. Divorce

223

Labor and employment

192

Access to credit

193

Parental rights E. Economic and Social Rights

224 224

193

Ownership of property and inheritance

194

Labor and employment

224

Rape

194

Access to credit

226

Domestic violence

194

Education

226

Education F. Protections Against Physical and Sexual Violence

Sexual harassment

195

F. Protections Against Physical and Sexual Violence

224

227

Commercial sex work and sex-trafficking

195

Rape

Sexual offenses against minors

196

Domestic violence

227

Sexual harassment

228

Commercial sex work and sex-trafficking

228

Sexual offenses against minors

228

5. VIETNAM

205

I. Setting the Stage: The Legal and Political Framework of Vietnam

208

A. The Structure of National Government

208

Executive branch

208

Legislative branch

209

B. The Structure of Local Governments

209

Regional and local governments

209

Judicial branch

210

C. The Role of Civil Society and Nongovernmental Organizations (NGOs)

210

D. Sources of Law and Policy

210

Domestic sources

210

International sources

211

II. Examining Reproductive Health and Rights

A. General Health Laws and Policies

211

211

Objectives

211

Infrastructure of health-care services

212

Financing and cost of health-care services

213

Regulation of drugs and medical equipment

214

Regulation of health-care providers

214

Patients’ rights

215

B. Reproductive Health Laws and Policies

215

227

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WOMEN OF THE WORLD:

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

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Foreword Imagine a world in which the laws and policies of every country allowed women to fully enjoy their reproductive rights. While this is still a distant goal, a confluence of factors has enabled women’s health and rights advocates to bring it into focus. The 1994 International Conference on Population and Development (ICPD) and the 1995 Fourth World Conference on Women (FWCW) were groundbreaking for so many reasons, among them that governments agreed that everyone has reproductive rights, and that they are an inalienable part of established international human rights. The recognition, long overdue, that the “traditional” human rights framework applies to women’s unique human condition, including their reproductive and sexual lives, has inspired women around the world. The ICPD and the FWCW also recognized that a legal and policy environment that ensures women’s equality is necessary to ensure positive reproductive and sexual health outcomes. But to create that environment, advocates and policymakers need more information to support their efforts. This series of reports, Women of the World: Laws and Policies Affecting their Reproductive Lives, is intended to give advocates and policymakers a more complete view of the laws and policies governing women’s lives to better enable legal and policy reform, to speed the implementation of laws that will improve women’s health and lives, and to assign accountability when governments fail to implement the laws designed to protect women. Initiated soon after the ICPD and the FWCW, the series to date has included reports covering Anglophone Africa, East Central Europe, Francophone Africa, Latin America and the Caribbean, and South Asia. The Center for Reproductive Rights and our collaborating organizations have raised awareness in each of the 35 countries covered by the series, and in many cases have contributed to improvements in laws and policies and their implementation. We are very pleased to introduce the newest report in our series, Women of the World: Laws and Policies Affecting their Reproductive Lives–East and Southeast Asia, covering China, Malaysia, the Philippines, Thailand, and Vietnam. This report, the product of almost three years of work, represents a collaborative effort with nongovernmental organizations in the region. Its release comes just after the ten-year anniversary of the ICPD and coincides with the

ten-year anniversary of the FWCW; it also coincides with the five-year anniversary of the establishment of the Millennium Development Goals, through which world leaders reaffirmed their commitment to achieve universal access to reproductive health care by 2015 and to end discrimination against women. The situation in East and Southeast Asia is illustrative of that in many other regions: Despite some gains, the principles agreed to at the ICPD and the FWCW have not been translated into legislation and policy capable of transforming the lives of the vast majority of women; existing legislation and policy are not backed by sufficient political will and financial commitment. In many instances, enforcement is weak and accountability is lacking. Inherent discrimination persists as medical services required only by women continue to be criminalized. We at the Center for Reproductive Rights want the law to work for women, ensuring their ability to exercise their reproductive rights and to enjoy full equality, no matter their country or community of origin. We hope our Women of the World publication will become a useful tool for improving women’s reproductive lives in East and Southeast Asia through legal advocacy and reform. Luisa Cabal, Director, International Legal Program Melissa Upreti, Legal Adviser for Asia, International Legal Program Center for Reproductive Rights December 2005

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WOMEN OF THE WORLD:

Overview* Governmental commitments at major international conferences such as the Fourth World Conference on Women (Beijing, 1995), the International Conference on Population and Development (ICPD, Cairo, 1994), and the World Conference on Human Rights (Vienna, 1993) have firmly established women’s reproductive rights as human rights that must be enforced. More recently, with the reaffirmation of the Millennium Development Goals (2000), governments have agreed that addressing women’s reproductive health as a fundamental human right is key to promoting gender equality and the right to development. This marks a distinct shift from the development trends of the 1970s and 1980s, which were dominated by population control programs that failed to recognize a woman’s right to control her own fertility. There is no doubt that women’s health and rights are now clearly included in the international political agenda. Governments today are legally obligated to uphold global commitments to women’s health and human rights by introducing gender-sensitive laws and policies that guarantee and safeguard women’s reproductive rights; allocating financial resources to implement existing laws, policies, and programs; and creating mechanisms to monitor and ensure their proper enforcement. In recent years, the women of East and Southeast Asia have made progress on a number of fronts. One of the most laudable achievements has been an impressive female literacy rate that ranges from 82% to 96%. This reflects tremendous progress toward gender equality in education and women’s empowerment. Literacy empowers women not only to proactively seek information about their health and make informed decisions about their reproductive lives, but also to speak out against injustice and hold their governments accountable for violations of their human rights. In addition, there has been a growing willingness in the region to address violence against women through legislation. Both Malaysia and the Philippines, for example, have introduced laws that enable women to confront domestic violence through legal measures and obtain protection orders against their abusers. This has led to a surge in reports of domestic violence, which is typically underreported because women fear retribution from their abusers. A deeper understanding of the impact of domestic violence on women’s health is evident in Malaysia and China, where steps have been taken to integrate emergency medical care for victims of domestic violence with public health services, making it possible for victims to obtain emergency contraception. Another promising development for women in the

*The overview has been drafted in collaboration with ARROW

region is that Thailand, Malaysia, and the Philippines have established human rights commissions to monitor, document, and report human rights violations. Their work can assist governments in fulfilling their obligations to protect human rights and can help raise awareness among the general public and the international community about violations of human rights. The single most encouraging regional trend for reproductive rights, however, has been the general shift away from coercive population policies that focus upon targets to those that emphasize a woman’s right to freely decide the number and spacing of her pregnancies. This shift reflects a growing international consensus that began in 1994 as a result of the International Conference on Population and Development. Despite some of the positive developments in the region, a major concern is that as in most regions of the world, reproductive health is still largely confined to the realm of policy. Comprehensive laws that guarantee women reproductive rights and establish mechanisms for securing the enforcement of such laws do not exist, hence women remain vulnerable to abuse and exploitation. Where legislation does exist, it tends to be limited to certain aspects of women’s reproductive rights, such as the right to family planning and

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

■ ■

■

■

■ ■

■

■

■ ■

the right to life, liberty, and security the right to health, reproductive health, and family planning the right to decide the number, spacing, and timing of children the right to consent to marriage and to equality in marriage the right to privacy the right to be free from discrimination on specified grounds the right to be free from practices that harm women and girls the right to not be subjected to torture or other cruel, inhuman, or degrading treatment or punishment the right to be free from sexual violence the right to enjoy scientific progress and to consent to experimentation

�� � �� ��

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A reproductive rights framework offers a powerful tool for advancing women’s reproductive health and empowering women to address the social conditions that jeopardize their health and lives. Reproductive rights are founded on principles of human dignity and well-being. Broadly speaking, they include two key principles: that all persons have the right to reproductive health care and to make their own decisions about their reproductive lives. More specifically, they encompass a broad range of internationally and nationally recognized political, economic, social, and cultural rights that include the following:

Some of the major obstacles to the fulfillment of reproductive rights as human rights in the region include persistent gender inequality, insufficient data on women’s health, religious fundamentalism, limited access to legal services, and the adverse impact of international policies.

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WHAT ARE REPRODUCTIVE RIGHTS?

OVERARCHING CHALLENGES

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maternal health care; in some cases it tends to be problematic, as in the case of laws that criminalize abortion. Consequently, the promises made by governments to uphold and protect women’s reproductive rights are still largely aspirational. This is not to suggest that existing laws and policies are irrelevant; on the contrary, existing legislative and policy barriers and gaps point to the need for reform in certain key areas and possibly the introduction of a comprehensive law that specifically addresses the gamut of women’s reproductive health concerns from a human rights perspective. What follows is a reflection on the overarching challenges and a deeper discussion of some of the specific concerns that continue to keep women and girls in East and Southeast Asia from the enjoyment of reproductive freedom.

PAGE 11

������������������������������� ��������������������� ���������������������������� ����������������������� ����������������������� Sources: United Nations Population Fund (UNFPA), Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003. UNFPA, The State of the World Population 2005.

1. Persistent gender inequality The ability of women to exercise their reproductive rights is greatly influenced by the extent to which they enjoy equal rights in education, marriage, citizenship, employment, property, and political participation. Women have made significant gains in education, for example, but that has not translated into gains in other areas. For example, women hold only 9% of seats in national parliaments in Malaysia and Thailand and 15% in the Philippines. In Thailand and Vietnam, studies show that women are paid less than men for the same work. In China and Thailand, the age of compulsory retirement is lower for women than for men. Women are discriminated against with respect to their ability to transfer citizenship to their children. In Malaysia, for example, if a child is born outside of the country, the child is considered a

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WOMEN OF THE WORLD:

citizen only if his/her father was a citizen of Malaysia at the confidentiality, privacy, and informed consent to medical protime of the child’s birth. Furthermore, inequalities in marcedures such as abortion and sterilization can make women riage persist for women. For instance, in Malaysia, 20% of all vulnerable to coercion or discrimination in health-care settings and deter them from seeking health services. The promotion Muslim marriages are polygamous. In Thailand, a husband of gender equality, and in some instances of human rights, has may divorce his wife if she commits adultery, but a wife can divorce an adulterous husband only if she can prove that in been included as a strategy in most reproductive health policies, but this is not enough to ensure that women’s rights to health, addition to committing adultery, her husband has financially equality, non-discrimination, and supported or “honored” another woman as his wife. In Vietnam, a self-determination are in fact guarReports to the Committee must demonstrate anteed and protected. Despite the woman cannot file for divorce if she that health legislation, plans and policies are ratification of international treaties is pregnant or nursing a child under based on scientific and ethical research and that call for the formal adoption of a one year of age. Such circumstancassessment of the health status and needs of es may compel women to silently rights-based approach to health care, women in that country and take into account accept inequality and even abuse not one of the governments studied any ethnic, regional or community variations or within marriage. Women who lack here has introduced a comprehensive practices based on religion, tradition or culture. equal rights and the ability to make reproductive health-care bill. In the General Recommendation 24, independent decisions within marPhilippines, a proposed reproductive CEDAW Committee, para. 9. riage are often unable to control the health law has been languishing for number and timing of their pregyears due to conservative opposition nancies, and they risk exposure to to abortion. In Thailand, advocacy unplanned pregnancy, unsafe abortion, maternal mortality, or groups are working in partnership with the government to HIV/AIDS. draft a bill, but nothing has been passed. In addition, with the exception of the Philippines, each of 2. Insufficient data on women’s health the countries surveyed for this report has ratified the ConAn important first step in monitoring and addressing vention on the Elimination of All Forms of Discrimination human rights violations is gathering reliable data, since a firm against Women (CEDAW) with reservations to provisions that grasp of grassroots realities is the very backbone of sound ensure equality in marriage and political participation, and an and effective laws and policies. Governments bear the primary responsibility for collecting data to measure the level of end to gender stereotypes. Indeed, the Malaysian Constitution was amended only in 2001 to recognize gender as a prohuman development of their citizens because it is a resourcehibited ground for discrimination, but this provision does not intensive process. Without reliable data, policymakers can neither understand nor address the incidence, causes, and apply to personal laws. Furthermore, gender discrimination against non-citizens such as migrant workers and refugees consequences of health and social problems. has been quite intense throughout the region, leaving these International treaty-monitoring bodies have repeatedly emphasized the importance of data collection for monitorpopulations particularly vulnerable to exploitation and abuse. ing the implementation of laws, policies, and basic human Malaysia’s two million foreign workers are charged higher fees rights. However, in East and Southeast Asia, there is a consisthan Malaysian citizens for their use of public health facilities, tent lack of official data on key reproductive health and rights and the renewal of a foreigner’s work permit may be refused issues for women and girls, especially on the ground of pregnancy. In addition, legislation such as the domestic sexual violence, unsafe abortion, and Measures to eliminate discrimination against adolescent access to reproductive violence act, which is meant to prowomen are considered to be inappropriate if tect women’s rights, does not extend health services. Although awarea health-care system lacks services to prevent, ness of domestic violence is wideto foreign workers. The very failure detect and treat illnesses specific to women. It spread throughout the region, only to enact laws that safeguard the right is discriminatory for a State party to refuse to to reproductive health-care services Malaysia has conducted a national provide legally for the performance of certain survey on the problem. Official data unique to women—such as contrareproductive health services for women. ception, maternal health care, and on the incidence of deaths due to General Recommendation 24, safe abortion care—itself constitutes unsafe abortion is virtually nonexCEDAW Committee, para. 1 1. istent. In some instances, especially gender discrimination. Further, the absence of laws that ensure patient with regard to maternal deaths, con-

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

PAGE 13

cerns about the multiplicity of data and Their Children Act of 2004; have led to confusion about the true however, considering the broad and The duty to fulfil rights places an obligation on nature and scope of the problem. persistent nature of human rights States parties to take appropriate legislative, Without an accurate baseline, it is violations, such limited services are judicial, administrative, budgetary, economic difficult to measure progress, deternot enough. It is the government’s and other measures to the maximum extent mine disparities, and hold governduty to ensure that legal counsel and of their available resources to ensure that ments accountable for their failure to representation are available to people women realize their rights to health care. The provide critical services. who cannot secure access to such Committee is concerned about the evidence 3. Religious fundamentalism services on their own. Furthermore that States are relinquishing these obligations as Religious fundamentalism proa responsive judiciary is an importhey transfer State health functions to private motes stereotypes about women tant pre-condition for securing the agencies. States and parties cannot absolve based on inequality between the two proper interpretation and application themselves of responsibility in these areas by sexes, thereby undermining women’s of laws. There are clear indications delegating or transferring these powers to ability to make independent decithat, particularly in cases involving private sector agencies. sions about their bodies and their sexual violence and harassment, General Recommendation 24, health. Religion is used frequently courts tend to favor the perpetrators CEDAW Committee, para. 17. in the political arena to deny womof violence by placing the burden of en full recognition of their rights. proof on victims, who must satisfy In the Philippines, where 83% of the population is Roman demanding evidentiary requirements rather than elaborate Catholic, religious fundamentalism backed by political power upon the injuries they have sustained. has become a formidable barrier to women’s access to family 5. Harmful impact of international policies planning. Catholic forces have gained considerable influence Across the region, international institutions including over the policy-making process and have used their influence the World Bank and the International Monetary Fund have to push forward a conservative agenda that focuses upon only been active in helping governments reform their economies. Countries in the region have experienced remarkable natural methods of family planning. economic growth in the last few decades, but conditions The influence of religious forces is not limited to women’s attached to loans and health-sector reforms proposed by access to health care, but extends to intimate relationships international institutions have forced governments to cut within the private sphere. In Malaysia, which is an Islamic public spending on health and education and introduce fees state, a proposal to recognize marital rape as a punishable for basic health services. Health sector reforms, which were offense was dropped from a national domestic violence act expected to increase the efficiency, affordability, coverage, because of opposition from religious conservatives in Parliament. In general, religious conservatives impose their moral and quality of health-care services,1 have in fact reduced women’s access to basic care. In Malaysia, efforts to reduce and theological views to undercut a human rights approach to issues such as sexual violence, HIV/AIDS prevention, and public expenditure on health care have led to the establishment of private hospitals that are known to charge more reproductive and sexual health education for adolescents. for services. And in Vietnam, doctor’s salaries in the public 4. Limited access to legal services health system are subsidized by user fees, leading to discrimiAccess to the judicial system through legal counsel and the nation against those who are insured or, due to poverty, guarantee of a fair trial are essential for securing the enforcement of rights guaranteed by the state. Without access, citizens unable to pay such fees. The dependence of governments on foreign sources for contraceptives has had an adverse impact cannot hold governments accountable for violations of human on their availability and affordability. In the Philippines, for rights, and this may foster impunity. Free legal assistance and counseling are important for women who may lack the inforexample, experts have noted a crisis in contraceptive supmation and support necessary to file a complaint and navigate plies, which has been compounded by the decision of the the judicial system when their rights have been violated. In U.S. Agency for International Development (USAID) to East and Southeast Asia, government legal aid services are not phase out its supply of contraceptives to the country. Furthermore, the conservative views of the current U. S. adminwidely available to women. The Women Lawyers Association istration on reproductive rights, particularly abortion, have of Thailand offers legal aid to low-income women, children, emboldened local fundamentalists and hampered progress and youth. In the Philippines, women have a formal right in the region through restrictive policies such as the global to legal counsel under the Anti-Violence Against Women

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WOMEN OF THE WORLD:

gag rule, threats of funding withdrawal, and censorship at regional, UN-sponsored meetings. LEADING CONCERNS

This section presents key issues that require urgent attention from policymakers, legislators, and advocates: fertility control, inadequate maternal health care, criminalization of abortion, sexual violence, rising prevalence of HIV/AIDS among women, and lack of reproductive health care for adolescents.

Source: UNFPA, State of World Population 2005.

1. Fertility control The ability of women to control the number, spacing, and timing of their children is a fundamental aspect of their reproductive rights. Universal access to modern methods of contraception is both an important pre-condition and an indicator of the fulfillment of this basic right. International legal bodies have repeatedly emphasized the obligation of states to create universal access to family planning, but also to protect women from coercion and discrimination when seeking contraceptive information and services. Although many governments in the region have taken noble strides toward this goal, important concerns include uneven access to family planning services, incentives to influence reproductive choice, restrictions on childbearing, and insufficient access to infertility treatment.

Uneven access to family planning services Access to family planning in the region is highly restricted for some women and modern methods of contraception remain beyond the reach of many. The use of all forms of contraception appears to have increased in the region, particularly among married women, with rates now ranging from to 49% in the Philippines to 84% in China. However, the use of modern methods of contraception is still notably low. In Malaysia and the Philippines, approximately only 30% of married women aged 15–49 use modern methods. The unavailability of reliable data suggests that certain groups of women, including unmarried women, adolescent girls, and widows, have either extremely limited access or none at all to information and services relating to family planning. In the Philippines, the rate of contraceptive use among women aged 15–19 is an alarmingly low 4%. In Malaysia the government prohibits the distribution of contraceptives to unmarried adolescents. Disparities in access also exist based on residence and ethnicity. In Thailand, the northern region has reported a contraceptive prevalence rate of 83.8%, whereas the Muslim-populated south has reported a lower rate of 73%. Rural Muslim women in Malaysia report a lower rate of modern contraceptive use, which is prohibited by Islam. Access also varies according to the type of contraception. Emergency contraception, for instance, is prohibited in the Philippines but widely available in Thailand and prescribed by doctors in public health facilities in Malaysia to victims of rape and incest. Religious conservatives and other ideologues have constructed barriers to women’s access to contraception. In the Philippines, under pressure from the Catholic church, the Arroyo government has adopted strict laws regulating the sale, dispensation, and distribution of contraceptive drugs and devices. Encouraged by this policy shift, some local government officials have begun to use the enhanced executive authority they were given through the decentralization of health care in the Philippines to further restrict the promotion of condoms, making access more limited in some places than others. In Manila City, a local administrative order that permits only natural family planning and actively prohibits the delivery of modern methods is still in place. Attempts to curtail women’s access to family planning have also been introduced in Malaysia, where public awareness programs on contraception have been discontinued in some public health facilities because of the government’s pronatalist stance. Incentives for the use of contraception Providing incentives for couples to practice family planning has been a controversial issue because doing so may impair a

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

woman’s ability to freely and responsibly decide the number, spacing, and timing of her pregnancies and may result in de facto coercion, particularly among low-income women. Nonetheless, incentives are the norm in many parts of the region. In China, women are offered incentives to undergo sterilization. In Vietnam, the government provides incentives for the use of specific methods of family planning such as sterilization and IUD insertion. In some instances, the Vietnamese government has made access to loans contingent upon women’s participation in family planning programs. Restrictions on childbearing With the exception of Malaysia, which has adopted a pronatalist stance, governments in East and Southeast Asia are using family planning programs as a tool to reduce population size. This is particularly evident in Vietnam and China. In Vietnam, the government formally stresses the benefits of small family sizes through the Law on Protection of Health, which promotes a family norm of one to two children. In Vietnam, incentives are mandated by law to ensure small families, although coercion is prohibited. China has a longstanding one-child policy that was codified in 2001. Although there are clear exceptions to the Chinese policy, there are indications that it has been rigorously—and sometimes coercively—enforced by both national and local government officials. Official incentives to have only one child include health insurance, welfare benefits, loans focused upon poverty alleviation, and paid leaves of absence for couples who comply with the policy. Furthermore, the one-child norm penalizes those who violate it with social compensation fees that can be hefty. China also restricts couples who may transmit congenital defects to their children from marrying unless they agree to use birth control or undergo sterilization. Childbearing in general is strictly monitored in China and couples are required to obtain “birth permits” before having children. Given the option of having only one child, Chinese couples tend to opt for male children and resort to sex-selective abortion as a means to this end despite the fact that sex determination during pregnancy and sex-selective abortion are prohibited. Those who are unable to terminate their pregnancies frequently abandon their female children shortly after birth. This has had devastating consequences for women in China and is evidenced by prevailing gender imbalance. Insufficient access to infertility treatment The problem of infertility for women needs greater attention from governments in the region. Assisted reproductive technologies (ARTs) are not widely available in the public health sector despite the growing demand. ART is in high demand in China, since 10% of Chinese couples of childbearing age suffer from infertility. However, in vitro fertilization

PAGE 15

is allowed only if it does not contravene the government’s “family planning, ethical principles, or relevant law.” Other prohibitions in China prevent single women from using ART and forbid the use of surrogates. There is currently no law that regulates assisted reproductive technologies in the Philippines, although the prevention and treatment of infertility is one of the government’s top ten reproductive health priorities. Thailand has no specific law on ART, but in 1997, the executive committee of the Medical Council approved regulations that permit infertility research and treatment. However, infertility services are not covered by social security or other health plans although sterilization may be covered; this situation persists despite the fact that infertility has been designated as a priority in the reproductive health program. Vietnam’s first in vitro fertilization birth took place in 1998, and by March 2003, 1,090 such births had occurred. Since then, the government has pledged to work toward the prevention and treatment of infertility, in part by introducing laws regulating the donation and reception of ova, sperm, and embryos, and other issues concerning in vitro fertilization. Multiple forms of ART are available in Malaysia, including artificial insemination and in vitro fertilization.

STRATEGIES FOR ACTION ■

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Expand family planning programs to ensure universal access to a full range of family planning services, including emergency contraception without coercion or discrimination. Promote the use of condoms to reduce the risk of infection to women of HIV/AIDS and other sexually transmissible infections (STIs). Introduce infertility treatment in public health facilities. Involve women in the formulation of family planning laws and policies and make improvements based on their experiences and needs. Abolish restrictive one—and two—child norms and encourage individuals to limit births by choice. Remove penalties for failure to comply with restrictions on childbearing and take steps to address coercion in the delivery of family planning services.

2. Inadequate maternal health care The right to survive pregnancy and childbirth is a basic human right. UN committees that monitor governmental compliance with international treaties have interpreted the

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WOMEN OF THE WORLD:

sia has the lowest maternal mortality rate of 41 deaths per 100,000 live births, and the Philippines reports the highest rate at 200 deaths per 100,000 live births Although Malaysia, China, and Thailand appear to have met the ICPD target of fewer than 125 deaths per 100,000 live births, there is a need to investigate the causes behind the continuation of maternal deaths despite the high number of hospital deliveries and the high rate of home births monitored by trained attendants. In Vietnam, the overall maternal death rate is 130 deaths per 100,000 live births and studies show that the percentage of women receiving prenatal care decreased from around 73% in 1990 to 68% in 2003, and 70% of births in 2002 were attended by health professionals, down from 90% in 1990. Maternal deaths can be prevented and the existing death rates indicate a breach of duty by governments to protect the lives of women. Malaysia’s confidential inquiry system for determining the causes of maternal deaths and making recommendations for improving maternal health services is an exemplary measure worthy of emulation by governments in the region. Unsafe abortions account for a significant proportion of maternal deaths in the region. Restrictive laws that criminalize abortion along with limited access to family planning and safe abortion services fuel this trend. AccordSource: UNFPA, State of World Population 2005. ing to some estimates, the proportion of maternal deaths due to unsafe abortion in China, Malaysia, and the Philippines failure of governments to protect women from maternal exceeds the global average of 13%.2 death as a failure to protect their right to life. Maternal Uneven access to maternal health care deaths are largely preventable and Maternal mortality rates in the can be avoided through routine States parties should not restrict region vary greatly by income level prenatal care and appropriate care women’s access to health services or to and proximity to care. Disparities during childbirth, including emerthe clinics that provide those services in access may be symptomatic of gency obstetric care. Yet the peron the ground that women do not have discrimination and therefore warsistence of high rates of maternal the authorization of husbands, partners, rant close attention. As a general death in the region highlights the parents or health authorities, because rule, wealthy women or those in failure of governments to fully comthey are unmarried urban areas have greater access to ply with international standards that or because they are women. Other services than low-income women, obligate them to protect women’s barriers to women’s access to rural women, or those who live in rights to life, equality and nondisappropriate health care include laws areas marred by conflict. The discrimination, and health care. The that criminalize medical procedures only parity is particularly stark in China, persistence of maternal deaths in needed by women punish women who where the 2000 maternal mortalthe region, especially due to unsafe undergo those procedures. ity rate was 9.6 deaths per 100,000 abortion, and disparities in access to General Recommendation 24, births in Shanghai, but was signifimaternal health care is problematic. CEDAW Committee, para. 14. cantly higher at 161 deaths in rural Persistence of maternal mortality Xinjiang and 466 deaths in Tibet. Although maternal mortality Furthermore, averages can be dangerously misleading, as rates have decreased throughout the region and the proporis the case in Malaysia, where the overall rate of maternal tion of births attended by trained personnel is high, the fact deaths is the lowest in the region but current data actually that a relatively prosperous and literate region continues to points to an increase in the maternal mortality rate. This is face a significant number of maternal deaths is cause for attributed to deaths among migrant populations who work concern. Of the countries surveyed for this report, Malay-

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

PAGE 17

of conception and criminalizes abortion except to save the life of the mother, while both Vietnam and China allow abortion for any reason. In Malaysia, the Philippines, and Thailand, abortion is not legally permitted on grounds of rape or incest although in Malaysia and Thailand, a victim of rape or incest may obtain an abortion if the procedure is authorized by doctors. In countries where the procedure is legal, governments have failed to ensure that accessible and safe abortion care is available to women. Medical abortion is available only in China. There are additional restrictions on minors seeking abortion, such as parental consent requirements that undermine the ability of young people to make independent decisions about their own health, and making them vulnerable to abuse. In China, for example, young women may be required to obtain parental consent before obtaining an abortion. Restrictive abortion laws have stigmatized the procedure and created an unfavorable environment for women seeking even legal abortions and post-abortion care. This problem is compounded by the absence of protocols for requesting and providing services. Often times, service providers endanger women’s lives by refusing to provide abortions to women in need because of their religious convictions and willful ignorance of the law. It has been widely reported that Filipino health-care professionals providing post-abortion services are often biased and abusive toward their patients, which may constitute inhumane and degrading treatment. Failure to address unsafe abortion The lack of comprehensive official data anywhere in the region about the prevalence of unsafe abortion has the dangerous consequence of rendering one of the most serious threats to women’s lives invisible. Sample studies and anecdotal evidence suggest that the number of deaths due to unsafe abortion and the rate of complications is high. In Thailand, where abortion is not covered by health insurance, 28.8% of women who sought abortions in 1999 developed severe complications. In the Philippines, approximately

STRATEGIES FOR ACTION ■

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Strengthen the primary health-care system by making emergency obstetric care widely available and by improving the overall standard of maternal health services. Expand access to maternal health services without discrimination on the basis of age, marital status, or nationality. Compile national data on the incidence of maternal deaths and identify the barriers that lead to disparities in maternal mortality rates within countries. Develop strategies to address unsafe abortion as a cause of maternal death.

in the informal sector without health benefits or adequate access to public health services. 3. Criminalization of abortion The right to safe and legal abortion is a basic human right and an important pre-condition for women’s reproductive autonomy. Legal prohibitions on abortion have been recognized as violations of women’s right to life. International legal bodies have specifically taken issue with the criminalization of abortion when a pregnant woman’s life and health are endangered and when a pregnancy results from rape or incest. There is international consensus for reviewing laws that contain punitive provisions against women who undergo illegal abortion. In most parts of East and Southeast Asia, the criminalization of abortion persists, and there is limited access to a full range of safe abortion services where the procedure is permitted. Another leading concern is the failure to address unsafe abortion. Denial of abortion rights The legal status of abortion in the countries surveyed for this report varies from highly restrictive to liberal. The constitution of the Philippines recognizes life from the moment

Rape

Incest

Fetal Impairment

• •

•

•

•

•

• •

•

•

To Save the To Preserve To Preserve Woman's Life Physical Health Mental Health

China* Malaysia Philippines Thailand Vietnam

• • • • •

• • • •

This table indicates the grounds on which abortion is explicitly permitted. Refer to the country chapters to understand how they are interpreted. •sex-selective abortion is prohibited

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WOMEN OF THE WORLD:

STRATEGIES FOR ACTION ■ ■

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Abolish criminal abortion laws. Create access to safe and affordable abortion services, including nonsurgical abortion, and post-abortion care by expanding access to such services at the level of primary health care. Ensure the humane treatment of women who have undergone abortion, whether legal or illegal. Undertake public education campaigns to eliminate the stigma against abortion. Compile national data on the incidence of deaths due to unsafe abortion as a basis for developing strategies to prevent these deaths.

400,000 unsafe abortions occur each year. In Malaysia, police reported a mere nine abortion-related deaths in the year 2002, but experts believe that the actual number is much higher. In China, instances of forced abortion have come to light. The procedure is often ordered by government officials without concern for the pregnant woman’s health or preference. This is a cause for concern in a country where, in 1999, an estimated four million abortions took place. The lack of reliable information on the incidence and circumstances in which women have abortions indicates the failure of governments to prioritize and allocate sufficient resources to a major human rights concern, and has made it difficult to assess the real impact of laws that criminalize abortion and the real scope of deaths due to unsafe abortion. Hard data is essential for countering moral and religious challenges to the legalization of the procedure in addition to ensuring that abortions are undertaken by choice and under safe conditions. 4. Sexual violence The right of women to be free from gender-based violence, including rape and other forms of sexual violence, has been recognized by the international community as a basic human right. International law formally recognizes genderbased violence as an impediment to women’s equality. In recent years, countries in the region have introduced a variety of laws and policies to deal with the crisis of sexual violence against women and girls, including a national domestic violence law in Malaysia and the Anti-Abuse of Women in Intimate Relationships Act in the Philippines. However, problems in the region include an overly narrow definition of rape, the absence of sexual harassment laws, and the trafficking of women and girls into commercial sex work. Overly narrow definitions of rape With the exception of the Philippines, laws in the coun-

tries surveyed define rape narrowly and recognize it only in limited circumstances. In Malaysia, for example, only vaginal penetration constitutes rape. Additionally, evidentiary rules requiring independent corroboration and proof of the use of force, such as those prescribed in the Malaysian Penal Code, make it difficult to convict rapists. Furthermore, women’s groups throughout the region have advocated for penal code reform to broaden the definition of and penalties for rape. A successful example is the Philippines, where an anti-rape law now classifies marital rape as a criminal offense, and rape has been reclassified as a crime against the person rather than just a socially unacceptable crime against chastity (efforts of women’s groups in Malaysia to criminalize marital rape have been unsuccessful despite their success in pushing for domestic violence legislation). Absence of sexual harassment laws Of the five surveyed countries, Malaysia, Thailand, and Vietnam have no specific legislation addressing sexual harassment. In Malaysia, women seeking to bring claims of sexual harassment must rely upon penal code provisions that categorize these offenses as being against the “modesty” of a woman. In addition, victims carry the double burden of proving the alleged perpetrator’s offense and his intention to sexually harass beyond a reasonable doubt. In response to the government’s indifference to sexual harassment crimes, the Joint Action Group against Violence against Women, a coalition of women’s organizations in Malaysia, proposed a sexual harassment bill to the Ministry of Human Resources in 2001, but the bill never became law. Even where laws have been adopted, government apathy exists. For example, the Philippines adopted the Anti-Sexual Harassment Act of 1995, which prohibits sexual harassment in employment, education, and training environments, and even extends liability to an employer or head of an institution who fails to take action in response to a claim of sexual harassment. However, the act has rarely been invoked: No Supreme Court cases have resulted from it, and cases filed in lower courts have failed to rule in favor of the woman. In China, a sexual harassment law was only introduced in 2005 and will not go into effect until January 2006. Trafficking Another major form of violence against women in most of the countries surveyed is the trafficking of women and girls into commercial sex work. The number of women trafficked from China, the Philippines, and Vietnam to more affluent countries such as Malaysia and Japan is on the rise. Governments are aware of the growing industry, and most have passed legislation criminalizing the practice. However, the construction and enforcement of these laws

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

STRATEGIES FOR ACTION ■

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Introduce an official zero-tolerance policy against sexual violence through appropriate legislation. Institute penal code reform to broaden the definition of and penalties for rape, and recognize marital rape as an offense. Undertake national studies to determine the true nature, scope, and causes of sexual violence against women and create a national database for developing effective strategies. Integrate domestic violence services with reproductive health services in the public sector and introduce emergency contraception as a routine part of emergency care. Ensure effective enforcement of anti-trafficking laws and integrate emergency medical care for victims of trafficking with enforcement strategies.

remains problematic. Law enforcement officials frequently threaten victims of trafficking as illegal aliens and prosecute women rather than the traffickers and clients. In Malaysia, for instance, police generally arrest or deport individual women, rather than prosecuting the traffickers. Victims of trafficking tend to be foreign women and are denied the legal protections normally available to citizens. They may be fined, whipped, or imprisoned for allegedly trying to enter the country illegally. A significant proportion of women in jails in Malaysia are believed to be victims of trafficking. Furthermore, poor enforcement of existing laws remains a problem. In Thailand between 1996 and 1999, 355 people were arrested for violating the Prostitution Prevention and Suppression Act, but only 14 were convicted and sentenced. 5. Rising prevalence of HIV/AIDS and other reproductive infections The vulnerability of women to HIV/AIDS has been internationally recognized, and governments have been urged to pay special attention to the critical links between women’s reproductive roles, their low sociolegal status and their vulnerability to HIV/AIDS. Almost half a million women are living with HIV/AIDS in East and Southeast Asia; with the exception of Thailand, prevalence rates have increased in each country since 2001. Experts maintain that despite growing rates of HIV/AIDS, governments have been slow to respond comprehensively to the pandemic. Some of the pressing concerns include the absence of laws that protect the rights of people living with HIV/AIDS, dwindling access

PAGE 19

to condoms, the absence of prevention of mother-to-child transmission programs, and the neglect of other sexually transmissible and reproductive infections and diseases. Absence of laws guaranteeing the rights of persons living with HIV/ AIDS China, Malaysia, Thailand and Vietnam have national policies for HIV/AIDS prevention and control, but they have failed to pass laws that formally recognize the human rights of persons living with HIV/AIDS. Such legislation would include recognition of the right to nondiscrimination in all aspects of life, including health care, and the right to treatment. This is of special concern because a number of formal measures to prevent the transmission of HIV/AIDS constitute inherent threats to individuals’ rights to privacy and to nondiscrimination. Examples include compulsory HIV/AIDS testing by several Malaysian states, Chinese laws that restrict the movement of HIV-positive individuals into and out of the country, and the Thai government’s requirement that individuals disclose their HIV status in order to receive financial assistance for education or occupational training and support. In contrast, the Philippines has passed a groundbreaking nondiscrimination law for persons living with HIV/AIDS. Dwindling access to condoms The changing nature of the HIV/AIDS epidemic has raised concerns about women’s ability to protect themselves against transmission. In most countries, the epidemic has spread

Source: UNFPA, State of World Population 2005.

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WOMEN OF THE WORLD:

STRATEGIES FOR ACTION ■

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Enact legislation that guarantees people living with HIV/AIDS their basic human rights to life, nondiscrimination, health, privacy, confidentiality, and humane treatment. Prohibit mandatory HIV testing, and ensure that tests are performed with the informed consent of individuals and are accompanied by pre- and posttest counseling. Protect pregnant women living with HIV/AIDS against coerced sterilization and abortion, while making both options available for women who choose to undergo these procedures. Introduce PMTCT programs to address the specific needs of pregnant women living with HIV/AIDS with due respect for their privacy, confidentiality, and personal decisions. Undertake public education campaigns to eliminate stigma, discrimination, and violence against people living with HIV/AIDS. Expand efforts to gather data on, prevent, and treat STIs and reproductive diseases.

beyond high-risk groups, leading to rising rates of infection among heterosexuals. The most common method of transmission in Thailand is through sexual relations. Although intravenous drug use remains the predominant method of transmission in China and Malaysia, the incidence of sexual transmission is steadily increasing in both countries. In Malaysia, the largest proportion of infected women is composed of housewives. Condoms are the only available and affordable means of preventing sexual transmission of the virus in these countries, but without gender equality, women are not able to insist on condom usage. In addition, restrictions on contraceptive advertising, as in Malaysia, and the growing shortage of condom supplies are likely to further restrict access to condoms for women. Unavailability of national data on condom usage also affects the direction and focus of public health programs. Furthermore, the Catholic church in the Philippines has blocked the use of national funds for condoms and other contraceptives. And there are deep concerns among reproductive health advocates that global funding for HIV/AIDS focuses on treatment and care rather than prevention, which may compel governments to shift their focus from prevention programs to treatment and care exclusively. Absence of prevention of mother-to-child transmission programs Prevention of mother-to-child transmission (PMTCT)

programs have become an important aspect of HIV/AIDS care globally as policymakers recognize the impact of gender discrimination on rising HIV/AIDS rates among women. Women become vulnerable to HIV and pregnancy when they have limited power to refuse sex or to demand the use of condoms despite knowing that their partner is HIV-positive. In the countries surveyed, China, Malaysia, Thailand, and Vietnam operate PMTCT programs; these initiatives are limited in scope, and information about their methodologies is not available. Nonetheless, the growing rate of HIV/AIDS in the region underscores the immediate need for PMTCT programs as an integral part of reproductive health care. Since these programs are primarily conceived as prevention programs for infants, policymakers must be careful not to compromise a mother’s right to informed consent with respect to testing, treatment, and confidentiality in care. The lack of PMTCT programs in the Philippines is potentially devastating. In the Philippines, for example, abortion is illegal, so an HIV-positive mother who does not want to risk transmission of the disease to her fetus has no option but to carry her pregnancy to term. In these situations, the risks of forced pregnancy and unsafe abortion are high. Both are detrimental to women’s health and involve violations of their basic human rights. Sexually transmissible infections (STIs) and other neglected reproductive infections and diseases HIV/AIDS has been able to draw the attention of governments, but other sexually transmissible infections and non-

Source: UNFPA, State of World Population 2005.

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

PAGE 21

transmissible infections such as reproductive tract infections certain services, including family planning services, to unmar(RTIs) and reproductive cancers have been largely neglected. ried adolescents. The denial of sexual and reproductive health Data on the incidence of these diseases is virtually nonexistent services is especially problematic for a region in which the in each of the countries surveyed, and legal and policy inforaverage age of marriage is 22. To presume that adolescents do mation is sparse. The failure to address infections other than not engage in any sexual activity or find themselves vulnerable HIV/AIDS leaves women vulnerto unwanted sexual encounters prior Adolescents who are subject to discrimination able to other chronic diseases, ectoto marriage is unrealistic. In Vietnam, are more vulnerable to abuse, other types of pic pregnancy, cancer, stigma, and it is estimated that around one-fifth violence and exploitation, and their health and even domestic violence. Malaysia is of all women become mothers by the development are put at greater risk. They the only country in the region that age of 19. According to the country’s are therefore entitled to special attention and has pledged to address reproductive ministry of health, around 60% of protection from all segments of society. cancer by establishing the National HIV carriers were adolescents in General Comment 4, Technical Committee for Cervical 2001. Furthermore, the situation Committee on the Rights of Children, para. 6. Cancer Screening. However, sermay not necessarily improve after vices needed to effectively detect and marriage. For example, in Thailand, treat STIs, RTIs, and reproductive cancers have generally not less than half of all married adolescent girls use contraception. Denial of services and information critical to the wellbeen integrated with other health services and have not been prioritized in the ongoing health-sector reforms. being of children and adolescents is contradictory to their best interest and amounts to a denial of their basic rights, 6. Lack of reproductive health care for adolescents including their rights to life, nondiscrimination, and health. The human rights of children and adolescents have been unequivocally articulated and affirmed through a range of Health risks for adolescent girls are further compounded in countries where abortion is criminalized. In Thailand in 1991, international human right treaties and policy documents. girls under the age of 21 accounted for around 30% of women The Children’s Rights Convention in particular establishes children’s right to the highest standard of health and recognizhospitalized for abortion-related complications. China seems es that in all matters relating to children, the best interests of to be an exception as it officially allows unmarried individuals, including adolescents, full access to family planning serthe child should take precedence over all other considerations. vices, although minors may be required to obtain parental International legal bodies have persistently emphasized the need to provide adolescents full access to reproductive health consent for abortion.3 The nonexistence of laws and policies recognizing the reproductive rights information and services, including of adolescents may make them vulsex education. However, adolescents States parties should provide a safe and nerable to discrimination in educain the region are repeatedly denied supportive environment for adolescents, that tional institutions. Legal provisions access to reproductive health-care ensures the opportunity to participate in allowing educational institutions to services and information. Govdecisions affecting their health, to build lifeernments have failed to ensure full expel students for getting married or skills, to acquire appropriate information, to pregnant were only recently amendaccess to reproductive and sexual receive counselling and to negotiate the healthed in China. health services as part of general behaviour choices they make. The realization of health care for adolescents, and they Reproductive and sexual health the right to health of adolescents is dependent education have also failed to guarantee comon the development of youth-friendly health prehensive sexual and reproductive Governments in the region have care, which respects confidentiality and health education in schools. recognized the need for sex educaprivacy and includes appropriate sexual and tion as part of their reproductive Denial of information and services in reproductive health services. health-care settings health, population and HIV/AIDS General comment No. 14, prevention strategies; however, one Although children and adolesCommittee on Economic, cents comprise more than 50% of the weakness of these programs as notSocial and Cultural Rights, para. 23. ed by experts in the region is that total population of at least Malaysia, the Philippines, and Vietnam, their the sexual and reproductive health needs are neglected. In some instances, adolescents are outand rights education that adolescents receive is intended rightly denied sexual and reproductive health services in pubto change adolescent sexual behavior rather than recoglic facilities. The government of Malaysia does not provide nize the rights of adolescents to reproductive health care

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WOMEN OF THE WORLD:

and show respect for their bodily integrity.4 Furthermore, abstinence is often the only socially sanctioned message in health education programs for adolescents. In Malaysia and the Philippines, sex education is often incorporated into other topics, including physical education, biology, and moral and religious studies. This diminishes the importance of sex education as a topic worthy of separate treatment. It also overlooks children and adolescents who are not in school, leaving them even more vulnerable to a host of reproductive health problems, including unplanned pregnancy and HIV/AIDS. In China, approximately one million students belonging to ethnic minority groups, 70% of whom are girls, drop out of school each year to provide financial support to their families.

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THE VITAL ROLE OF

Formally prohibit age-based discrimination in the provision of health-care services and ensure that the best interests of children and adolescents supercede all other considerations. Ensure that adolescents have access to information and services without discrimination and with due respect to their level of maturity and dignity. Ensure that the same rights to informed consent, privacy, and confidentiality that are granted to adults are granted to adolescents. Institute age-appropriate reproductive and sex education programs based on a human rights framework in schools and colleges. Involve adolescents in the development of laws and policies pertaining to their health and rights.

NON-GOVERNMENTAL ORGANIZATIONS (NGOS)

NGOs that advocate for women’s human rights play an important role in the region by conducting research for law and policy reform, advocating on behalf of women, monitoring law and policy implementation, and holding governments accountable for violations of women’s reproductive rights. In countries with less open political climates, statesponsored mass women’s organizations have played an important role. For instance, the All-China Women’s Federation (ACWF) and the Vietnam Women’s Union (VWU) review laws that discriminate against women and participate in the drafting of laws. At the same time, these state-sponsored organizations have limited freedom to detract from the state’s official position on key issues, including birth control. NGOs such as those in Thailand, Vietnam, China, and the Philippines have been playing an active role in providing women access to health services by offering family planning information, counseling, and services. They have worked to increase access to antiretroviral treatment in Malaysia and to prevent and manage abortion complications in the Philippines. In Thailand, they focus on eliminating gender violence and the trafficking of women and children. In China, the ACWF and other women’s NGOs have established shelters, hotlines, and counseling centers for battered women, and they have trained law enforcement officials to curb domestic violence.

PROMOTING A RIGHTS-BASED APPROACH TO WOMEN’S REPRODUCTIVE HEALTH

In relation to health, a rights-based approach means integrating human rights norms and principles in the design, implementation, monitoring, and evaluation of health-related policies and programs. These include human dignity, attention to the needs and rights of vulnerable groups, and an emphasis on ensuring that health systems are made accessible to all. The principle of equality and freedom from discrimination is central, including discrimination on the basis of sex and gender roles. – World Health Organization5 The role of international law International law is fundamental to safeguarding women’s reproductive rights in East and Southeast Asia. With the notable exception of Malaysia, the countries surveyed for this report have largely committed to six core international human rights treaties (see “Human Rights Treaty Ratification in East and Southeast Asia”). Of these treaties, CEDAW and the CRC are the most widely ratified treaties in the region. Treaty ratification Governments that have signed and ratified, or acceded to, international treaties bear certain legal obligations. They are obligated to recognize women’s reproductive rights by ensuring that national laws and policies are in compliance with international legal standards; to report to treaty monitoring bodies that monitor compliance; to implement and publicize concluding observations and recommendations issued by treaty monitoring bodies; and, to work in partnership with NGOs to ensure the protection and advancement of human rights.

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

PAGE 23

HUMAN RIGHTS TREATY RATIFICATION IN EAST AND SOUTHEAST ASIA

The chart below provides the current status of the following six core international human rights treaties in each of the countries surveyed for this report: ■ ■ ■ ■ ■ ■

International Covenant on Civil and Political Rights (ICCPR) International Covenant on Economic, Social, and Cultural Rights (ICESCR) Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) Children’s Rights Convention (CRC) International Convention on the Elimination of All Forms of Racial Discrimination (CERD) Convention against Torture and Other Cruel, Inhuman, and Degrading Treatment (CAT)

CHINA

MALAYSIA

PHILIPPINES

THAILAND

VIETNAM

Accession

Accession

-

-

Signature

-

Ratification

-

-

Accession

ICESCR

Ratification

-

Ratification

Accession

Accession

CEDAW

Ratification with

Accession with

Ratification

Accession with

Ratification with

reservations

reservations

reservations

reservations

-

-

ICCPR CCPR-OP1

CEDAW-OP

Ratification

Ratification with

-

reservations CRC

Ratification

CERD

Accession

CAT

Ratification

Accession

Ratification

Accession

Ratification

-

Ratification

Accession

Accession

-

Accession

-

-

Source: Office of the United Nations High Commissioner for Human Rights, UN Treaty Database, http://www.unhchr.ch/tbs/doc.nsf.

Reservations to treaties Malaysia has ratified (acceded to) the fewest treaties; the Philippines is the only country to have ratified all six without reservation. Although some governments in the region have expressed reservations to key treaty provisions, it is a widely accepted norm of international law that once a government has signed a treaty, it is obligated not to act contrary to the treaty’s spirit and principles. Thailand6 and Malaysia’s7 reservations to CEDAW are particularly noteworthy because they disregard provisions that would guarantee women’s equality. Specifically, Thailand has refused to recognize Article 16, which eliminates discrimination against women in marriage and family matters and prohibits child marriage. Malaysia has refused to recognize particular provisions in Article 16 that secure women’s equal rights upon entering marriage, in being a party to a marriage, in dissolving a marriage, and as guardians of children. Further reservations reflect Malaysia’s unwillingness to dismantle gender stereotypes, to permit women to participate in politics, and to grant women equal rights with men regarding their

children’s nationality. In Malaysia, international treaty provisions are ratified on the understanding that international standards will be modified to accommodate national laws. The Philippines has also ratified ICCPR’s first optional protocol8 and, along with Thailand, CEDAW’s optional protocol.9 Optional protocols accompany existing treaties and create procedures for individuals seeking to redress the violation of their human rights when attempts to secure a domestic remedy have failed. Their ratification is important because it can open doors for women who have exhausted domestic channels and have nowhere else to turn. The remedies that treaty-monitoring bodies may provide for those who use optional protocols may include recommendations to governments for punishing the perpetrator of a crime, compensation for victims, and suggestions for specific reforms in the country’s health-care system or legal system. While the decisions of international bodies are not legally enforceable in the strictest sense, they are binding and can be used by advocates to create political pressure on errant governments to fulfill their treaty obligations.

PAGE 24

WOMEN OF THE WORLD:

THE ROLE OF TREATY-MONITORING BODIES

International treaty-monitoring bodies (TMBs) occasionally issue general recommendations that elaborate upon existing treaty provisions. The CEDAW Committee drafted General Recommendation 24 on Women and Health, which explains the nature of States obligations created by the right to health that's guaranteed by CEDAW13. It establishes the importance of women’s health as “a central concern in promoting the health and well-being of women,” and requires States to “eliminate discrimination against women in their access to health-care services throughout the life cycle”.14 It further recognizes that the obligation to respect women’s right to health requires States parties to “refrain from obstructing action taken by women in pursuit of their health goals”.15 The Committee has expressed particular concern about the health needs and rights of women belonging to vulnerable and disadvantaged groups.16 Furthermore, the Committee on the Rights of the Child has expressed concern about the failure of states to pay attention to the specific needs of adolescents as rights holders and to promote their health and development. This concern motivated the Committee on the Rights of the Child to draft General Comment 4 on “Adolescent health and development in the context of the Convention on the Rights of the Child” which requires States parties to “take all appropriate legislative, administrative and other measures for the realization and monitoring of the rights of adolescents to health and development as recognized in the Convention.”17 It requires States parties to “ensure that adolescent girls and boys have the opportunity to participate actively in planning and programming for their own health and development”.18 TMBs regularly issue concluding observations or comments during the periodic state reporting process that may contain expressions of concern about certain specific issues and recommendations for action. The following are key examples of the committees’ potential for advancing women’s reproductive rights in the region (emphasis is added by the Center): “The Committee urges the Government to maintain free access to basic health care and to continue to improve its family planning and reproductive health policy, inter alia, through making modern contraceptive methods widely available, affordable, and accessible.” Vietnam, Committee on the Elimination of Discrimination Against Women, July 31, 2001, U.N. Doc. A/56/38 19

“The Committee is deeply concerned about reports of forced abortions and forced sterilizations imposed on women, including those belonging to ethnic minority groups, by local officials in the context of the one-child policy, and about the high maternal mortality rate as a result of unsafe abortions.” China, Committee on Economic, Social, and Cultural Rights, May 13, 2005, U.N. Doc. CESCR/E/C.12/Add.107 20

“The Committee urges the Government to examine the ways in which its population policy is implemented at the local level and initiate an open public debate thereon. It urges the Government to promote information, education, and counseling, in order to underscore the principle of reproductive choice, and to increase male responsibility in this regard.” China, Committee on the Elimination of Discrimination Against Women, February 3, 1999, UN Doc. A/54/3821

“The Committee expresses concern about the prevalence of violence against women and, in particular, domestic violence. It also expresses concern at the lack of legal and other measures to address violence against women, as well as at the failure of the State party specifically to penalize marital rape.” Vietnam, Committee on the Elimination of Discrimination Against Women, July 31, 2001, U.N. Doc. A/56/3822

“The Committee is particularly concerned over the absence of data on adolescent health, including on teenage pregnancy, abortion, suicide, accidents, violence, substance abuse, and HIV/AIDS. In this regard, the Committee recommends that the State party increase its efforts to promote adolescent health policies and strengthen reproductive health education and counseling services.” Thailand, Committee on the Rights of the Child, October 26, 1998, UN Doc. CRC/C/155/Add.9723

“The Committee recommends the State Party to ensure access to reproductive health counseling and provide all adolescents with accurate and objective information and services in order to prevent teenage pregnancies and related abortions; and strengthen formal and informal education on sexuality, HIV/AIDS, STIs, and family planning.” Philippines, Committee on the Rights of the Child, June 3, 2005, UN Doc. CRC/C/15/Add.25924

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

Reporting status Most of the countries have reported at least once on their compliance with the international human rights treaties they have ratified. With the exception of Malaysia, all of the countries have reported to the CEDAW Committee.10 Malaysia’s first combined initial and second periodic report is due for consideration by the Committee in 2006.11 Similarly, with the exception of Malaysia, the countries surveyed have reported to the CRC, although they have been three to six years late in submitting their reports.12 The failure to meet reporting deadlines may indicate a country's failure to prioritize human rights. STRATEGIC RECOMMENDATIONS

Women’s health policies must be developed within a broad framework linking human rights principles with population and development, poverty eradication, social justice, gender equality and equity, and women’s empowerment, and comprise a comprehensive set of strategies that are designed to protect and promote their rights. – Asian Pacific Resource and Research Centre for Women (ARROW) The fulfillment of women’s reproductive rights requires multidisciplinary strategies based on a human-rights framework. At the very least, governments should introduce comprehensive reproductive health legislation that guarantees the rights of individuals to determine the number, spacing, and timing of their children and the right to make choices about reproduction free from discrimination, coercion, and violence. Comprehensive reproductive health legislation that includes penal code reform regarding issues such as abortion and sexual violence can provide a formal means for addressing reproductive rights violations. This will help improve the delivery of reproductive health care—a goal shared by governments in the region. What follows are general recommendations for promoting a rights-based approach to reproductive health care and holding governments accountable for violations. To governments: ■ Introduce gender concerns in the daily work of key departments such as ministries of health, law, women’s affairs, and finance, and ensure that these offices obtain sufficient technical and financial resources to support law and policy implementation, the monitoring of reforms, and research. ■ Promote the participation of women in all levels of government including parliament, ministries, and judicial bodies. ■ Make the legal system more accessible by undertaking public campaigns that raise awareness of legal rights, and create legal aid services for those who require free

PAGE 25

legal counsel and assistance. Increase the capacity of government officials to incorporate human rights principles into every aspect of their work through training and sensitization. As a first step, help law and health ministries and the judiciary to promote a human rights approach to health. ■ Submit reports to treaty-monitoring bodies with adequate information and data on key reproductive health issues, and publicize and implement concluding comments issued by such bodies at the national level. ■ Withdraw reservations to CEDAW and ratify the optional protocol to CEDAW to ensure full implementation of the treaty. To advocates for women’s health and rights: ■ Build collaborative strategies with health-service providers, lawyers, and community-based organizations to monitor and document violations of human rights, and develop strategies to establish accountability for violations by government and non-state actors through various strategies, including litigation. ■ Monitor governments to ensure that they respond to complaints about discrimination, coercion, and violence that undermine women’s health in the private and public spheres. ■ Develop collaborative strategies among diverse nongovernmental organizations by strengthening sexual and reproductive health and rights partnerships at the international, national, state, and local levels. ■ Monitor and publicize governmental compliance with human rights principles in reproductive health and women’s empowerment policies and programs and in relationships with international financial institutions and donors. ■ Expose and advocate against the political collusion of religious conservative bodies with the state in the formulation of reproductive health policy, legislation, and judicial decision-making. ■ Counter the influence of international funding institutions that propose budget cuts for health programs by pushing governments to defend their international treaty obligations to citizens. ■ Seek remedies for violations of human rights in national courts and if national remedies fail, consider filing complaints with international legal bodies. ■ Lobby governments for the withdrawal of reservations to CEDAW and for the ratification of the optional protocols to CEDAW and the ICCPR. ■

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ENDNOTES

1. Asian Pacific Resource and Research Centre for Women (ARROW), ICPD: Ten Years On: Monitoring on Sexual and Reproductive Heath and Rights in Asia (2005), at 32. 2. World Health Organization (WHO), Reproductive Health Strategy § 17 (May 2004), available at http://www.who.int/reproductive-health/publications/strategy.pdf. 3. ARROW, supra note 1, at 9. 4. ARROW, supra note 1, at 9. 5. World Health Organization (WHO), Human Rights-Based Approach to Health, http:// www.who.int/trade/glossary/story054/en/. 6. Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981, ratified with reservations by Thailand Sept. 8, 1985). 7. Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981) available at http://www.un.org/womenwatch/daw/cedaw/reservations-country.htm 8. Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornogrophy, adopted May 25, 2000, G.A. Res. 54/263, U.N. GAOR, 54th Sess., UN Doc A/RES/54/263 (2000) (ratified by the Philippines, entered into force Jan. 18, 2002). 9. Optional Protocol to the Convention on the Elimination of Discrimination against Women, Oct. 6, 1999, G.A. Res. 54/4, U.N. GAOR, 54th Sess., U.N. Doc A/Res/54/4 (1999) (ratified by the Philippines and Thailand, entered into force Dec. 22, 2000). 10. Consideration of reports submitted by States parties under article 18 of Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Combined initial and second periodic reports of States parties, Malaysia, CEDAW Committee, U.N. Doc. CEDAW/C/ MYS/1-2 (2005). 11. Id. 12. Submission of Reports By State Parties of the Committee on the Rights of the Child, 39th Sess., U.N. Doc. CRC/C/148 (2005). 13. General Recommendation 24 of the Committee on the Elimination of Discrimination Against Women, 12th Sess., para. 2, (1999). 14. Id. 15. Id para. 14. 16. Id. para. 6. 17. General Comment 4 of the Committee on the Rights of the Child, 33rd Sess, para. 39. U.N. Doc. CRC/GC/2003/4 (2003). 18. Id. para. 39 (d). 19. Concluding Observations of the Committee on the Elimination of Discrimination Against Women: Vietnam, 25th Sess., para. 232-276, U.N. Doc. A/56/38 (2001). 20. Concluding Observations of the Committee on Economic, Social, and Cultural Rights: China, 34th Sess., para. 36, U.N. Doc. CESCR/E/C.12/Add.107 (2005). 21. Concluding Observations of the Committee on the Elimination of Discrimination Against Women: China, 20th Sess., para. 251-336, U.N. Doc. A/54/38 (1999). 22. Concluding Observations of the Committee on the Elimination of Discrimination Against Women: Vietnam, 25th Sess., para. 232-276, U.N. Doc. A/56/38 (2001). 23. Concluding Observations of the Committee on the Rights of the Child: Thailand, 19th Sess., para. 25, U.N. Doc. CRC/C/155/Add.97 (1998). 24. Concluding Observations of the Committee on the Rights of the Child: Philippines, 39th Sess., U.N. Doc. CRC/C/15/Add.259 (2005).

WOMEN OF THE WORLD:

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

1. China Statistics GENERAL

Population ■

Total population (millions): 1,315.8.1

■

Population by sex (thousands): 639,189.0 (female) and 674,120.0 (male).2

■

Percentage of population aged 0–14: 24.2.3

■

Percentage of population aged 15–24: 16.3.4

■

Percentage of population in rural areas: 61.5

Economy ■ Annual percentage growth of gross domestic product (GDP): 9.7.6 ■

Gross national income per capita: USD 1,100.7

■

Government expenditure on health: 2% of GDP.8

■

Government expenditure on education: 2% of GDP.9

■

Percentage of population below the poverty line: 5.10

WOMEN’S STATUS ■

Life expectancy: 73.9 (female) and 70.3 (male).11

■

Average age at marriage: 22.1 (female) and 23.8 (male).12

■

Labor force participation: 80.3 (female) and 90.1 (male).13

■

Percentage of employed women in agricultural labor force: Information unavailable.

■

Percentage of women among administrative and managerial workers: Information unavailable.

■

Literacy rate among population aged 15 and older: 82% (female) and 94% (male).14

■

Percentage of female-headed households: Information unavailable.

■

Percentage of seats held by women in national government: 22.15

■

Percentage of parliamentary seats occupied by women: 20.16

CONTRACEPTION ■

Total fertility rate: 1.72.17

■

Contraceptive prevalence rate among married women aged 15–49: 84% (any method) and 83% (modern method).18

■

Prevalence of sterilization among couples: 46.1% (total); 35.9% (female); 10.2% (male).19

■

Sterilization as a percentage of overall contraceptive prevalence: 54.5.20

MATERNAL HEALTH ■

Lifetime risk of maternal death: 1 in 710 women.21

■

Maternal mortality ratio per 100,000 live births: 56.22

PAGE 27

PAGE 28

WOMEN OF THE WORLD:

■

Percentage of pregnant women with anemia: 52.23

■

Percentage of births monitored by trained attendants: 97.24

ABORTION ■

Total number of abortions per year: 7,930,000.25

■

Annual number of hospitalizations for abortion-related complications: Information unavailable.

■

Rate of abortion per 1,000 women aged 15–44: 26.1.26

■

Breakdown by age of women obtaining abortions: Information unavailable.

■

Percentage of abortions that are obtained by married women: Information unavailable.

SEXUALLY TRANSMISSIBLE INFECTIONS (STIS) AND HIV/AIDS ■

Number of people living with sexually transmissible infections: Information unavailable.

■

Number of people living with HIV/AIDS: 840,000.27

■

Percentage of people aged 15–49 living with HIV/AIDS: 0.1 (female) and 0.2 (male).28

■

Estimated number of deaths due to AIDS: 44,000.29

CHILDREN AND ADOLESCENTS ■

Infant mortality rate per 1,000 live births: 33.30

■

Under five mortality rate per 1,000 live births: 47 (female) and 39 (male).31

■

Gross primary school enrollment ratio: 115% (female) and 115% (male).32

■

Primary school completion rate: Information unavailable.

■

Number of births per 1,000 women aged 15–19:5.33

■

Contraceptive prevalence rates among married female adolescents: Information unavailable.

■

Percentage of abortions that are obtained by women younger than age 20: Information unavailable.

■

Number of children under the age of 15 living with HIV/AIDS: Information unavailable.

CHINA

PAGE 29

ENDNOTES 1. See United Nations Population Fund (UNFPA),The State of World Population 2005, at 112 (estimate for 2005). 2. See United Nations Population Fund (UNFPA), Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003 (2003), http://www.unfpa.org/profile/default.cfm. [hereinafter UNFPA, Country Profiles] 3. See The World Bank,World Development Indicators 2004, at 38 (2004), http:// www.worldbank.org/data/ (estimate for 2002).[Hereafter The World Bank]. 4. See UNFPA, Country Profiles, supra note 2. 5. See UNFPA,The State of World Population 2005, supra note 1, at 112, (estimate for 2003). 6. See The World Bank, supra note 3. (estimate for 1990-2002). 7. See The World Bank,World Development Indicators 2004, Data Query, http://devdata.worldbank.org/data-query/ (statistical figure obtained through the Atlas method) (estimate for 2003). 8. See UNFPA,The State of World Population 2005, supra note 1, at 112. 9. See United Nations CyberSchoolBus, InfoNation, Government Education Expenditure (2004), http://www.un.org/Pubs/CyberSchoolBus/infonation/e_infonation.htm (estimate for 1997). 10. See The World Bank, Country at a Glance Tables for China 2004, at 1 (2004), http://www.worldbank.org/data/countrydata/countrydata.html. 11. UNFPA,The State of World Population 2005, supra note 1, at 108 (estimate for 2005). 12. See UNFPA, Country Profiles , supra note 2. 13. See Id. 14. See Id. 15. See Save the Children, State of World’s Mothers 2004, at 36 (2004), http:// www.savethechildren.org/mothers/report_2004/images/pdf/SOWM_2004_final.pdf (estimate for 2004). 16. See United Nations Statistics Division, Millennium Indicators Database (2005), http://unstats.un.org/unsd/mi/mi_series_results.asp?rowId=557 (last updated Mar. 16, 2005) (estimate for 2005). 17. See UNFPA,The State of World Population 2005, supra note 1, at 112, (estimate for 2000-2005). 18. Id. at 108. 19. See Engenderhealth, Contraceptive Sterilization: Global Issues and Trends, tbl. 2.2, at 47 (2002) (estimates for 1992). 20. See Id., tbl. Supp. 2.5, at 55. 21. See World Health Organization (WHO) et al., Maternal Mortality in 1995: Estimates Developed by WHO, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), 42 (2000) (estimate for 1995). 22. See UNFPA,The State of World Population 2005, supra note 1, at 108. 23. See Save the Children, supra note 15, at 36 (estimate for 1989-2000). 24. See UNFPA,The State of World Population 2005, supra note 1, at 112. 25. See Stanley K. Henshaw et al., The Incidence of Abortion Worldwide, 25 Int’l Fam. Planning Persp. S30 –S38 (Supp. 1999), http://www.agi-usa.org/pubs/journals/25s3099. html (estimate for 1995-1996). 26. See Department of Economic and Social Affairs, United Nations Population Divisions, United Nations World Abortion Policies 1999, U.N. Doc. ST/ESA/ SER.A/178 (1999), http://www.un.org/esa/population/publications/abt/abt.htm (estimate for 1995). 27. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., UNAIDS/World Health Organization (WHO) Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 Update: China 3 (2004), http://www.who.int/GlobalAtlas/PDFFactory/HIV/EFS_PDFs/EFS2004_CN.pdf (estimate for 2003). 28. See UNFPA,The State of World Population 2005, supra note 1, at 108. 29. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., supra note 27. 30. See UNFPA,The State of World Population 2005, supra note 1, at 108. 31. See UNFPA, Country Profiles, supra note 2. 32. See UNFPA,The State of World Population 2005, supra note 1, at 108. 33. See Id. at 108.

PAGE 30

T

he People’s Republic of China lies to the west of the East and South China Sea and borders 14 other countries including India and Russia.1 China has one of the oldest civilizations in the world.2 It was founded on October 1, 1949, by the Communist Party of China (CPC), under the leadership of Mao Zedong.3 The country was conceived as a socialist nation dedicated to the principles of Marxism-Leninism and the Maoist ideology of class struggle,4 and was the result of years of civil unrest and an internal power struggle between the Kuomintang and the CPC.5 The government gained popular support by curbing inflation, restoring the economy, rebuilding many war-damaged industrial plants, and unifying the country.6 In 1958, Mao launched the Great Leap Forward, a radical initiative aimed at accelerating industrial growth that led to one of the deadliest famines in human history.7 Mao stepped down from the presidency in 1959 amid heavy criticism in the aftermath of the Great Leap Forward.8 Meanwhile, CPC Secretary-General Deng Xiaoping gained political support through his introduction of pragmatic economic reforms that ended famine and dramatically increased income and productivity.9 To regain power and halt the “capitalist corruption” of the masses, Mao in 1966 instigated a popular rebellion against the leadership, the Great Proletarian Cultural Revolution, plunging the country into political and social anarchy that lasted until his death in 1976.10 Subsequently, Deng Xiaoping assumed leadership of the Chinese government and the CPC,11 officially adopting open-door economic policies guided by capitalist, free-market principles.12 He also advanced the principles of the “Four Modernizations”—a development strategy aimed at modernizing industry, agriculture, science and technology, and national defense.13 Deng was succeeded in 1993 by President Jiang Zemin,14 who focused on advancing production, culture, and the interests of the people of China.15 In March 2003, he was succeeded by Hu Jintao.16 China has an estimated population of more than 1.3 billion,17 approximately 48.5% of which is female.18 More than 91.1% of the country is Han Chinese, and the remainder of the population consists of 56 other ethnic minorities.19 China is officially atheist,20 but prevalent religions include Buddhism, Daoism (Taoism), Islam, Catholicism, and Christianity.21 China’s official language is Mandarin (Putonghua, based on the Beijing dialect), spoken by more than 70% of the population.22 Other languages include Yue (Cantonese), Wu (Shanghaiese), Minbei (Fuzhou), Minnan (Hokkien-Taiwanese), Xiang, Gan, Hakka dialects, and other ethnic languages.23 China has been a member of the United Nations since October 24, 1945,24 and is a permanent member of the United Nations Security Council.25 China has joined several eco-

WOMEN OF THE WORLD:

nomic alliances, including the Asia-Pacific Economic Cooperation (APEC) in 1991, and the World Trade Organization (WTO) in 2001,26 and has a co-operative relationship with the Association of Southeast Asian Nations (ASEAN).27

I. Setting the Stage: The Legal and Political Framework of China Fundamental rights are rooted in a nation’s legal and political framework, as established by its constitution. The principles and goals enshrined in a constitution, along with the processes it prescribes for advancing them, determine the extent to which these basic rights are enjoyed and protected. A constitution that upholds equality, liberty, and social justice can provide a sound basis for the realization of women’s human rights, including their reproductive rights. Likewise, a political system committed to democracy and the rule of law is critical to establishing an environment for advancing these rights. The following section outlines important aspects of China’s legal and political framework. A. THE STRUCTURE OF NATIONAL GOVERNMENT

The constitution of China came into force on December 4, 1982, and was amended in 2004 to “respect and protect human rights.”28 It establishes a “socialist state under the people’s democratic dictatorship led by the working class and based on the alliance of workers and peasants.”29 State organs are required to practice democratic centralism,30 and political power belongs to the people as exercised through their elected representatives in the National People’s Congress (NPC) and local people’s congresses.31 Executive branch The executive branch of the Chinese government consists of the president, the vice president, and the State Council (guo wu yuan), its premier, and vice premiers.32 The president of China is the titular head of state and is nominated, elected, and removed by the NPC.33 The president serves for a maximum of two consecutive five-year terms.34 The president’s functions include promulgating NPC decisions regarding statutory enactments, deciding on State Council appointments and removals, declaring a state of emergency or war to the public, and conducting foreign diplomatic relations.35 The State Council is the most powerful executive body in the Chinese government.36 The premier presides over the State Council and has final decision-making power pertaining to issues within the State Council’s authority.37 The composition of the council includes vice premiers, state coun-

CHINA

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cilors, ministers, an auditor-general, and a secretary-general.38 Council members serve five-year terms and the premier, vice premiers, and state councilors may serve no more than two consecutive terms.39 The State Council has undergone multiple restructurings to reduce the central government’s involvement in economic affairs.40 It is currently composed of the General Affairs Office, 28 ministries and commissions, 17 directly affiliated organs, 7 working offices, and a number of news agencies and academic institutions.41 Among the departments within the State Council are the Ministry of Education (MOE), Ministry of Labor and Social Services (MOLSS), Ministry of Health (MOH), and the National Population and Family Planning Commission (NPFPC).42 The NPC oversees the work of the State Council,43 which has the authority to enact administrative regulations;44 stipulate the responsibilities of ministries, commissions, and local people’s governments; formulate measures to execute the government budget;45 and implement economic, social, health, population, development, and other national policies and plans passed by the NPC.46 It may submit proposals to the NPC regarding matters within its jurisdiction.47 Although the State Council formally answers to the NPC and its Standing Committee, in practice it is subordinate to the CPC and tends to implement the principles and policies adopted by the party.48 The constitution mandates that “[n]o organization or individual may enjoy the privilege of being above the Constitution and the law.”49 However, in practice, party policies shape the work of the State Council, whose senior members are usually influential party leaders.50 Former President Deng condemned this centralization of power and introduced measures to separate and clarify the powers and duties of state and party organs in an effort to improve the balance of power.51 Recently, an administrative license law was adopted to regulate government acts at all levels.52 Legislative branch The legislative branch of the Chinese government consists of the NPC (renmin daibiao dahui), the “highest organ of state power,” and its permanent representative body, the Standing Committee, which together exercise legislative power for the country.53 The NPC comprises no more than three thousand deputies elected to five-year terms by local people’s congresses made up of deputies elected by the people of each electoral district, special administrative regions, national autonomous regions, and the armed forces.54 Among the NPC deputies must be an appropriate number of women.55 Special committees within the NPC assist in discharging legislative responsibilities.56 Special committees include, among others, the Legisla-

tive Committee, the Education, Science, Culture, and Health Committee, and the Civil and Judicial Affairs Committee.57 The NPC meets in annual sessions.58 Among its powers and functions are approving amendments to the constitution and supervising the enforcement of the constitution; enacting and amending national laws;59 electing and removing members of the executive branch and leaders of the Supreme People’s Court (SPC), Central Military Commission (CMC), and Supreme People’s Procuratorate (SPP);60 examining and approving national plans for economic and social development, and for the national budget; deciding on questions of war and peace; and nullifying or amending decisions of its Standing Committee.61 The Standing Committee of the NPC is the permanent office of the NPC.62 It is composed of the chairperson, vice chairpersons, the secretary-general, and appointed deputies from the NPC.63 The chairperson, vice chairpersons, and the secretary-general form the Council of Chairmen, which handles the daily work of the Standing Committee.64 The Standing Committee has the authority to interpret and supervise the enforcement of the constitution and national laws;65 annul local and State Council legislation that contravenes the constitution or national laws; supervise the State Council, the CMC, the SPC, and the SPP;66 and appoint or remove members of the judiciary and procuratorate.67 Between NPC sessions, the Standing Committee may amend national laws; approve necessary adjustments to national economic and development plans and the state budget; appoint State Council and CMC members; and declare a state of emergency or war.68 B. THE STRUCTURE OF LOCAL GOVERNMENTS

For administrative purposes, the country is divided into provinces, municipalities, and autonomous regions.69 China has twenty-three provinces (including the disputed province of Taiwan), five autonomous regions (including the contested Tibet Autonomous Region), four centrally administrated municipalities, and two special administrative regions (Hong Kong and Macau).70 Each division is further divided into prefectures, counties, districts, and cities, and counties are subdivided into townships and towns.71 People’s congresses and people’s governments are established in all administrative divisions.72 The structure and authority of people’s congresses and governments are prescribed by the constitution and designated by the central government.73 Executive branch The people’s governments serve as the organs of executive power in their respective administrative divisions, subordinate to the State Council, the people’s government of the preceding

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division, and the people’s congress at the corresponding division.74 People’s governments are led by governors in counties and provinces, mayors in municipalities and cities, and heads of districts, townships, and towns who are appointed by the corresponding people’s congresses for three or five-year terms.75 The functions and powers of the people’s governments are determined by the State Council and may include the following: implementing resolutions and laws of higher state organs;76 issuing administrative measures, decisions, and orders within its authority; amending or repealing inappropriate directives of subordinate departments and governments; overseeing economic, health, education, family planning, and other affairs in their region; issuing decisions and orders; and safeguarding citizens’ and women’s rights.77 Beneath the people’s governments in townships, towns, and villages are residents’ and villagers’ committees that manage local affairs.78 The primary tasks of these committees, which are led by a chairperson elected by the residents,79 are to mediate conflicts between local residents; manage public security, health, and social services; and convey residents’ opinions and demands to the people’s government immediately above.80 National and local people’s governments and administrative bodies (i.e. the Ministry of Health, provincial departments of health) are staffed by cadres (ganbu), or civil servants, who range in title from the State Council premier to clerks and researchers.81 They are bound by the Civil Servant Law and the rights and obligations of civil servants as outlined by the Ministry of Personnel.82 Legislative branch The constitution mandates the establishment of a people’s congress, the local legislative organ, in all administrative divisions.83 Deputies to people’s congresses are elected and removed by their constituents, or by their constituents’ elected representatives in the people’s congress at the next lower administrative division.84 Self-government of national autonomous areas National autonomous areas are regions inhabited by ethnic minorities in concentrated communities and approved by the State Council.85 They are classified as autonomous regions, autonomous prefectures, and autonomous counties, and are governed by “organs of self-government” in the form of people’s congresses (legislative) and people’s governments (executive).86 The people’s congresses and governments of national autonomous areas serve functions similar to those of other local organs of China, with an additional right of autonomy.87 People’s congresses and governments of autonomous regions are empowered by the constitution and statutes88 to adopt

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special policies and regulations in light of local political, economic, and cultural characteristics of minority peoples.89 Special administrative regions China’s constitution empowers the NPC to establish special administrative regions (SARs) as it deems necessary.90 The Hong Kong SAR was established on July 1, 1997, and the Macao SAR was established on December 20, 1999.91 According to China’s Ministry of Justice, the government administrates the SARs with the principle of “one country, two systems” in order to maintain national unity, territorial integrity, and prosperity.92 The principle is described as refraining from imposing socialist policies upon autonomous regions and accepting their basic laws as well as their current system of governance.93 Most laws in this report are not applicable to Hong Kong and Macao.94 Special economic and development zones Special economic and development zones were established in accordance with economic reforms in the 1980s to facilitate economic development, technological advancement, and foreign investment.95 The State Council has established five major special economic zones and various technological development zones, coastal economic open zones, free trade zones, and other zones where preferential financial and economic regulations are employed.96 These regions are often urban trade centers, populated by well-educated business people who enjoy greater accessibility and choice in public and private health care.97 Judicial branch The constitution provides for a multitier judicial system composed of the Supreme People’s Court, local people’s courts, and special people’s courts.98 People’s courts exercise independent judicial powers99 and are answerable to the national or local people’s congresses.100 Their primary function is to safeguard the socialist system of government led by the working class, uphold the legal system and public order, and “the citizens’ right of the person” and other constitutional rights.101 The Supreme People’s Court (SPC) is the highest judicial organ in China.102 It is composed of a judicial committee and criminal, civil, economic, administrative, and other divisions.103 The NPC appoints an SPC president,104 and other members are appointed by the NPC Standing Committee.105 The SPC is responsible for supervising the administration of justice and may remand or reverse erroneous decisions by all subordinate people’s courts.106 It has original jurisdiction in national criminal cases,107 civil cases of “major impact,”108 and “grave and complicated” administrative cases.109 Other responsibilities of the SPC include making a final review of death penalty cases110 and issuing judicial interpretations regarding application of laws and decrees in judicial proceed-

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ings that are equivalent to statutes.111 Local people’s courts are divided into higher people’s courts (HPCs), established in provinces, autonomous regions, and municipalities;112 intermediate people’s courts (IPCs) in prefectures;113 and basic people’s courts (BPCs) in counties, districts, and cities.114 Members of local people’s courts are appointed and removed by the corresponding people’s congress, or may be recruited through open examination.115 The HPCs and the IPCs have jurisdiction over civil,116 administrative,117 and criminal cases that occur within their designated regions,118 and over appeals from subordinate court decisions.119 BPCs handle minor criminal, civil, and administrative cases,120 establish representative courts (people’s tribunals) in their localities, and oversee people’s mediation and arbitration committees.121 Judicial committees are mandatory bodies within the SPC and local people’s courts.122 Their primary task is to provide judicial oversight to ensure correct determination of facts and proper application of laws.123 The president of the court presides over the committees, and other members are appointed or removed by the corresponding people’s congress.124 Legal aid is available to help indigent citizens to reduce, postpone, or avoid litigation costs.125 They may apply for legal aid in matters such as seeking state compensation, social insurance, pension or relief funds, spousal maintenance, and support payments for parents, grandparents, or children.126 The constitution requires trials to be conducted openly, available for public auditing, and open to the press,127 except in cases involving state secrets, personal privacy, or juvenile offenders,128 or upon request by litigants in divorce and commercial proprietary cases.129 Customary forms of alternative dispute resolution People’s mediation is an integral part of the Chinese judicial system as stipulated by the constitution130 and various statutes.131 It aims to settle disputes between citizens out of court under the principle of “equality and willingness.”132 People’s mediation committees are established by and consist of local residents and have jurisdiction over matters of commerce, marriage, inheritance, adoption, and property.133 The committees operate independent of the court system, although they are guided by local people’s governments and people’s courts. There were 1.7 million mediated cases of family disputes in 2003, or 40% of the total number of mediated civil disputes in the country.134 When mediation fails or is inappropriate, arbitration through third party adjudication may be employed. The Arbitration Law was formulated “with a view to ensure fair and timely arbitration of economic disputes, reliable protection to the legitimate rights and interests of parties concerned, and

a healthy development of the socialist market economy.”135 Disputes over labor, contracts, and property may be submitted for arbitration,136 but disputes over marriage, adoption, guardianship, childrearing, and inheritance are explicitly exempt from the statute.137 C. THE ROLE OF CIVIL SOCIETY AND NONGOVERNMENTAL ORGANIZATIONS (NGOS)

The Chinese government defines NGOs as “not-for-profit organizations formed by citizen volunteers which carry out activities aimed at realizing the common aspirations of their members in accordance with organizational articles of association.”138 Under the law, NGOs are classified as social organizations, noncommercial enterprises or institutions, and public and private fundraising foundations. The majority of NGOs in China are labor federations or social service providers that are supported by state funds or private monies.139 The Bureau of NGO Administration, housed in the Ministry of Civil Affairs under the State Council, is the government agency responsible for registering, approving, inspecting, and supervising the operation of NGOs.140 The Chinese government permits NGOs so long as their activities do not interfere with the interests of the state, oppose the principles of the constitution, “endanger national unity, security or ethnic unity,” or contravene “national interest [or] … prevailing social morality.”141 Powerful entities known as people’s organizations are organized and fully funded by the government and considered loyal to the CPC.142 People’s organizations are entitled to a 100% tax deduction143 and do not have to be registered or supervised by a government agency.144 These organizations include the All-China Federation of Trade Unions, the China Communist Youth League (CCYL), and the All-China Women’s Federation (ACWF).145 The CCYL shares a close relationship with the CPC and represents the interests of the youth population on issues such as education, employment, and rights.146 The ACWF is a government-sponsored organization founded in 1949 “to represent and safeguard women’s rights and interests and promote equality between women and men.”147 The ACWF acts as a bridge between policymakers and civil society and is intended to be “an important part of the enabling environment for gender equality in China.”148 The federation is responsible for drafting legislation that protects women’s rights and was recently entrusted with writing the final draft of the Amendments to Law on the Protection of Women’s Rights and Interests (“Women’s Rights Law”).149 The ACWF has helped formulate policies and laws on women’s health and popularized related programs and measures.150 Over the years,

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the ACWF has launched several projects to promote public awareness of women’s health issues and to encourage scientific research, and has conducted surveys to collect information on women’s health for use by government agencies.151 Although all domestic NGOs in China are required to register with the bureau, many grassroots NGOs are unable to find a sponsoring government agency and therefore operate without registration.152 The Ministry of Civil Affairs estimates that out of seventy thousand NGOs in China, only about twenty thousand were officially registered with the government.153 D. SOURCES OF LAW AND POLICY

Domestic sources The primary domestic sources of Chinese law are the constitution, legislation, and judicial interpretations of law. The constitution is fundamental law and has supreme legal authority.154 It establishes China as a country governed by the rule of law.155 The constitution provides fundamental rights for all citizens, including equality before the law;156 freedom of speech, assembly, association, religion, and marriage;157 freedom from unlawful arrest or detention, libel, and infringement of physical integrity;158 and the right and duty to work and receive education.159 It also directs the state to respect and protect human rights,160 encourage economic development, supply social assistance and benefits,161 and create conditions to ensure that citizens enjoy their rights.162 The constitution guarantees women’s equality in political, economic, cultural, social, and family life.163 It charges the government with the responsibility to protect the legitimate rights and interests of women and to prohibit maltreatment of women and children.164 The constitution further prohibits discrimination or oppression on the basis of ethnicity.165 However, constitutional rights may be abrogated for the “interest of the state, of society, or of the collective,” or for national security and as punishment for crimes.166 Legislation enacted by the NPC, the State Council, and the local people’s congresses is subordinate to the constitution. Another formal source of domestic law is judicial interpretation formulated by the SPC or the SPP on questions concerning specific applications of law in judicial practice.167 All lower courts (including HPCs, IPCs, and BPCs) are compelled to follow judicial interpretations; however, case rulings by a higher court are not binding on lower courts because decisions are made on a case-specific basis.168 International sources The Standing Committee of the NPC, represented by the president, ratifies and abrogates treaties and important agreements concluded with foreign states.169 China has ratified the

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following international legal instruments: the Convention on the Elimination of Discrimination Against Women (CEDAW), the Convention on the Rights of the Child (CRC), the International Covenant on Economic, Social, and Cultural Rights (ICESCR), the Convention Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment (CAT), the International Convention on the Elimination of All Forms of Racial Discrimination (CERD), and the Optional Protocol to the CRC on the Sale of Children, Child Prostitution, and Child Pornography.170 The Chinese government has submitted reports to the committees that monitor implementation of these treaties.171 China has signed, but not ratified, the International Covenant on Civil and Political Rights (ICCPR) and the Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict.172 China hosted the Fourth World Conference on Women in Beijing in 1995, and attended the International Conference on Population and Development (ICPD) in September 1994, the ICPD+5, and Beijing+5.173 At the Millennium Summit in 2000, China joined 189 countries in adopting the Millennium Declaration outlining eight major Millennium Development Goals, including eradicating poverty, establishing universal primary education, promoting gender equality, improving maternal health and child mortality rates, and combating HIV/AIDS.174

II. Examining Reproductive Health and Rights In general, reproductive health matters are addressed through a variety of complementary, and sometimes contradictory, laws and policies. The scope and nature of such laws and policies reflect a government’s commitment to advancing the reproductive health status and rights of its citizens. The following sections highlight key legal and policy provisions that together determine the reproductive rights and choices of women and girls in China. A. GENERAL HEALTH LAWS AND POLICIES

The constitution of China guarantees “the protection of the people’s health” through the development of medical and health services; the promotion of modern and traditional Chinese medicines; encouragement and support for the establishment of medical and health facilities by rural economic collectives, state enterprises and institutions, and neighborhood organizations; and public health activities.175 China’s Civil Law further provides citizens with the “right of health and life.”176

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Objectives China’s health-care policies are formulated by the MOH under the leadership and directives of the NPC and the State Council. They fit within the broader framework of the Tenth Five Year Plan (2001–2005) and the Decision of the CPC Central Committee and the State Council Concerning Public Health Reform and Development as adopted in 1997.177 The MOH sets forth the following health-care strategies: ■ accelerate the development of the public health-care system; ■ strengthen prevention and treatment of serious illnesses by implementing, among other measures, the Law on the Prevention and Treatment of Infectious Diseases;178 ■ introduce a quality health-care system in rural areas; ■ initiate urban health-care system reforms under the guidance of the State Council’s Directives on Deepening Urban Health-Care System Reforms; ■ strengthen public security and health administration; ■ encourage improvements in maternal and infant health care; ■ widely disseminate information on how to prevent chronic, noncommunicable diseases; ■ support the advancement of medical technologies, improve the quality of medical schools throughout the country, and offer better training and education to medical personnel, particularly those stationed in rural areas; ■ promote the development of traditional Chinese medicine; ■ increase collaboration and information sharing with international health agencies; and ■ assist local health departments in their implementation of national health-care programs, with a focus on long-term development and the sustainable distribution of resources.179 The MOH is also responsible for formulating national health plans such as the National Plan for the Development of Rural Primary Health Care (2001–2010), the National Action Plan for Raising Quality of Birth Population and Reducing Birth Defects (2002–2010), and the National Plan for Health Education and Promotion (2005–2010).180 It is also responsible for implementing health components of the central government’s long-term national plans as stipulated in the National Plan for the Development of Chinese Women (2001–2010) and the National Plan for the Development of Chinese Children (2001–2010).181 A primary focus of several national programs is improving the rural health-care system and addressing the lack of

health awareness in rural areas. The National Plan for Health Education and Promotion (2005–2010) calls for a rural health education campaign, with the goal of disseminating health information among rural residents, and raising their awareness of basic health-care issues from 36% to 60%–80%, and of maternal and infant health-care issues to 80% by 2010.182 The Chinese government encourages and supports the establishment of health facilities by rural economic collectives, state enterprises, and neighborhood organizations.183 The central government is directed to prioritize and provide additional financial resources to support the development of health services for the Western Region, composed mainly of impoverished and ethnic minority districts.184 Eastern provinces and municipalities are required to play an active role in the development of the Western Region, providing financial assistance in order to improve the health services of lowincome communities in the west.185 Infrastructure of health-care services Government facilities China has only 2% of the world’s medical resources, yet it provides enough health-care resources to treat 22% of the world’s population.186 The government is the largest healthcare provider in the country; in 2002, it funded 306,038 medical institutions made up of 63,858 urban and township hospitals, 365 sanatoriums, 219,907 clinics, 1,839 specialized prevention and treatment centers, 3,580 epidemic prevention stations, and 3,067 maternal and infant health-care institutions.187 In sum, these facilities are staffed by 5.6 million medical and technical personnel, including 2.4 million certified physicians and physician’s assistants, and 1.3 million registered nurses.188 The government plans to fully staff and equip all provincial medical and health institutions by 2010.189 Another objective within this timeframe is to improve development and training for rural and urban doctors, preventive care personnel, medical technicians, laboratory technicians, and more than ten thousand infectious disease prevention and control personnel, at or above the county level.190 The Regulations on Management of Medical Service Organizations and its Rules for Implementation regulate organizations that provide health-care services.191 These facilities include all types of hospitals, such as cooperative care, Chinese medicine, joint (eastern/western) practice, minority medicine, and specialty and rehabilitative care; maternal and infant health-care centers; urban, township, rural, and street-level health clinics; and other health-care centers, stations, and organizations.192 Medical facilities must also comply with national standards and submit to inspection, approval, licensure, reg-

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istration, and periodic appraisals by the national or local health department.193 Privately run facilities Private health facilities, which were outlawed during the Cultural Revolution (1966–1976), rebounded in the 1980s and shifted Chinese health care from a system of centralized public health funding to one that was market-oriented.194 Since then, the government has left health-care costs to individuals. As a result, out-of-pocket costs for health care have soared in China and coverage has become increasingly inequitable.195 Financing and cost of health-care services Government financing The government’s budget for public health care has dropped substantially since the adoption of a decentralized, market-oriented system. The government’s health expenditure shows a progressive decline from 32% of the total budget in 1986, to 14% in 1993, and 5.8% in 1996.196 In 2001, the total budgetary allocation for health undertakings by the government at all levels was 80 billion Chinese Yuan (CNY) (USD 9.67 billion), approximately 4.2% of the total budget.197 The most significant impact can be seen in the erosion of the rural Cooperative Medical System (CMS), which insured 90% of the rural population at the peak of its popularity in 1970, but only about 7% by 1993.198 CMS is funded through community financing and bolstered by a system of mutual assistance that provides health stations, paid village doctors to deliver preventative, primary, and secondary health care, medications, and partial reimbursement for patients receiving services at township and county hospitals.199 Economic and agricultural reforms in the early 1980s led to the disintegration of the cooperative organizations that funded the CMS, leading to the decline of health care in rural areas.200 In 1998, China promulgated the Decision on Establishing a Basic Medical Insurance System for Urban Employees, instituting an urban health-care system that guarantees basic medical insurance for employees under the jurisdiction of the Ministry of Labor and Social Services (MOLSS).201 By 2002, 97% of prefectures and cities had developed basic medical insurance programs (BMIPs).202 BMIPs cover all employers and employees in cities, government organizations, enterprises, and private nonenterprise units, as well as freelance workers.203 Participants in BMIPs receive medical services from public hospitals, which are then reimbursed on a feefor-service basis according to a fee schedule established by the government.204 As of 2004, more than 109 million people were participating in BMIPs, of whom 79.75 million were active workers and 29.27 million were retirees.205 Insurance premiums are paid by both the employer, at 6% of total wages, and employees, at 2% of total wages.206

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Employees’ payments go directly into personal accounts while the employer’s premium payments are divided between personal accounts, which mostly pay for outpatient services, and social security program funds, which usually cover hospitalization fees and treatment for chronic illnesses.207 Retirees are exempted from premium payments and they generally receive medical services for lower fees.208 Free medical service is no longer provided for civil servants and employees of public institutions; instead, they are now entitled to medical subsidies.209 In addition, employers are encouraged to provide supplementary medical insurance for their workers and are allowed to write these costs off as a portion of their operating expenses.210 Certain reproductive health services such as midwife care and contraceptive services are provided free of charge. (See “Reproductive Health Laws and Policies” for more information.) Private and international financing The Chinese Ministry of Health has several collaborative programs with the World Health Organization (WHO), including programs on reproductive health, nutrition, vaccination, health promotion, and health care delivery. For 2002–2003, WHO spent USD 11.5 million on these programs, setting aside 1.1% (USD 122,445) for reproductive health care and 2.7% (USD 312,416) for sexually transmissible infections, including HIV/AIDS.211 The United Nations Population Fund (UNFPA) has assisted China since 1980.212 Following the ICPD in 1994, the Chinese government and UNFPA discussed new initiatives that would help realize ICPD principles.213 Under the fourth UNFPA program in China, birth targets and quotas were lifted in the 32 counties in which UNFPA maintained its program.214 This program marked a major shift from a government-mandated family planning program to one that integrated the needs and desires of individuals in the target counties.215 As a result, local advocacy networks were created and officials were trained to respect the right of individuals to make their own decisions about their reproductive lives without coercion.216 Cost Total individual expenditure for public health in 2003 was CNY 311.33 billion (USD 37.6 billion).217 Urban households spend about 7% of their annual household expenses on medicine and medical services, costing approximately CNY 430.5 (USD 52) per person.218 In rural areas, annual average individual spending on health care ranges from CNY 57.54 (USD 7) to CNY 201.72 (USD 24), which is 5.76% of total living expenses for rural households.219 The MOH reports that fees for government-sponsored medical treatments have increased

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by about 8.2% annually since 1999.220 Its surveys indicate that almost 50% of Chinese citizens cannot afford medical treatment when they are sick, and about 30% are not hospitalized despite medical necessity.221 Almost 50 million people participated in employment injury insurance programs in 2004, and most provinces are formulating related insurance plans in accordance with the 2004 Regulations on Insurance for Work-Related Injuries.222 In 2002, social insurance and welfare funds for retirees paid CNY 266 million (USD 32 million) in medical care expenses, an increase of 20% from the previous year.223 In an effort to address rising health-care costs, the Chinese government has promised to standardize fees for medical services and medicines. In China, medicines account for 70% of total health-care costs, compared with 6%–12% in Western countries.224 Essential medications must be sold in accordance with the prices set forth or suggested by the government, while nonessential medicines should be priced reasonably, guided by the principles of fairness, rationality, honesty, good faith, and adjustment for the quality of the medication.225 Violators are subject to confiscation of illegal gains, fines of up to five times the amount of the illegal gains, suspension of their business license, and possible civil liability.226 Medical facilities are required by statute to charge patients according to the prices fixed by the local people’s government or its pricing department.227 Medical organizations or personnel that charge more than what they are allowed are subject to severe fines, closure, administrative penalties, and/or suspension of their operating or practicing license.228 The Maternity Insurance Scheme was introduced by the central government in 1988 and is currently available in 29 provinces, autonomous regions, and municipalities.229 In 2003, more than 36 million female workers were covered by maternity insurance, and about 360,000 pregnant employees received these benefits.230 The government aims to achieve 90% maternal insurance coverage for eligible female workers by 2010.231 The scheme provides female workers with maternity subsidies and covers the costs of medical and health-care services throughout pregnancy and during maternity leave,232 which must be a minimum of 90 days.233 Most employees of urban enterprises and some female employees of government agencies and public institutions are covered by the scheme.234 Employers, not individual employees, are responsible for paying maternity insurance premiums, and organizations not participating in the scheme must provide comparable maternity benefits.235 Failure to pay maternity benefits may result in administrative penalty or civil liability if harm was caused.236 Regulation of drugs and medical equipment Several laws and regulations establish guidelines for the

research, production, trade, use, supervision, and management of modern and traditional medicines, with special provisions for narcotics, psychotropic substances, toxic drugs for medicinal use, radioactive drugs, and traditional Chinese medicines.237 The Pharmaceutical Administration Law was revised in 2001 and formulated to enhance the supervision and control of pharmaceuticals, and ensure their quality, efficacy, and safety “to safeguard the health and legal rights and interests of the people.”238 Pharmaceutical manufacturers, retailers, and dispensaries in medical organizations must be examined, approved, and licensed by the State Food and Drug Administration (SFDA) or face fines of CNY 10,000 to CNY 30,000 (USD 1,208 to USD 3,624).239 Manufacturers may only produce pharmaceuticals, with the exception of some traditional Chinese medicinal herbs and prepared formulas, after obtaining the registered document of approval issued by the SFDA or the MOH.240 New medications must undergo clinical testing approved by the State Council and examination and evaluation by the SFDA, and comply with pharmaceutical standards set forth by the SFDA’s Pharmacopoeia Committee.241 Drugs classified as prescription medications and certain nonprescription medications may be dispensed only by licensed pharmacists or other legally certified pharmaceutical technicians.242 Pharmaceutical retailers and dispensaries are prohibited from substituting or altering prescriptions written by doctors, and must reject prescriptions containing incompatible substances or excessive dosages.243 Regulation of health-care providers Health-care providers are regulated by the Medical Practitioner Law, Measures for the Management of Nurses, Law on Maternal and Infant Health Care, Measures for Administrating Traditional Medical Practitioner and Specialty Medical Practitioner Qualification Exams, and the Regulations on Management of Medical Service Organizations and Rules for its Implementation.244 The Medical Practitioner Law sets standards for physicians and physician assistants regarding their qualifications, standards of practice, assessment, training, and legal responsibilities.245 Exams for physician licenses are formulated by the MOH, while physician assistant qualification exams are prepared by the health administration at or above the provincial level.246 The exams are administered to applicants with appropriate medical education and practical training.247 Upon receipt of the government’s medical practitioner license, physicians must register with the central government’s medical practitioner registration system in order to practice medicine legally.248 Licensed medical practitioners are granted the right to provide health-care services within their registered field.249

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They are expected to abide by relevant laws; fulfill professional responsibilities and adhere to professional ethics; care for, respect, and protect patients and their privacy; improve and advance skills and techniques; and provide medical education to patients.250 National strategies for improving the regulation of healthcare providers include the prosecution of medical personnel who accept “red pockets” (bribes), those who charge unreasonable and unlawful fees, and those who violate other norms of medical ethics.251 Furthermore, the government is committed to banning unlicensed medical practitioners, technicians, and facilities; the production and sale of counterfeit medicine; unlawful blood collection and sale; and food contamination, in accordance with the State Council decision concerning further strengthening food safety.252 One of the MOH’s key strategies for improving health care in China is the execution of the National Plan for the Development of the Nursing Profession (2005–2015).253 The 1993 Measures for the Management of Nurses were introduced to promote the field of nursing, accelerate the development of nursing science, strengthen the skills of nursing professionals, and recognize the important work of nurses in medical, preventative, and rehabilitative health care and treatment.254 The measures outline the educational, clinical, and clerical requirements for practicing nurses.255 To receive a license, nurses must pass a qualifying exam administered by the local government.256 Afterward, nurses must register with the county’s health department; registration is subject to renewal and assessment every two years.257 Traditional medicine refers to traditional Chinese medicine as well as the medical traditions of the Tibetan, Mongolian, and Uygur minority populations.258 Practitioners of traditional medicine are subject to standards and licensing procedures similar to those applied to mainstream medical providers. To receive a license, they must be secondary school graduates (or equivalent); complete three years of apprenticeship under a practitioner with at least twenty years of clinical experience; obtain a practical training completion certificate from the provincial department of Chinese medicine; undertake a clinical residency for at least two years under the supervision of a licensed medical practitioner at a medical facility; and successfully complete a provincial qualification exam.259 Specific laws apply to health-care workers and medical facilities in the field of maternal and infant health care. Medical facilities that perform premarital health examinations, genetic disease diagnosis, prenatal consultations, sterilization surgeries, and abortions must adhere to specific standards set forth by the MOH and obtain a maternal and infant healthcare service permit from the local health department.260 The

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law mandates that provincial people’s governments must establish technical appraisal committees under the supervision of the local maternal and infant health-care offices within the local health department.261 These committees are responsible for inspecting the staff, equipment, and services of a medical facility to determine whether a maternal and infant healthcare service permit will be issued.262 The permit is valid for three years and is renewable upon reassessment.263 Maternal and infant health-care workers are required to fulfill the conditions of the Basic Standards for Specialty Maternal and Infant Health-Care Technical Services, and hold a license for maternal and infant health-care technical services or a license for midwifery.264 Health-care workers can receive a maternal and infant health-care technical service license upon passing a national qualification exam.265 Personnel conducting premarital health examinations must be licensed medical practitioners with at least three years of clinical experience in obstetrics or gynecology (OB/GYN)266 and must hold a maternal and infant health-care technical service license.267 These exams, which screen engaged couples for hereditary illnesses, infectious diseases, major psychiatric disorders, and reproductive health problems,268 must be conducted at facilities with a maternal and infant health-care technical service permit.269 These facilities must be equipped and staffed according to the specifications outlined in the Standards for Premarital Health-Care Work (Revised) and the Basic Standards for Maternal and Infant Health-Care Technical Services.270 The Measures for the Management of Prenatal Diagnostic Technology regulate health-care workers who conduct prenatal consultations and examinations for diagnosis of genetic or gestational birth defects.271 According to the measures, all prenatal screening technicians and clinicians must be qualified and licensed by local health departments, satisfy the conditions of the Basic Standards for Prenatal Screening Technician, and hold a maternal and infant health-care service license.272 In addition, physicians must have supplementary training in ligation surgery (sterilization) and abortion prior to performing these operations.273 Medical facilities providing prenatal services must have an obstetrics department staffed by trained personnel and furnished with appropriate equipment, as well as a committee of medical ethics, and must comply with the basic standards for prenatal screening facilities.274 Midwives must undergo relevant training, examination, and licensure by the county health department or authorized health-care organizations.275 They must also have facilitated at least five births under the supervision of a licensed physician, carry sterile medical supplies, be able to identify high-risk pregnancies and obstetric emergencies, follow the

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Regulations for Rural Midwife Deliveries, and keep written medical records.276 Both midwives and medical institutions that perform deliveries must issue birth certificates and report any perinatal deaths, stillbirths, infant deaths, or babies with birth defects to the provincial health department.277 Organizations that provide family planning technical services must adhere to standards set by the State Council, obtain a license from the local health department that is subject to renewal every three years, and submit to regular inspections.278 Patients’ rights China’s policies on patients’ rights are outlined in various laws and regulations. The Criminal Law provides criminal detention or a maximum of three years’ imprisonment for medical workers who cause death or severe harm to the health of the patient through gross negligence.279 In addition, persons unlawfully practicing medicine (including performing family planning surgeries) without obtaining the necessary licenses are subject to fines, criminal detention, public surveillance, or, in the event that death is caused, no fewer than ten years’ imprisonment.280 Hospitals must respect the legitimate rights and interests of patients to have medical care, informed consent, freedom of choice, and privacy; to file complaints; and to practice their cultural and religious beliefs.281 The Law on Maternal and Infant Health Care also sets forth provisions dealing with patients’ rights. (See “Maternal health” for more information.) Additionally, family planning agencies must receive patient consent; provide safe and effective services and medications; and ensure patient safety when performing contraceptive services, sterilization procedures, special examinations or treating particular diseases.282 No specific laws address the confidentiality of pregnancyrelated information. Under the Measures for the Management of Prenatal Diagnostic Technology, both the pregnant woman and her family members have access to information pertaining to the pregnancy.283 Furthermore, the decision to continue or terminate the pregnancy after prenatal screenings is to be made jointly by “man and wife.”284 Family members may also grant permission for medical facilities to conduct an autopsy of an aborted fetus.285 However, premarital health examination records must be properly stored to maintain individual confidentiality.286 Statutes stipulate that HIV status must be kept in the strictest confidence, and medical providers are prohibited from releasing any HIV-positive patient’s personal information without consent.287 B. REPRODUCTIVE HEALTH LAWS AND POLICIES

China’s reproductive health laws and policies are formulated to complement its strategy on population control and development, promote family planning, maintain low birth rates as

part of its “have fewer children and prosper quicker” poverty alleviation project, and improve the quality of the population.288 The government rewards families that observe its family planning policy and has a national system of Social Support for Some Rural Families Practicing Family Planning, which was to expand to more areas in 2005.289 Regulation of reproductive health technologies Encouraging research and development of new reproductive techniques and medicine has been identified as key to the effective implementation of the Regulation on Administration of Family Planning Technical Services.290 In an effort to correct the gender imbalance that has ensued from sex-selective abortion, the Population and Family Planning Law strictly prohibits reproductive health and family planning organizations, service providers, prenatal screening centers, and other medical facilities from conducting tests to determine the gender of the fetus unless medically necessary.291 The law also prohibits providers from performing sex-selective abortions.292 Human assisted reproductive technologies (ART) are in high demand in China, since 10% of Chinese couples of childbearing age suffer from infertility.293 In 2001, the Ministry of Health issued a series of statutory measures regarding the safety, standards, management, and use of ART, including artificial, intravaginal, intracervical, intrauterine, or intratubal insemination; in vitro fertilization; and embryo transfer.294 At the end of June 2005, the ministry approved 46 medical institutions as providers or developers of ART and six medical facilities to establish sperm banks.295 The Standards, Ethical Principles, and Measures for the Management of ART authorize their use for medical treatment, as long as it adheres to the government’s family planning policy, ethical principles, and other relevant laws.296 Couples with infertility, a family history of genetic diseases, sexually transmissible infections, or other physiological ailments preventing natural conception are eligible to receive ART services.297 Single women are prohibited from using ART, but it is unclear whether this rule also applies to widowed or divorced women.298 The law forbids surrogate motherhood, which is thought to involve too many legal, ethical, and moral complications.299 The marketing of gametes, zygotes, and embryos is illegal, and financial incentives may not be offered for donors, although the law does permit the allocation of social benefits and subsidies for work, transportation, and health care for donors.300 ART service providers must ensure that donors and recipients are informed about the procedures and possible dangers involved in the utilization of the technologies, and written consent from the couple must be provided prior to the commencement of any procedure.301 ART providers are also barred from

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manipulating the DNA of gametes302 and may not conduct medically unnecessary sex-selection or sex-determination.303 Violations of these prohibitions may result in criminal punishment.304 Medical facilities providing ART must receive permission to do so from the Ministry of Health and the provincial departments of both health and family planning.305 Organizations in violation of ART laws are punished according to the Regulations on Management of Medical Organizations and Rules on its Implementation.306 Government monitoring of reproductive health The Law on Maternal and Infant Health Care and its Implementation Measures mandates premarital health exams for engaged men and women to check for hereditary illnesses, infectious diseases, major psychiatric disorders, and reproductive health problems.307 If these conditions are discovered, the examining physician will issue a medical “suggestion” of “unsuitable for marriage,” “unsuitable for reproduction,” or “delay marriage.”308 The 2003 amendment to the Regulation on Marriage Registration abolished compulsory premarital medical exams for marriage registration, but the Implementation Measures for the Law on Maternal and Infant Health Care stipulate that local marriage regulations may continue to mandate premarital exams;309 consequently, some still do.310 Since the government lifted the universal requirement for mandatory premarital medical exams, the number of couples who voluntarily undergo them has decreased dramatically.311 However, premarital exams are still greatly encouraged by the government and identified as a strategy in several national health plans.312 Physicians who perform premarital exams are required to consult with couples if a serious disease is detected.313 Couples may be deemed “unsuitable” for marriage or reproduction by a physician on grounds including mental illness and hereditary or degenerative disease.314 When a diagnosis indicates that childbearing would be medically inappropriate, the couple may be married only after taking long-term contraceptive measures or undergoing sterilization.315 Couples may be advised to postpone marriage if one party is suffering from the infectious phase of a contagious illness, an acute phase of a mental disorder, or another debilitating medical condition.316 In cases of nonsymptomatic carriers of infectious and viral diseases who wish to be married, physicians must provide full disclosure about the illness and make recommendations on protective, preventive, and treatment measures.317 All premarital medical diagnoses must be supported with a scientifically based explanation, physicians must provide information about the possible repercussions of any medical conditions on marital and reproductive life, and the couple must sign

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documents indicating that they understand and are willing to comply with the doctor’s recommendation.318 The only recourse available to couples seeking to dispute their status as unsuitable for marriage or reproduction is to petition local health authorities for a medical reappraisal.319 Couples who have been advised to delay marriage and have been educated on the marital and reproductive consequences of the disease(s) in question are permitted to marry if they insist.320 Physicians are required to respect the couple’s wishes and note on their premarital exam certificates that “medical management is recommended.”321 Family planning General policy framework Chinese citizens have a constitutional obligation to practice family planning.322 Husbands and wives also have a duty to practice family planning created by the Marriage Law.323 The primary objectives of the Population and Family Planning Law are to promote family planning and to protect citizens’ legitimate rights and interests. To achieve these ends, the law proposes a number of strategies, including some of the following: ■ establish premarital health care and maternal and infant health-care systems to prevent and reduce the incidence of birth defects and improve the health of newborns; ■ increase access to family planning services throughout the country; ■ through health-care facilities, provide the public with basic population and family planning services, pregnancy checkups and follow-up for married women of reproductive age, and technical services relating to family planning and general reproductive health; ■ have family planning service workers guide citizens to choose safe, effective, and appropriate methods of contraception; and ■ encourage research and the widespread use of new family planning technologies and products.324 The Regulations for the Management of Family Planning Technical Services were introduced in 2002 to strengthen administration of family planning services, control population quantity, improve the quality of the population, and utilize technological and medicinal advances to increase the capacity of family planning services.325 The regulations aim to protect the right of citizens to reproductive health care, the right of informed choice in the use of contraceptives, and the right to receive suitable family planning technical services.326 Under the regulations, citizens are entitled to the following services from urban and rural family planning facilities: ■ reproductive health education, consultation, and advocacy;

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medical examination, consultation, guidance, and follow-up regarding contraceptive methods and related issues; ■ contraceptive procedures such as insertions of intrauterine devices (IUDs), sterilization surgeries, abortions, and follow-up visits, exams, and consultations; and ■ other reproductive, contraceptive, and infertility treatments authorized by the MOH and the State Council.327 Under the Population and Family Planning Law, specific regulations and plans for population and family planning are formulated by the provincial, municipal, and autonomous regional people’s congresses and implemented by local family planning departments, villagers’ committees, and residents’ committees.328 The law prescribes family planning as a fundamental state policy and advocates one child per couple.329 In general, local regulations permit married couples without children to make their own arrangements to have a first child.330 Within three months of a pregnancy, couples must bring their residency papers, marriage certificate, premarital health-care exam certificate, and a letter from the work unit or the villagers’ committee to the local people’s government or family planning department to register for a “birth permit.”331 In limited circumstances, married couples may petition the local family planning department for permission to have a second child. Pregnancies for a second child without government approval or in violation of local laws and regulations must be terminated under the directives of family planning technical service personnel.332 In some provinces, the local villagers’ or residents’ committee are permitted to “take measures” and establish a deadline for terminating the pregnancy.333 Couples who refuse to undergo an abortion are given a warning, and if the abortion is not performed, the couple may be fined up to CNY 2,000 (USD 242).334 Citizens who have children without permission from the government must pay social compensation fees, must assume financial responsibility for all maternal health-care costs, and are denied maternity insurance benefits for leave and subsidies; rural citizens are refused future increases in land allocation.335 Couples who volunteer to have only one child are awarded a certificate of honor that entitles them to some of the following: award money, subsidies for child care, preferential treatment in land allocation, and extra social security benefits.336 Married couples of childbearing age may also enter into a family planning contract with their work unit (state-owned enterprises) for additional benefits and services.337 (Refer to “Population” for more information.) ■

Since signing the ICPD Programme of Action, the Chinese government has altered its national strategy for population control in order to curb excessive population growth and maintain a low and stable fertility rate. In early 2000, the National Population and Family Planning Commission of China (NPFPC) officially changed the focus of its national strategy for population and family planning from a fertility control regime to a more client-centered program that ensures individuals receive quality reproductive health care and make informed choices about their reproduction.338 This new focus stems from a 1995 pilot project introduced in an explicit commitment to ICPD objectives that addressed quality of care services in 11 districts in eastern China.339 The goals of these pilot projects were to meet the diversified needs of people, increase the availability of information to ordinary citizens, standardize service and operational procedures, improve the competence of service providers, and establish a surveillance system that could be used to monitor quality of care services.340 The program has since been introduced throughout China, with 827 counties participating in 2001, covering more than 40% of the country, including some of the poorest areas in the Western Regions.341 Contraception Primary contraceptive methods used in China are IUDs, sterilization, condoms, oral pills, injections, implants, and spermicides. The most popular contraceptive method is the IUD, used by 45.5% of women in China.342 An official 2001 survey indicates contraceptive prevalence at 86.9% among married women of childbearing age, and 99.1% of those women utilized modern contraceptive methods.343 Contraception laws and policies According to the Population and Family Planning Law, family planning should be practiced “chiefly by means of contraception,” and the government is charged with creating the necessary conditions for its citizens to knowingly choose safe, effective, and appropriate contraceptive methods.344 The law obligates citizens of reproductive age to adopt contraceptive methods and to accept technical services and guidance for family planning.345 Several types of emergency contraception are readily available to Chinese women and adolescent girls through the government’s family planning facilities.346 At least one type of emergency contraceptive pill is sold by drugstores and pharmacists without a prescription.347 Regulation of information on contraception The major sources of contraceptive information are the Information, Education, and Communication (IEC) component of family planning programs and friends and relatives.348 Knowledge of modern contraceptive methods among Chi-

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nese women has increased significantly since the government implemented the Programme of Action of the ICPD in 1994.349 Surveys indicate that 86% of Chinese women know of modern contraceptive methods, 83% have information about reversible family planning methods, 94% have information about condoms, and 98% have information about IUDs and female sterilization.350 The Population and Family Planning Law instructs government departments in charge of family planning, education, science and technology, culture, health, civil affairs, press, publishing, broadcast, and television to organize and develop information and education pertaining to population and family planning.351 Regulations issued in 1989 by the State Administration of Industry and Commerce ban advertisements of sex products which are defined as products that treat sexual dysfunction or that “assist in sexual life,”352 including condoms.353 However, the ban against advertising condoms was lifted in 2004 under the urging of the NPC, when the Chinese government adopted a policy of encouraging condom use for the prevention of HIV/AIDS.354 The Regulations for the Management of Family Planning Technical Services stipulate that citizens have the right to information on the different types of contraceptive methods available and the right to make informed choices regarding their use.355 Sterilization Sterilization was utilized by 36% of Chinese women in 2002, and ranks as the second most popular family planning method, according to the NPFPC.356 Comparatively, only 9.24% of men undergo sterilization as a strategy for family planning.357 Sterilization: laws and policies Sterilizations performed for the purpose of family planning or in accordance with the Law on Maternal and Infant Health Care are provided free of charge.358 Female sterilization operations require the informed and written consent of the patient, and if the woman is unable to understand the procedure or is illiterate, responsibility for consenting to the operation and signing the consent form falls to the woman’s legal guardian.359 The Population and Family Planning Law stipulates that couples with children are “encouraged” to choose long-acting contraceptive methods.360 The Chinese government formally prohibits the use of physical coercion to compel persons to submit to abortion or sterilization.361 There are reports of physically coerced sterilizations, though they have not been confirmed.362 The government also condemns the use of population and family planning centers as detention centers meant to coerce women into undergoing sterilizations or abortions. Nevertheless, the

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practice has been reported in some areas.363 The government has promulgated regulations which provide free sterilization services for married couples of childbearing age in rural areas.364 Citizens who fail to limit the number of children they have are required to pay social compensation fees that can range from one-fifth to ten times the average worker’s annual net income, in addition to other financial penalties.365 The government offers a number of incentives designed to encourage individuals to undergo sterilization. Under the Population and Family Planning Law, individuals who undergo “surgical procedures” for family planning are granted extended leave and extra benefits from their workplace.366 Other laws condition the right to marry upon sterilization: under the Maternal and Infant Health Care Law, if a doctor finds that a couple is at risk of transmitting disabling congenital defects to their children, the couple may only marry if they “voluntarily” undergo long term contraception or sterilization.367 Government delivery of family planning services China utilizes a five-tier network to provide family planning services at the national, provincial, prefectural, county, and township levels.368 The network covers 95% of all urban and rural areas with more than 2,500 county technical service units, 140,000 technical service staff, and 4 million family planning specialists, excluding volunteers and part-time workers in villages.369 The law emphasizes the importance of contraception to the implementation of family planning programs in the country.370 Compulsory population control techniques were used as a strategy by the government from the 1970s until the early 1980s, leading to 18 million IUD insertions, 21 million sterilizations, and 14 million abortions,371 but the public outcry that ensued forced the government to scale back its aggressive methods and implement more “realistic” and “reasonable” family planning strategies.372 The current Population and Family Planning Law states that citizens must be informed of “safe, effective, and appropriate contraceptive methods” and that the “[s]afety of recipients of birth control procedures must be ensured.”373 Married couples of childbearing age who practice family planning receive basic family planning technical services free of charge.374 Couples who abide by family planning laws are rewarded with monthly stipends, extra land for agricultural use, preferential treatment in employment and training, and access to loans, subsidies, old-age insurance, and medical and educational benefits for themselves and their child.375 Family planning services provided by NGOs and the private sector Since government facilities mainly target married couples,

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young people, especially young female migrant workers, must rely on the private and NGO sectors for family planning and contraceptive services.376 China’s NGOs have been instrumental in popularizing family planning programs and measures.377 The China Family Planning Association (CFPA), established in 1980, is the largest family planning/reproductive health social organization in the country, with 83 million volunteers and more than 1 million branches throughout the country.378 Its members and activities are vital channels for disseminating family planning, reproductive health (including contraception), and HIV/AIDS information and services to the public.379 Approximately 150 million people participate in the CFPA’s educational activities each year, and several programs target reproductive health-care services to women, unmarried people, poverty-stricken regions, adolescents, migrant workers, and ethnic minorities.380 The CFPA has 20 provincial service centers that offer gynecological checkups; pregnancy tests; diagnoses of infertility, STIs, and HIV/AIDS; training in the use of emergency contraception; and sales of various contraceptives and maternal, health care, and reproductive health products.381 The association aims to enable people of all ages, genders, nationalities, and socioeconomic statuses to make informed decisions about their reproductive lives.382 It also monitors family planning services to ensure that people of childbearing age enjoy their lawful rights to reproductive health care.383 In addition, the CFPA raises public awareness by publicizing the medical, social, and psychological factors and risks of unsafe abortions in an effort to eliminate the problem.384 The Chinese Working Women’s Network runs a Center for Women Workers and mobile service centers that provide health checkups and reproductive health education for migrant workers in the South China industrial areas.385 Contraceptive tablets and condoms are available for purchase without a prescription at drug stores and supermarkets throughout China.386 Hotels, bars, university campuses, construction sites, entertainment venues, and other public places around the country are required to install condom vending machines.387 Many NGOs, among them the CFPA Association, the Red Cross Society of China, and Population Services International, disseminate free or low-cost contraceptives such as condoms to targeted populations (e.g. adolescents and migrant workers) in many poverty-stricken areas and in areas with high risk for HIV/AIDS.388 Maternal health China’s maternal mortality rate has been decreasing steadily, from 63.6 deaths per 100,000 live births in 1997 to 53 in 2000, 50.20 in 2001, and 43.2 in 2002.389 Obstetric compli-

cations are the third leading cause of death among city hospital patients, and diseases originating in the perinatal period are among the top ten causes of death of women in urban and rural areas.390 Laws and policies China initiated a Safe Motherhood Program during 2000–2001 that successfully lowered the maternal mortality rate by almost 30% in 378 impoverished counties in the Western region, and it has since been expanded nationwide.391 The program includes a special poverty relief fund for 5% of the poorest pregnant women, which aims to provide quality maternal and infant health care (including hospital delivery), and the “Green Lifeline” project which establishes emergency and referral systems at county, township and village level health institutions for treatment of sick and high-risk pregnant women with the goal of providing 24-hour access to emergency obstetric care.392 China incorporated maternal and infant health care into its Ninth (1996–2000) and Tenth (2001–2005) Five-Year Plans for National Social and Economic Development and National Plans for Women’s and Children’s Development (2001–2010).393 Implementation rules, regulations, and standards in obstetrics were developed to improve the three-tiered (county, township, and village) maternal and child health-care network, which has played an enormously important role in greatly reducing once-common or chronic diseases affecting rural women.394 In 1995, China had 349 maternal and child health-care medical facilities, 49 gynecological and obstetric hospitals, gynecological departments in 14,000 hospitals, 2,832 maternal and child-care clinics, and 35 children’s hospitals.395 The Department of Maternal and Infant Health Care and Community Health (DMCH), established in 2001 under the auspices of the Ministry of Health, has several primary objectives, including the following: ■ establish policies, laws, statutes, plans, and regulations governing administration of the Law of the People’s Republic of China on Maternal and Infant Health Care (MIHC) and oversee the implementation of relevant technologies; ■ design technology appraisals and training programs, such as continuing medical education, and develop protocols for assessing the professional qualifications of health personnel; ■ develop plans, policies, and standards to raise “the quality of the birth population” and supervise their implementation; ■ develop plans, measures, and technological standards for women’s health care and guide their implementation;

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monitor health MICH organizations and health education facilities; ■ establish polices regarding children’s health care, survival, protection, and development; and ■ enable international cooperation and exchanges with respect to primary health care, maternal and infant health care, and health education.396 These objectives are carried out by six divisions within the DMCH, including the administrative office, the office of women’s health, and the office of children’s health.397 The DMCH is also responsible for composing a yearly health action plan, collecting observational data, and documenting the situation of women’s and children’s health for its annual report.398 Pregnant women who suffer from serious illnesses or exposure to teratogenic substances are entitled to medical guidance, particularly if their life or health or the fetus’s development is endangered.399 Couples discovered to be or suspected of suffering from serious genetic diseases are expected to take appropriate measures (contraception, including possibly sterilization) in accordance with their doctor’s advice.400 Pregnant women are referred for a prenatal diagnostic exam if an abnormality is found in their fetus,401 and physicians may recommend an abortion if the fetus suffers from a genetic disease or defect of a serious nature, or if the women’s health or life is threatened.402 The government considers fetal diseases to be serious if they fulfill the following criteria: they have a high likelihood of occurring; they cause severe harm and place a high disease burden on society, families and individuals; there is no effective clinical treatment; and they can be reliably diagnosed.403 Couples who have given birth to an infant with a serious defect must submit to medical examinations prior to a second pregnancy.404 Government policy encourages hospital deliveries as a strategy to combat infant and maternal illnesses and mortality.405 Where hospital delivery is not possible, the Law on Maternal and Infant Health Care mandates that pregnant women shall deliver at home under the care of governmentlicensed midwives or birth attendants.406 Women with highrisk pregnancies must deliver in hospitals.407 Delivery of services Public facilities The DMCH of the MOH is responsible for enforcement, management, and implementation of the Law of Maternal and Infant Health Care.408 Since the law was adopted, a series of rules, regulations, and policies was issued to enable its effective implementation. These include the Basic Standards for Specialty Maternal and Infant Health-Care Technical Services, Measures for the Management of Maternal and ■

Infant Health-Care Specialty Technical Service Permits and Personnel Qualifications, Measures for the Management of Maternal and Infant Health-Care Medical Technology Appraisals, and Standards for Premarital Health-Care Work (Revised).409 At the end of 2002, the Chinese government estimated that 90.14% of expectant mothers received prenatal checkups and 97.2% of midwives in rural areas practiced modern midwifery.410 Health initiatives that have sought to provide primary health care for all rural residents, particularly women and children, encompass strategies to increase hospital births, reduce maternal deaths by 25%, reduce infant deaths by 20%, enhance infant nutrition, and offer quality health-care services for women and girls.411 In the National Plan for the Development of Chinese Women (2001–2010), the government set forth the goals of hospital deliveries for 65% of rural pregnancies and 90% of high risk pregnancies, and licensed midwife or birth attendant facilitated deliveries for 95% of pregnancies in impoverished regions.412 In addition, free midwifery services have been offered to peasant and herder women since November 2004 through a pilot program introduced in the eight counties of Qinghai Province.413 The Law on Maternal and Infant Health Care and the Rules for its Implementation entitle women of childbearing age and pregnant women to the following services: ■ premarital health-care instruction on topics such as sex, procreation, contraception, family planning, and genetic and reproductive diseases; ■ premarital health consultations to provide guidance and advice about medical conditions related to marriage and childbearing; and ■ premarital medical exams to identify the presence of diseases that “may have an adverse effect on marriage and childbearing,” including genetic and infectious diseases, and mental disorders.414 Additionally, women of childbearing age and pregnant women have the right to receive the following types of specialized health-care services from medical institutions: ■ contraceptive, family planning, and reproductive health consultations and services; ■ instruction on maternal and infant health care; ■ periodic prenatal physical checkups and follow-ups; and ■ newborn health care.415 The MOH has established 3,200 maternal and child health-care hospitals, staffed by 500,000 workers, throughout the country.416 Family planning stations and clinics are available in 93.5% of towns and townships and 80.1% of vil-

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lages.417 To provide reproductive services in poor and remote areas, the government has dispatched mobile service vans equipped with examination and diagnostic technologies in 2,404 counties.418 In 2003, the hospital delivery rate grew to 79.4%, up from 43.7% in 1985.419 Private facilities including NGOs A number of international and domestic NGOs provide maternal health-care services in China. Distribution of maternal health-care information to the general public and specifically to women is a major component of the China Family Planning Association’s activities in the area of reproductive health.420 Several NGOs, including the Zigen Fund, the Tibet Poverty Alleviation Fund (TPAF), the Terma Foundation, the Swiss Red Cross, and ProLiteracy, train doctors, midwives, and birth attendants to improve maternal and obstetric services.421 PLAN, Health Unlimited, and women’s federations in several provinces and counties provide training in maternal and child health care for medical staff and communities.422 The TPAF, in partnership with the government, developed a Tibet-wide Safe Motherhood Strategy aimed at reducing maternal mortality by 10% by 2010. The TPAF is implementing the strategy by equipping and upgrading maternal health-care facilities and building their capacity for obstetric surgeries and safe deliveries.423 It has also assisted local health departments in launching the Community Medical System (CMS) to rural families to reduce the cost of health care, including the cost of deliveries at clinics and hospitals.424 The Terma Foundation has a “Healthy Mother, Healthy Babies” campaign that seeks to improve maternal outcomes in the Tibet region by providing at-risk women with prenatal vitamins and nutritional and lactation education, and equipping health workers with diagnostic tools to identify high-risk pregnancies and life-threatening postpartum and neonatal diseases.425 PATH has worked in China since the 1980s, advancing reproductive health, family planning, and maternal and infant health-care services by offering technical assistance, including the development of new contraceptives. Currently, it is working with the CFPA to provide life-planning skills (addressing, for example, romantic relationships, sex, contraception, condoms, and STIs/HIV) for adolescent girls and migrant workers through peer educators and employersponsored seminars.426 Health Unlimited has been working in the area of maternal and child health care in China since 1993.427 In addition to training health-care workers, it provides vital equipment (such as incubators and fetal monitors) and support services and conducts community education campaigns to improve

maternal and infant mortality rates.428 Nutrition The Law on Maternal and Infant Health Care, effective since 1994, requires medical institutions and personnel to provide consultation and instruction on prenatal nutrition as part of prenatal health-care services.429 The law also calls for educating mothers about nutrition for newborn babies and promoting breastfeeding.430 There are national campaigns to improve maternal nutrition, including attempts to eliminate iodine-deficiency disorder by distributing iodine salt and capsules for pregnant women, distribution of tetanus toxoid vaccines during pregnancy to reduce the incidence of neonatal tetanus, and programs to reduce iron-deficient anemia.431 Additionally, the water supply has been improved, benefiting 92.38% of the rural population of China in 2000.432 And to improve infant nutrition, the Ministry of Health is also trying to reverse the decline in the rate of breastfeeding (from 76% in 1998 to 64% in 2005), by mandating breastfeeding education for all postnatal women in medical/health facilities, restricting promotion of breast milk substitutes, and revoking operating licenses for facilities that violate these provisions. 433 Safe abortion China’s induced abortion rate peaked in the 1980s and has declined by 53% since, from 43 abortions per 1,000 women of childbearing age in 1990 to 18 per 1,000 in 2001.434 Nonetheless, approximately 4 million induced abortions were performed in 1999, according to government statistics.435 Studies show that abortion has assumed a greater role in controlling fertility in China because of contraceptive failure and reduced rates of contraceptive use.436 Government statistics indicate that 72% of abortions in China overall, and 90% of abortions in urban areas, result from contraceptive failure.437 The family planning program was reoriented after China signed the ICPD in 1995 from a focus on controlling population to providing quality health-care services. The change has led to a notable fall in abortions.438 Nonetheless, induced abortion is recognized as a major contributor to China’s fertility decline. Furthermore, the incidence of abortion among urban, college-educated women—whom the government effectively targeted through its family planning programs—is at least six times higher than that of rural, illiterate women.439 Abortion laws and policies Currently, the Criminal Law of China, enacted by the National People’s Congress in 1979 and revised in 2005, contains no provisions under which abortion, performed with the consent of the pregnant woman by a licensed doctor, constitutes an offense.440 However, sex-selective abortions for nonmedical

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purposes are strictly prohibited by the Population and Family Planning Law 2002 and are expected to be criminalized in an amendment to the Criminal Law.441 In spite of this prohibition, the practice continues. One official study in Hainan province found that 68% of abortions were of female fetuses.442 Early abortions may be performed surgically by licensed medical personnel in a clinic, using the vacuum aspiration technique or medically.443 The government approved the use of medical abortion in 1988.444 Although mifepristone is legally available at hospitals, concern about side effects led the government to ban sales of the drug on the open market.445 Abortions at or during the second trimester are medically or surgically performed in a hospital by a licensed physician.446 There are no national laws or regulations limiting the gestational age at which a pregnancy may be terminated, and the Ministry of Health’s Rules for Birth Control Surgeries describe methods for terminating pregnancies up to 27 weeks.447 However, local legislation and policies place restrictions upon the conditions under which a woman may terminate a pregnancy. The 1994 Law on Maternal and Infant Health Care specifies the following three conditions under which an abortion may be medically necessary: ■ where the fetus has a “serious deformity;” ■ where the fetus has a serious hereditary disease; and ■ where the pregnancy endangers the life of the pregnant woman. 448 Permission for a non-medically necessary abortion must be obtained from the county or local people’s government’s family planning department if a birth permit was issued for the pregnancy by the provincial population and family planning department.449 Unapproved abortions result in official admonishments, fines of up to CNY 3,000 (USD 362.50), revocation or future denial of birth permits, and possible required sterilization for the woman.450 Second trimester abortion (starting at 14 weeks) of a government-sanctioned pregnancy may be performed only upon approval of the local family planning agency, and in numerous provinces, local legislation bans these abortions unless they are deemed medically necessary.451 To proceed with a pregnancy termination, a woman’s consent is required.452 If the woman is unable to consent, such consent must be obtained from her guardians.453 Unauthorized health-care workers who conduct a termination of pregnancy that results in a patient’s death or disability may face criminal charges.454 The 2002 Population and Family Planning Law states that “husbands and wives bear equal responsibility for family planning.”455 This provision may be interpreted to require a husband’s consent in obtaining an abortion.456

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A woman receives 14 days of paid sick leave for a firsttrimester abortion and 30 days if the pregnancy is terminated after the first trimester. In some parts of the country, paid sick leave is extended if a woman who has an abortion has an IUD inserted, or is sterilized after the abortion is performed.457 Government delivery of abortion services Abortion services are provided by the Government of China as a public service.458 Family planning technical service facilities from the village to the provincial level offer abortion services and follow-up care.459 There has been much concern about government officials at various levels coercing women to undergo abortion. Although the use of physical coercion to compel women to submit to abortions is prohibited,460 it has been reported that officials in at least one province have forced women to abort unplanned pregnancies immediately.461 In response, the central government and the NPFPC issued an official condemnation of these actions, imposed administrative penalties, and fired the responsible officials.462 Because the Population and Family Planning Law delegates the responsibility of its implementation to provincial governments and states only that compliance with birth limits should be “chiefly” achieved through the use of contraception, some existing provincial regulations mandating sterilization or abortion do not directly contradict the law and have remained in effect.463 HIV/AIDS and other sexually transmissible infections (STIs) At the end of 2003, 80,000 of the estimated 840,000 people who tested positive for HIV in the country were clinically confirmed AIDS cases.464 The number of AIDS cases and AIDS-related deaths has increased dramatically in the last several years. The reported number of AIDS cases increased by 44% between 2001 and 2002, and the increase was 206% between 2000 and 2001.465 Among adults, the national HIV/AIDS prevalence rate is less than 0.1%; however, certain regions have significantly higher HIV/AIDS infection rates (about 80%), particularly among high-risk groups such as intravenous drug users.466 While intravenous drug use is the predominant mode of HIV transmission in China, sexual transmission is steadily increasing, primarily among sex workers.467 Between 1997 and 2002, the rate of sexually transmitted HIV infections nearly doubled, from 5.5% to 10.9%.468 Figures from 1997, 2001 and 2002 indicate that HIV prevalence is also increasing among unmarried youth (1.7%), pregnant women (1.3%), and newborns through mother to child transmission (0.4%).469 Prior to the enactment of Regulations for the Management of Blood Products in 1996, a significant number of HIV infections resulted from blood transfusions, and this remains a

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problem in rural areas.470 In some provinces, an average of 60% of former plasma donors are reportedly infected with HIV and the unregulated sale of plasma/blood remains a common phenomenon.471 Awareness of the epidemic is low among the general public, especially in vulnerable groups such as sex workers.472 One survey revealed that only 14% to 30% of sex workers knew condoms could prevent HIV infection, and only 2% to 30% considered themselves at risk of being infected.473 Lack of knowledge is also behind discriminatory attitudes against people with HIV/AIDS.474 Prevalence of HIV/AIDS among Chinese gay men ranges from 3% to 5%, and lack of essential knowledge and unsafe sex with multiple partners are the primary causes of infection.475 The central government has no program or policy addressing this population, although local governments, working in concert with foreign partners, have begun to offer limited HIV/AIDS services for gay men.476 There are currently an estimated eighty thousand children orphaned by AIDS in China, and the number is expected to grow to two hundred sixty thousand by 2010.477 Laws and policies The Law on the Prevention and Treatment of Infectious Diseases was enacted in 1989 and amended in 2004 in order to prevent, control, and eliminate the occurrence and epidemic of infectious diseases such as HIV/AIDS and other STIs.478 The law applies to all individuals who are physically present in China. Individuals suspected of having an infectious disease are mandated by the law to submit inquiries, examinations, investigations, and undergo treatment provided by disease control and medical institutions.479 These facilities are also charged with providing necessary treatment and control measures appropriate to the patient’s condition.480 Anyone with knowledge of an individual who has or is suspected of having HIV/AIDS or other designated STIs (e.g. gonorrhea, syphilis, and hepatitis) is compelled by law to report him or her to medical or disease control agencies, which must then immediately notify relevant government departments and the Ministry of Health.481 The law prohibits individuals who have or are suspected of having HIV/AIDS or STIs from being employed in jobs in which the spread of such diseases might be difficult to control.482 Violations of these provisions are punishable by up to three years’ imprisonment, and in cases where the consequences are especially serious, up to seven years’ imprisonment.483 If the illegal action leads to personal or property damage, the violator may be subjected to civil action.484 Several border control laws address issues related to the exit and entry of persons with STIs or HIV/AIDS at airports, sea-

ports, and train stations. Health and quarantine organs must bar carriers or suspected carriers of infectious diseases from exiting the country,485 and foreigners with AIDS or venereal or infectious diseases are prohibited from entering the country.486 Attempts to evade border health inspection, falsify one’s health status, or spread communicable diseases may be punished with a fine and/or up to three years’ imprisonment.487 The Blood Donation Law, which became effective in 1998, was enacted to control the spread of STIs and HIV/AIDS by regulating blood banks and blood donors.488 The law requires blood banks to ensure the quality of blood by guarding against risk of contamination by persons with STIs or HIV/AIDS.489 Donors must undergo a free medical exam and must be in satisfactory physical health—specifically, free from HIV/AIDS—to be eligible to give blood.490 The Regulation on Management of Blood Products also establishes provisions to strengthen control and guarantee quality and safety of blood products, and prevent the spread of infectious diseases through their use.491 Individuals engaged in illegal selling of blood face fines and imprisonment for up to five years.492 Hospitals that fail to screen their blood and thereby transmit HIV to a patient may face civil liability.493 The Maternal and Infant Health Care Law also addresses the issue of STIs and HIV/AIDS in premarital couples. If one party is discovered to be in an infectious stage of an infectious disease, such as gonorrhea, syphilis, or HIV/AIDS,494 the examining practitioner will offer medical advice and issue a premarital medical “suggestion” advising the couple to postpone marriage.495 The 2003 revision of the Regulation on Marriage Registration alleviated the requirement that people registering for marriage must undergo premarital medical exams, and officials from the Ministry of Health have stated that HIV carriers have the right to marry;496 however, some provinces have refused to issue marriage certificates to people living with HIV/AIDS (PLWHA ).497 China’s efforts to prevent the spread of HIV/AIDS were bolstered in 1994 through the signing of the Paris Declaration, a global statement calling for the prevention and control of the disease. Subsequently, the Ministry of Finance established a special fund for HIV/AIDS prevention and control in 1996.498 The China Medium- and Long-Term Plan for HIV/AIDS Prevention and Control (1998–2010) (CMLTP), issued and distributed by the State Council in 1998, sets out the government’s objectives for HIV/AIDS prevention and control, which include the following: ■ ensure that provincial governments incorporate HIV/AIDS prevention work into the local economic and social infrastructures; ■ create a surveillance system that monitors the preva-

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lence of the disease; and establish and modify laws and regulations related to STIs and HIV/AIDS.499 In 2001, China’s minister of health signed the Declaration of Commitment on HIV/AIDS at the United Nations General Assembly Special Session on HIV/AIDS, reiterating China’s commitment to HIV/AIDS prevention and control.500 The same year, the State Council issued the China HIV/AIDS Containment, Prevention, and Control Action Plan (2001–2005) to ensure that the objectives and tasks set out in the CMLTP would be achieved.501 The principles of the action plan are as follows: ■ focus on educating the general public and vulnerable populations about high-risk behavior and harm reduction; ■ strengthen health education and behavioral interventions and emphasize the development of effective, sustainable programs; and ■ increase guidance, monitoring, and supervision of programs.502 The action plan aimed to achieve the following targets by 2005: ■ condom usage rate of over 50% among high-risk populations; ■ HIV/AIDS training for all personnel engaged in HIV prevention and control, clinical treatment and care, laboratory testing, blood collection, and provision; and ■ integration of local and national HIV/AIDS information networks.503 During a high-level HIV/AIDS meeting of the UN General Assembly in September 2003, the Chinese government made several commitments to fighting HIV/AIDS, including the following: ■ holding health-care workers accountable if their professional negligence results in the further spread of the disease; ■ providing free antiretroviral (ARV) medicines to lowincome PLWHA in urban areas and all PLWHA in rural areas; ■ increasing international cooperation on HIV/AIDS by welcoming continued financial and technical support from other countries and international organizations.504 The central and local governments have pledged more than CNY 10 billion (USD 1.2 billion) to improve the strength of the health-care system and professional capacity for HIV/ AIDS prevention and control.505 Recent regulations related to HIV/AIDS include a trial implementation of the Principles for Prevention and Protection of Medical Personnel from HIV Exposure to establish ■

working protocols, exposure-reduction methods, and emergency procedures to reduce the risk of HIV infection among health-care workers. 506 The MOH has also issued guidelines for pregnant women for prevention of HIV/AIDS transmission;507 issued guidelines and technical manuals for free ARVs; organized the National HIV/AIDS Clinical Task Force to provide HIV/AIDS services training for primary, county, and township health workers; and established ten AIDS clinical training centers.508 The government has taken several steps toward fulfillment of the goals of CMLTP, including exempting imported ARVs from duty and VAT (value added tax) for five years to increase their availability and affordability;509 expediting approval of ARVs;510 and encouraging domestic drug producers to produce generic ARVs.511 Condom quality has improved, as has condom dissemination, and free condoms are now supplied to PLWHA.512 The government has introduced a series of measures to improve the quality of life of PLWHA and their families. Medical facilities appointed to care for PLWHA must provide treatment immediately and are not allowed to refuse care.513 To increase accessibility of HIV/AIDS treatment, home care programs are available for patients in remission or in situations where isolated treatment is inappropriate.514 Anonymous HIV tests are conducted free of charge in areas with large numbers of HIV/AIDS cases, in poverty-stricken regions, and for vulnerable populations.515 Pregnant women with HIV/AIDS are given free counseling, medical screenings, and ARVs to prevent transmission of the virus to their fetus.516 In partnership with NGOs and international organizations, the government provides PLWHA with agricultural tax-exemptions and microcredits, and allows their children to attend school free of charge.517 In 2004, the State Council premier announced the Four Frees and One Care policy, which provides the following: ■ free ARV drugs for all people diagnosed with HIV/ AIDS in rural areas; ■ free voluntary counseling and testing (VCT) in high prevalence areas; ■ free education to children orphaned by AIDS; ■ free VCT and prevention of mother-to-infant transmission services for pregnant women; and ■ care to PLWHA facing financial difficulties.518 The government’s four-tier (county, prefecture, province, and national) disease prevention and control network implements this policy through the China National Free ARV Treatment Program.519 Among the strategies of the program are China CARES (Comprehensive AIDS Response) pilot initiatives, which are community-based HIV/AIDS treat-

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ment and care projects in 127 counties throughout 28 provinces; and the provision of support and resources from the Chinese Center for Disease Control to provinces according to their needs.520 Regulation of information on HIV/AIDS and other STIs Information on HIV/AIDS and STIs is disseminated to the Chinese population through a number of campaigns conducted by ministries and government divisions. The State Council Policy on HIV Prevention and Control calls upon all levels of government to disseminate information on HIV prevention to all child-care centers, schools, enterprises, and media outlets.521 On annual World AIDS Day, which falls on December 1, the Chinese government sponsors national HIV/ AIDS awareness campaigns involving conferences, entertainment, interviews with experts, on-site consultations, hotlines, distribution of educational materials, and activity reports.522 Other national programs initiated by NGOs and government divisions include HIV/AIDS Prevention and Health for the Whole Family, sponsored by the ACWF and the Ministry of Health,523 and Red Ribbon Action, sponsored by the CCYL, the Ministry of Education (MOE), and the MOH.524 Government departments offer a variety of HIV/AIDS education and awareness campaigns organized by the State Council Coordination Mechanism on AIDS/STIs to maximize the effectiveness of HIV/AIDS prevention and control efforts.525 Since the State Administration of Industry and Commerce lifted the ban against condom advertisements in 2004, the government has adopted a policy of encouraging condom use for the prevention of HIV/AIDS using public service television commercials, billboards, and publications.526 The MOE set forth guidelines defining the standards for HIV/AIDS training materials in schools and curricula.527 The ministry is also responsible for implementing programs for HIV prevention and voluntary, nonremunerated blood donation in all high schools, vocational schools, and institutes of higher learning.528 The Ministry of Railways and various transportation departments target commuters and migrant workers by printing HIV/AIDS information on the backs of tickets and conducting campaigns at major stations and ports.529 The All-China Federation of Trade Unions and the NPFPC both conduct awareness raising campaigns, educational seminars, and training programs throughout the nation.530 The government’s antidiscrimination protections for PLWHA are somewhat contradictory. The Notice on the Administration of HIV Positive People and Patients states that HIV-positive individuals and their relatives cannot be discriminated against.531 The notice also guarantees PLWHA and their children the same legal rights and social benefits

afforded to other citizens, including access to day care and education.532 Citizens are urged to follow their social duty in combating discrimination, and local governments are obligated to ensure that PLWHA are provided with a friendly, considerate, and healthy environment where they are encouraged to think positively, correct high-risk behavior, and receive care that prolongs the quality of their lives and their lifespan.533 These provisions were also included in the State Council Notice on Strengthening HIV/AIDS Prevention and Control of 2004.534 However, despite policies denouncing HIV/AIDS discrimination, violations are punishable only by minor administrative penalties, and some legislative measures seem more supportive of segregation than acceptance. For instance, PLWHA are required to submit to medical consultations before marriage and may be issued premarital medical exam certificates with a recommendation to “postpone marriage” for an indefinite period.535 Officials from the Ministry of Health have stated that PLWHA have the right to get married, but in many provinces, such as Hunan and Jiangsu, HIV-positive individuals cannot obtain a marriage certificate.536 In addition, it has been reported that AIDS orphans, who are often HIV-positive, face maltreatment by their peers and teachers, and are refused entry to schools, hotels, and businesses.537 Adolescent reproductive health China has one of the largest adolescent populations in the world. According to the 2000 census, more than 320 million people in China are between the ages of 10 and 24, accounting for 26% of the total population.538 About 50% of Chinese adolescents are female.539 Laws and policies Though China has signed and ratified international instruments with provisions for adolescent reproductive health care, such as the ICPD Programme of Action, the Beijing Platform for Action, and the ICPD+5, family planning and reproductive health services for adolescents are extremely limited in China.540 However, the Chinese government has taken several steps to improve availability and accessibility of reproductive health care for adolescents. In 2002, a government hospital in Beijing opened the country’s first clinic for adolescent psychological and sexual health-care services.541 The clinic provides adolescents with free or low-cost gynecology, maternity, urology, pediatrics, and psychological counseling services.542 Similar facilities have since opened in several cities.543 These government-funded adolescent health-care facilities offer free abortion services for pregnant girls under 18 years of age, and some permit anonymous abortions without parental notification.544

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Delivery of adolescent reproductive health services by NGOs and international organizations NGOs and international organizations are addressing the inadequacy of adolescent reproductive health services through a variety of programs. A CFPA initiative provides information about reproductive and maternal and infant health care, puberty, and family planning to unmarried youths to encourage responsible behavior, such as contraceptive use, and decrease incidences of premarital pregnancies and induced abortions.545 The United Nations Development Programme (UNDP) and UNFPA created pilot projects on adolescent reproductive health (ARH) in Shanghai and Beijing, where students function as youth volunteers and peer educators to help increase awareness of sexual and reproductive health issues and generate support from local leaders, teachers, parents, and family planning workers.546 The program also involved the targeted marketing of contraceptives, thereby increasing both the accessibility of condoms and awareness of reproductive health issues for underserved adolescents.547 These initiatives have produced promising results.548 The UNDP and UNFPA plan to concentrate their advocacy efforts on policy development and the recognition and realization of reproductive health rights for young people.549 In the future, the pilot ARH projects will be expanded to other areas and various approaches will be tested to provide youthcentered information, counseling, and services.550 The UNFPA will strengthen the capacity of program managers to integrate ARH into the existing health-care system and offer assistance to improve the overall health-care system.551 HIV/AIDS is a growing problem among China’s youth. The Red Cross Society of China (RCSC) has introduced youth peer education for HIV/AIDS prevention and care in more than 15 provinces.552 Implemented and funded by local people’s governments and international NGOs, the programs’ objectives are to give accurate information about HIV/AIDS and its prevention to adolescents through peer education to reduce high-risk behavior, improve decision making, and dispel the stigma of the disease.553 The program is expected to be expanded to migrant workers, sex workers, and PLWHA.554 To combat discrimination against AIDS orphans, local people’s governments, China’s Center for Disease Control, and domestic and international NGOs have launched public awareness campaigns, provided subsidies to foster families, and organized summer camps for AIDS orphans.555 C. POPULATION

China is one of the most populous countries in the world,

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inhabited by more than 1.3 billion people, comprising onefifth of the world’s population. Since the 1950s, family planning has been a national policy with the goal of ensuring that families have only one child, thereby reducing the rapidly climbing population growth rate.556 In the 1970s, the government launched the “wan, xi, shao” (“later, longer, fewer”) campaign emphasizing later marriage, longer intervals between births, and fewer births.557 At the onset of the campaign, couples were discouraged from having more than two children, but by the late 1970s no more than one child was recommended.558 The campaign was the first to introduce national, provincial, and local birth rate targets.559 Fears that excessive population growth would derail economic development drove the Chinese government to go further and launch the one-child policy in 1979.560 The policy restricted couples from having more than one child and required official “birth permits” before conceiving a child.561 It is widely reported that at the policy’s inception, coercive methods were frequently exercised to ensure its enforcement.562 After abandoning the compulsory birth control strategies employed in the 1970s and 1980s, China adopted less stringent measures in implementing its population policies. Although the shift places greater focus on individual rights, “these rights are mostly to receive services, not to reject them,” and citizens must still adhere to birth limitations.563 The government’s population policies have been criticized for reinforcing patriarchal attitudes by supporting son preference, a critical factor in the “missing girls” phenomenon whereby female babies are abandoned, neglected, or killed, or their births hidden from family planning authorities so couples can try to have a son.564 The policies have also been faulted for contributing towards skewed sex ratios, where more boys than girls are born. Currently, newborns in China are disproportionately male with national statistics indicating that the male to female sex ratio for newborns is 119 boys to 100 girls.565 In some regions, the ratio is 130 boys to 100 girls.566 China’s population control program has led to a dramatic decline in the country’s national birth rate, which has dropped from a high of 23.33 births per 1,000 persons in 1988 to 12.86 births per 1,000 persons in 2002, with urban areas reporting record low rates.567 In 2002, the official national fertility rate in China was 1.19 average number of live births per women aged 15-49.568 Although China is now on the path to population stabilization and a low fertility rate,569 the Chinese government maintains that further reduction in population is necessary to ensure economic and social well-being.570 In a decision promulgated by the CPC Central Committee and

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the State Council in 2000, excessive population growth was cited as a “crucial factor” in hindering the country’s economic and social development.571 The government has indicated that in the long run, economic development will limit childbearing; in the meantime, the government “relies on publicity and education, advances in science and technology, multipurpose services and … the reward and social security systems” to secure compliance with its population control laws.572 Laws and policies China is committed to achieving a peak population of 1.6 billion by the mid-21st century and a steady decline in population thereafter.573 In 2001, China codified its one-child policy and current family planning policy and practices in the Population and Family Planning Law.574 The law was enacted to bring about “a coordinated development between population on the one side and the economy, society, resources, and the environment on the other,” and to promote family planning for the enhancement of family happiness and the prosperity of the country.575 According to the Population and Family Planning Law, the government “advocates” one child per married couple, and requests to have a second child are subject to local laws and regulations.576 Regulations permitting a second child vary across provinces, autonomous regions, and municipalities. In general, couples fulfilling the following criteria may petition the local family planning department to have a second child: ■ their first child is disabled with no hope of entering the work force; ■ they are remarried and one of the spouses has no children; ■ they were diagnosed as infertile and became pregnant after adopting a child; ■ both husband and wife are single children; ■ they are ethnic minorities living in rural or autonomous national regions; or ■ they live in a rural area and their first child is a girl.577 One of the earliest exceptions to the one-child policy, the provision permitting rural couples with a daughter to have a second child, was enacted in 1984 as a concession to the strong resistance to birth limits and the desire to have multiple children among rural couples who lack pension plans and must rely on their offspring to support them in their old age.578 The government’s population and family planning objectives for 2000–2010 are outlined in a decision released jointly by the CPC Central Committee and the State Council. They are as follows: ■ limit the total population to 1.4 billion by 2010; ■ balance the sex ratio of newborn babies;

enable individuals of childbearing age access to basic reproductive health-care services; and ■ widely promote the informed use of various contraceptive measures.579 China’s family planning policies were further reiterated in the Tenth Five-Year Plan for National Economic and Social Development (2000–2005), and called for the following results: ■ sustain the low birth rate; ■ improve prenatal and postnatal care; ■ improve management of family planning in rural areas and among migrant populations; ■ establish rewards for family planning; and ■ accelerate the work of legislation for population and family planning.580 In 2005, the government launched a nationwide program called Social Support for Some Rural Families Practicing Family Planning, which provides cash rewards to elderly (60 years old or above) rural couples with one child or two daughters in compliance with population and family planning policies.581 Eligible recipients are entitled to a minimum of CNY 600 (USD 72) a year, or CNY 1,200 (USD 144) per couple.582 Some rural families with daughters are given privileges in housing, employment, education, and welfare support under the NPFPC’s Care for Girls program, launched in 2000, which seeks to reverse the newborn gender disparity and “improve the environment for girls’ survival and development.”583 Under the program, daughter(s)-only families receive loans and funding of up to CNY 5,000 (USD 604) for incomegenerating production, free schooling, and lectures on gender equality, and girls receive free health exams to ensure they are properly cared for by their families.584 Both incentives and penalties are used to encourage compliance with the population policy. Couples who follow the population policy receive social and economic incentives such as insurance, welfare benefits, poverty-alleviation loans, and work relief.585 Citizens who do not follow the directives of the population policy are required to pay a social compensation fee.586 Unmarried couples, women under the legal age for marriage, and both parties of an extramarital affair who have a child may also be subjected to social compensation fees.587 These fees are significant and may be several times the amount of an individual’s annual income.588 Families who do not pay their social compensation fees within the specified time period are subject to additional fees and charges,589 and anyone who fails to make payments may be given administrative sanctions or face disciplinary actions from their work unit or organization.590 Civil servants and state functionaries who violate family planning laws are subjected to harsher punishments.591 (See “Family planning” for more information). ■

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Ethnic minority groups The people’s congresses in autonomous national regions may formulate their own family planning policies in light of the central government’s stated interest in improving the quality of life and economic and social development of ethnic minority populations and the need for family planning regulations.592 These policies allow most ethnic minority families to have two or three children; allow more than three in small ethnic minority populations or for those living in harsh geographical conditions; and place no official constraints on the number of children of Tibetan farmers and herdsmen.593 Implementing agencies All sections of the government are directed to promote and implement the population policy, including the family planning administrative departments, social organizations such as trade unions and women’s federations, the armed forces, and the mass media.594 Family planning departments that fail to fulfill birth targets are admonished by their supervising agency, and the person in charge may be given administrative penalties.595 The NPFPC formulates, coordinates, and oversees the population policy.596 The NPFPC is headed by a minister, several vice ministers, and departmental director-generals.597 There are eight major departments in the NPFPC: the general office; the Department of Policies and Regulations; the Department of Development and Planning; the Department of Publicity and Education; the Department of Science and Technology; the Department of Finance; the Department of Personnel; and the Department of International Cooperation.598 The general office organizes and coordinates surveys, research, and analysis of key population and family planning issues to support policy-making at the commission’s top levels.599 The general office also examines and supervises the enforcement of major population and family planning policies formulated by the CPC Central Committee and the State Council. There are family planning commissions at the provincial, prefectural, and county levels and family planning committees below them.600 The NPFPC has ties with numerous research and mass educational organizations to manage and implement the population control policies.601 Several Chinese NGOs assist the government on population control issues. Among them are the Family Planning Association, the Population Association, the Association for Promotion of Population Culture, the Population Welfare Foundation, the Association for Healthier Births and Better Childbearing, the Association for Research on Healthier Births, and the Family Planning Institute of China Medical Association.602 With the help of these NGOs, China’s government is experimenting with less stringent fertility controls. In 2004,

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the NPFPC, working closely with the MOH, the CFPA, and UNFPA, established pilot programs in 32 counties that abandoned birth quotas and upgraded services in family planning clinics. In these counties, women and men were given more freedom of choice when selecting contraceptive methods, including wider access to condoms and birth control pills.603

III. Legal Status of Women and Girls The health and reproductive rights of women and girls cannot be fully understood without taking into account their legal and social status. Laws relating to their legal status not only reflect societal attitudes that shape the landscape of reproductive rights, they directly impact their ability to exercise these rights. A woman or adolescent girl’s marital status, her ability to own property and earn an independent income, her level of education, and her vulnerability to violence affect her ability to make decisions about her reproductive and sexual health and to access appropriate services. The following section describes the legal status of women and girls in China. A. RIGHTS TO EQUALITY AND NONDISCRIMINATION

The constitution of the People’s Republic of China pronounces all citizens equal before the law and states that women “enjoy equal rights with men in all spheres of life, in political, economic, cultural and social, and family life.”604 The government is entrusted to “protect the rights and interests of women, appl[y] the principle of equal pay for equal work to men and women alike[,] and train and select cadres from among women.”605 Other constitutional provisions obligate the government to uphold the freedom of marriage, protect families, and prevent the maltreatment of women and children.606 The Chinese government has encouraged women to participate in politics by passing a number of legislative measures, which have resulted in the steady increase of female government officials since the establishment of the Republic (See “Legal and Political Framework” for more information). In addition to the constitution, a number of laws address the rights and interests of women and girls, including the Civil Law, Marriage Law, Law on Maternal and Infant Health Care, Law of Succession, Labor Law, Women’s Rights Law, Trade Union Law, Compulsory Education Law, Education Law, Adoption Law, Criminal Law, Law on the Protection of Minors, and Law on Population and Family Planning. The Women’s Rights Law of 1992, revised in 2005, was the first

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basic law to protect women’s rights and interests in a comprehensive and systematic manner and provides that women enjoy equal rights and status with men in all aspects of political, economic, cultural, social, and family life.607 There is currently no law explicitly protecting homosexuals from discrimination, or recognizing and promoting their particular rights. Homosexuality was a criminal offense until 1997, and it was classified by the Chinese Psychiatric Association as a mental illness until 2001.608 Formal institutions and policies The government has established a number of institutional procedures and official policies to advance gender equality. The National Working Committee on Children and Women under the State Council (NWCCW) was established on February 22, 1990, to implement China’s policy of gender equality and ensure adherence to the principle of devotion to women and children’s survival, protection, and development.609 The NWCCW assisted the State Council in drafting and promulgating the National Plan for the Development of Chinese Women (1995–2000) and the National Plan for the Development of Chinese Children (1995–2000), and is currently overseeing the National Plan for the Development of Chinese Women (2001–2010) and the National Plan for Development of Chinese Children (2001–2010).610 The NWCCW is composed of officials from 28 ministries and commissions, and 5 NGOs, including the Chinese Communist Youth League (CCYL) and the ACWF.611 The main role of the NWCCW is to make the rights and interests of women and children a priority at all levels of government.612 Specifically, some of the working committee’s primary responsibilities include the following: ■ strengthening legislation that protects the rights of women and children and addressing prominent barriers to the development of this population; ■ encouraging the full implementation of key international treaties such as CEDAW and CRC that protect the rights and interests of women and children; ■ establishing and strengthening mechanisms to ensure the implementation of women’s and children’s programs at the local level; ■ training relevant government officials to implement programs for women and children; ■ addressing key obstacles to the provision of education and health care for all women and children; and ■ ensuring sanitary conditions in low-income and minority regions to improve the survival and development of their women and children.613 The Office of Workers, Youth, and Women (OWYW) is an integral part of the Committee on Internal and Judi-

cial Affairs of the NPC. Some of the main activities of the OWYW include researching, drafting, and monitoring the implementation of national legislation on women, children, and adolescents; and monitoring local laws concerning women, children, and adolescents.614 The ACWF was founded in 1949 “to represent and safeguard women’s rights and interests and promote equality between women and men.”615 The ACWF is entrusted, under statute, with representing and upholding “the rights of women of all nationalities and all walks of life and striv[ing to] … protect … women’s right and interests.”616 The federation is responsible for creating legislation pertaining to women’s issues and was recently entrusted with writing the final draft of the amendments to the Women’s Rights Law.617 The federation is a member of the NWCCW and enjoys consultative status with the Economic and Social Council of the United Nations.618 Members include female workers’ committees of trade unions in factories and mines, as well as registered national or local women’s organizations approved by ACWF. At present there are about sixty thousand grassroots women’s federations at or above the township and neighborhood committee levels, and more than nine hundred eighty thousand women’s groups.619 According to the World Bank’s East Asia Environment and Social Development Unit, the ACWF in some ways functions as a “quasi-governmental agency” and is constrained to a certain extent because of its close association with the Chinese government. Nevertheless, the ACWF acts as a bridge between policymakers and civil society and is, thus, “an important part of the enabling environment for gender equality in China.”620 B. CITIZENSHIP

Under the 1980 Nationality Law of the China, men and women have equal rights regarding the acquisition, loss, and restoration of citizenship.621 C. MARRIAGE

The right to marriage and the freedom of marriage are protected by the constitution, the Civil Law, the Marriage Law, and Women’s Rights Law.622 The constitution guarantees women equal rights in marriage and in the family and obligates the government to take measures to protect women’s right of self-determination in marriage and prohibit external interference with their freedom of marriage.623 Men and women have equal rights to marriage, and a marriage must be based upon the complete willingness of both parties.624 The Marriage Law is the fundamental code governing marriage625 and establishes the legal marriage age as 22 for men and 20 for women.626 The Law on the Protec-

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tion of Minors stipulates that parents or guardians may not force or permit their minor children to marry or undertake an engagement.627 The Population and Family Planning Law rewards couples who delay their marriage beyond the minimum ages with welfare benefits such as longer nuptial leaves from work.628 The Marriage Law prohibits marriages based upon an arbitrary decision by a third party, monetary or material gains, and other types of interference or compulsion by a third party or the prospective spouse.629 A marriage that has been coerced or obtained under conditions restricting personal freedom may be dissolved upon request by the coerced party to the marriage registration office or the people’s court. This request must be submitted within one year of the marriage registration date, or within one year of regaining personal freedom.630 Coercion refers to any actions that threaten the life, physical body, health, reputation, or assets of the coerced party or his or her close relatives.631 Bigamy is prohibited, as is marriage between certain blood relatives or those infected with diseases that may render a person unfit for marriage.632 Using force to interfere in anyone’s freedom of marriage is a criminal offense, punishable by up to two years of imprisonment or criminal detention, or up to seven years of imprisonment if the victim is killed.633 This crime can only be investigated upon the filing of a formal complaint.634 Even children are prohibited from interfering with their parents’ matrimonial rights and cannot abandon their financial duty to support their parents upon a parent’s marriage to a new spouse.635 Although the right to marriage is protected under the law, it is not absolute and is subject to certain restrictions. Until recently, the Regulations on Management of Higher Education Students stipulated that students and graduate students would be automatically dismissed or expelled if they got married or had children while they are in school.636 This 15year-old provision was abolished in the recent revision to the Regulations which came into effect on September 1, 2005, providing greater rights of self-determination for students.637 The Marriage Law and the Regulations on Marriage Registration do not explicitly state that marriage is limited to members of the opposite sex. However, it is implied by references to “husband and wife,” “man and woman,” “male and female,” and “father and mother” in the language of the statutes.638 Furthermore, senior officials of the Ministry of Civil Affairs, which is in charge of marriage registration, have stated that China is not prepared to recognize any marriage between people of the same sex.639 With limited exceptions, couples must register with their local marriage registration department and obtain a marriage

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certificate in order to legally establish their marital relationship.640 The Regulations on Marriage Registration, revised in late 2003, provide that Chinese citizens may apply for a marriage certificate if they can show identification cards and residency papers, and sign an affidavit attesting to their unmarried status and lack of blood relation to their intended spouse.641 Prior to these revisions, Chinese citizens were required to obtain a letter from their work unit verifying their unmarried status and were compelled to undergo premarital medical examinations to determine their “fitness for marriage.”642 (See “Examining Reproductive Health and Rights” for more information.) The revised regulations allow transgender individuals who have undergone sex change operations and officially changed their sex on their identity cards to register for marriage as their new gender and prohibit discrimination against them.643 Both the Women’s Rights Law and the Marriage Law establish women’s property rights within marriage and also establish equal rights for women in the possession, use, proceeds, and disposal of common marital property, regardless of the income status of either party.644 Under the Marriage Law, property acquired by the husband and wife during their marriage is classified as jointly owned, unless otherwise stipulated by a written agreement between the husband and wife.645 Husband and wife possess equal rights upon joint property, and decisions regarding disposition of this property must be made by husband and wife following discussion and mutual agreement.646 The Marriage Law covers a number of rights and duties that extend to both husbands and wives. They are to have equal status within the family, and must be faithful and respect one another.647 Each has the right to engage in work, study, and social activities without restriction or interference from the other.648 They have a duty to practice family planning and to protect, discipline, raise, and educate their children.649 Husbands and wives also have a duty to provide for each other, and if either fails to do so, the other may demand maintenance payments.650 Marriage and ethnic minorities Ethnic minorities in autonomous regions and prefectures may, with approval from a regional representative of the central government, alter resolutions, decisions, orders, and instructions to incorporate local practices regarding marriage and family.651 In some national autonomous regions, for instance, the legal marriage age was changed to over 18 for women and over 20 for men.652 D. DIVORCE

Husbands and wives can file for divorce jointly or separately,

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and a woman’s right to seek a divorce is protected from interference.653 Grounds for divorce may include bigamy or cohabitation; domestic violence, maltreatment, or desertion; gambling or drug addiction; and other serious actions that destroy marital affections.654 Restrictions are placed on the ability of a husband to seek divorce. A husband cannot apply for a divorce while his wife is pregnant, within one year after the birth of a child, or within six months of a miscarriage or the termination of a pregnancy as required by the government’s family planning policy.655 These rules apply unless a people’s court determines that it is necessary to accept the husband’s divorce request.656 A woman’s ability to seek divorce during any of these periods is not restricted.657 Couples who did not register their marriage in accordance with the Marriage Law may be regarded as a married couple for the purpose of divorce proceedings if they fulfilled the criteria for marriage prior to the enactment of the Regulations on Marriage Registration on February 1, 1994; otherwise, the court is to treat such relationships as cohabitation.658 Where both spouses wish to divorce, the marriage registration office will issue divorce certificates after confirming the intentions of both parties and verifying that arrangements exist for the division of property and the care of children.659 When only one spouse desires a divorce, he or she may either request mediation or appeal to a people’s court to initiate divorce proceedings.660 The Marriage Law provides that the court shall grant a divorce if mediation fails due to any of the following circumstances: ■ mutual affection no longer exists; ■ bigamy or cohabitation of a married person with any third party; ■ domestic violence, maltreatment, or desertion of one party by another; ■ the continuation of bad habits such as gambling or drug addiction despite repeated admonition; ■ separation of at least two full years due to incompatibility; ■ other circumstances leading to the loss of mutual affection; or ■ one party is declared missing, leading the other party to file for divorce.661 According to the Civil Procedure Law, parties involved in divorce litigation must appear in person before the court even if they are represented by counsel.662 For purposes of dividing property at divorce, property is classified either as jointly possessed or as solely belonging to the husband or wife. Examples of jointly possessed property include the following: ■ pay and bonus; ■ property obtained as an inheritance or gift (with

exceptions); earnings from investment of separate property; ■ retirement pension and arranged compensations for bankruptcy that both husband and wife have acquired or will acquire; and ■ housing purchased using marital assets, even if the deed lists only one party.663 In contrast, the following are considered separate property items: ■ prenuptial property possessed by only one spouse; ■ medical expenses, disability living allowances, and other property acquired by one party as a result of personal injury; ■ property (including housing) acquired as an inheritance or gift as specified to one party in a will or gift contract; and ■ one party’s private articles for daily use or any other individually held items.664 Notwithstanding these provisions, the Marriage Law permits spouses to identify in writing their prenuptial and joint property holdings.665 Upon seeking a divorce, the spouses shall first negotiate with each other and attempt to reach an amicable agreement on the disposition of their jointly possessed property.666 If the parties fail to reach an agreement, “the people’s court shall make a judgment, taking into consideration the actual circumstances of the property and the rights and interests of the wife and child, or children.”667 Before property is distributed, the law provides that “debts incurred jointly by the husband and wife during their marriage shall be paid off out of their jointly possessed property,” with any remaining property then divided between the spouses.668 If the jointly possessed property is insufficient to pay the debts, the “parties shall work out an agreement with regard to the payment. If they fail to reach an agreement, the people’s court shall make a judgment.”669 In general, only jointly possessed property is distributed upon divorce, but the Marriage Law does provide for the distribution of individual property in some instances. The law maintains that even if the spouses stipulated that they were individual owners of their property during the marriage, the spouse who assumed a greater responsibility as caretaker of the children or elderly parents and who assisted in the other’s work may request compensation at the time of the divorce.670 If one party to the divorce is unable to meet minimum living standards after the division of property, the other party shall provide assistance, which may be in the form of residential or ownership rights to a dwelling.671 In addition, if the divorce is granted because one spouse has committed bigamy, cohabited with a third party, acted violently toward the family, or ■

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maltreated or deserted family members, the spouse “without fault” shall have the right to request additional compensation for his or her losses.672 The party without fault may claim compensation either as part of the divorce decree or as a separate matter within one year of the divorce, unless the spouse has clearly surrendered such a claim at the time of the divorce.673 Spouses may claim compensation for loss of material goods as well as emotional harm for divorces granted by the people’s court.674 Divorce settlements are legally binding unless there was coercion or deception during the proceedings.675 Parties who attempt to conceal, deceive, destroy, or manipulate joint property at the time of the divorce may be awarded none or a smaller share of the joint property and may be subjected to civil litigation.676 Furthermore, parties in violation of the divorce decree through arrears in spousal maintenance, child support payments, noncompliance with division or inheritance of property, or visits to children, may be detained or fined by local authorities.677 There is no legislation explicitly dealing with judicial separation. Marriages and divorces between Chinese citizens and foreign nationals are bound by the laws of the location in which the marriage or divorce occurred.678 Spousal maintenance agreements are subject to the laws of the country to which the claimant is most closely connected.679 As long as one party to the marriage is a Chinese citizen, the people’s court may exercise jurisdiction over the case, and either spouse may petition the court for recognition of a foreign divorce judgment.680 Parental rights Child custody may be awarded to either parent. Under the Women’s Rights Law, favorable consideration is given to a wife’s reasonable demands for custody, and to the rights and interests of the children, especially if the wife has lost the ability to bear children due to sterilization or other reasons.681 The Marriage Law establishes that, in principle, the mother is granted custody of an infant she is breastfeeding.682 If the husband and wife cannot agree on the custody of their weaned child, the people’s court shall make a judgment based on the rights and interests of the child and the actual conditions of both parents.683 Whether children are placed in the custody of the mother or the father, they remain the children of both parents according to the law and both the mother and father have a continuing right and duty to raise and educate their children.684 The noncustodial parent also has a duty to bear some or all child support expenses, including living expenses, tuition and education costs, medical fees, and other relevant expenses.685 The people’s court will make a judgment about the amount and

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duration of child support payments for parents who cannot come to an agreement on their own.686 Those who fail to pay child support may be brought before the people’s court, and impoverished petitioners may apply for legal aid from the state in these cases.687 Parents not given custody of their children are granted visitation rights.688 Visits must be negotiated between the parties, with the court making a ruling when the parties are unable to agree.689 The custodial parent or legal guardian of a child may petition the people’s court to terminate visitation rights if the other parent’s visit endangers the child’s physical or mental health.690 Children under the age of 14 are eligible for adoption if they are orphaned or abandoned, or if their parents are unable to rear them.691 The consent of both parents must be obtained prior to placing their child for adoption, unless one parent is deceased or cannot be found.692 If an adoptee is aged ten or older, his or her consent must be obtained prior to the adoption.693 Same-sex couples are not granted the right to adopt children together. The Adoption Law states that when a person with a spouse adopts a child, the male and female parties must adopt the child in concert.694 Family planning regulations hold that parents who have voluntarily given up a child for adoption may not have additional children.695 Ethnic minorities Although China does not have separate divorce and custody policies for minority groups, the Marriage Law and the Adoption Law give the country’s autonomous regions, where most minority groups reside, “the right to formulate certain adaptations in keeping with the principles of [the law] and in light of the specific conditions of the local nationalities with regard to marriage and the family.”696 In China’s Hubei province, for instance, both the husband and wife must be present to express their views before a divorce is granted.697 E. ECONOMIC AND SOCIAL RIGHTS

Ownership of property and inheritance The Civil Law grants women and men equal rights regarding protection of their personal property and the right to inherit under the law.698 Property rights are also addressed by the Women’s Rights Law, which guarantees women an equal right to property, including the allotment of agricultural land and land for housing construction.699 The Women’s Rights Law additionally guarantees an equal right to inherit property.700 This is also incorporated into the Law of Succession.701 Under these statutory schemes, property is inherited in the first order by the spouse of the decedent, the decedent’s children, and the decedent’s parents, and without discrimination on the basis of gender.702 Daughters-

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in-law or sons-in-law are entitled to inherit property as successors in the first order if they were primarily responsible for taking care of their parents-in-law.703 A widow has the right to dispose of inherited property as she wishes, and interference with this right is prohibited.704 Husbands and wives, and unmarried, cohabiting couples are the first to inherit each other’s property regardless of whether a widowed spouse remarries, and they may dispose of the inherited property without interference.705 Within marriage, women have equal rights with their spouses in the possession, use, proceeds, and disposal of joint property.706 This right is not affected by the income status of either the husband or the wife.707 Property acquired by the husband and wife during marriage is generally presumed under the law to be held in joint possession, unless they otherwise agree.708 Certain types of property, however, may be considered a spouse’s separate property. (See “Divorce” for more information.) Rural women and rights to agricultural land Rights to agricultural land are guaranteed to women regardless of their marital status.709 The central government assigns agricultural land to local administrative bodies that utilize a membership system for land distribution.710 Legally, women and men have equal rights to rural land, and no organization or individual may deprive women of their lawful rights.711 However, pervasive patriarchal attitudes generally result in the exclusion of women from these local bodies, and they are often deprived of their right to inherit the agricultural land of their father or spouse.712 Labor and employment In 2002, 335.52 million women, or 45.5% of the total female population, were employed in China.713 In recent years, women have grown to comprise 38% of urban employees as an additional 5.65 million have entered the urban workforces.714 Under the constitution, citizens have the right as well as the duty to work.715 Pursuant to the constitutional principle that women enjoy equal rights with men in all areas of life, the government shall provide “equal pay for equal work,” and equal opportunities to women for training.716 The Labor Law enacted in 1994 reaffirms the principle of equal pay for equal work and calls for the distribution of wages according to work.717 The law prohibits sex discrimination and grants women equal rights with men in employment.718 Employers are forbidden from imposing higher recruitment standards for women or from using sex as a basis for excluding female workers, unless the work is deemed unsuitable for women.719 Labor laws restrict women from working in certain areas due to female physiology, particu-

larly during menstruation, pregnancy, puerperium, lactation, and menopause.720 Employers may not assign female workers to work in mines or in conditions involving intense physical labor.721 Employers are required to ensure that the work environment does not adversely affect women’s reproductive capacity or the health of the next generation.722 The labor laws provide special protections for pregnant women and lactating mothers, and employers are prohibited from revoking their labor contracts, decreasing their salary, or demoting them during these periods.723 Restrictions, however, are placed on the physical intensity of work.724 When a worker reaches her seventh month of pregnancy, or when she is breastfeeding a child of less than one year, employers are prohibited from extending her hours, assigning her to night shifts, or assigning her to work in operations involving toxic substances.725 If she is unable to perform her regular duties because of pregnancy, the volume of work must be reduced or other work must be arranged.726 Pregnant workers or women workers with a baby under one year of age are granted paid, periodic breaks for resting or feeding.727 Women workers are entitled to a minimum of 90 days paid maternity leave, of which 15 days may be allocated for prenatal leave.728 In the event of multiple births, 15 days of additional leave are awarded for each additional child.729 Women who experience a miscarriage are entitled to a portion of their paid maternity leave.730 Time spent for prenatal exams is paid, and provincial regulations determine the duration and number of prenatal visits pregnant workers are entitled to during pregnancy.731 Under special circumstances, pregnant workers may petition the local health department to increase the number of prenatal exams.732 Female workers, regardless of their reproductive status, are entitled to maternity insurance and other social insurance benefits.733 Workplaces staffed with a large number of female workers are required to individually or jointly establish a gynecological clinic, a lounge for pregnant workers, a feeding room, a nursery, and a kindergarten, and endeavor to solve any difficulties female workers experience in the areas of reproductive health, feeding, and child care.734 As the Chinese population ages, a greater number of older women are present in the workforce, and special provisions have been established to address menopausal issues. Women over 45 who suffer from adverse symptoms of menopause are given less work and are entitled to at least two breaks of no less than 30 minutes each.735 If employers violate a female worker’s rights, they are ordered by the labor department to correct the situation and pay a fine.736 Employers are responsible for compensating any woman who has been harmed by their violation of the law, and the persons in charge may be investigated for crimi-

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nal liability if the violation leads to serious injury, death, or substantial loss of or damage to personal property.737 In cases where employers assign pregnant or lactating females to work with toxic substances, the local health department will issue a warning, and if the situation is not rectified in a timely fashion, it may fine the employer CNY 50,000 to CNY 300,000 (USD 6,041 to USD 36,247), or assess criminal liability where serious poisoning occurs.738 Employment statutes provide procedural mechanisms for workers and employers seeking to resolve labor disputes.739 Laborers have the right to criticize, report, or file charges against employers for endangering the safety of their life or health.740 The Regulations on Settlement of Labor Disputes in Enterprises instruct disputing parties to first attempt to negotiate a solution. If the parties are unwilling to negotiate or if negotiations fail, the case may be referred to the labor dispute mediation committee, which is composed of representatives of employees and employers as well as representatives from trade unions, one of whom chairs the committee.741 If mediation fails or if either party wishes to apply directly for arbitration, they may appeal to the labor dispute arbitration committee at the county, city, or district level. These arbitration committees comprise persons from the trade union council, the government’s labor department, and the economic administrative department.742 If one or both parties refuse to accept the arbitration awards, they may bring the case before the people’s court.743 The Women’s Rights Law, like the Labor Law, guarantees women an equal right to work and equal pay for equal work.744 The law provides that no employer should refuse to hire women, or set a higher threshold for hiring women based on gender, except in industries or positions for which women are deemed unfit.745 In the interest of women’s health and safety in the workplace, the law states that women should not be assigned to unsuitable work or labor and special protective measures should be employed during menstruation, pregnancy, childbirth, and lactation.746 Like the Labor Law, the Women’s Rights Law prohibits the dismissal of female workers from employment or reducing their salary based on pregnancy, maternity leave, or lactation.747 The law additionally forbids employers from terminating women due to marital status.748 Trade unions are obligated to uphold the constitution and strive for the protection of women’s rights and interests within the scope of their work.749 The rights and obligations of trade unions are governed by the Trade Union Law. Trade union membership is available to “all … workers in enterprises, institutions, and government departments within … China … who rely on wages or salaries as their main source of

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income … irrespective of … sex.”750 Trade union committees for female workers are allowed in workplaces with relatively large numbers of women. In workplaces with relatively small numbers of women, a representative of female workers must be included on a trade union committee.751 If the special rights and interests of female workers are infringed upon by an employer, the trade union shall formally lodge a complaint with the employer and “negotiate an appropriate remedy.”752 The Regulation on Labor and Social Security Inspection also urges labor protection monitoring committees of the local labor department to ensure that employers comply with the law against child labor, observe special protection laws for women and minors, and assign penalties for any violation.753 The Law on Safety in Mines stipulates that mining enterprises must practice special labor protections for female workers and may not assign women or adolescents to any underground work.754 The retirement age for Chinese women is generally five years lower than that of their male counterparts. Professional women working for any institution or industry run by the government reach retirement age at 55, but men may work until age 60. For blue-collar workers, the retirement age is 50 for women and 55 for men.755 Discrimination against women in the state’s retirement policy was recently outlawed by the revision of the Women’s Rights Law, which shall be effective on January 1, 2006.756 Access to credit Chinese women and men have equal rights with regard to access to credit.757 Since 1996, the central and local governments have made budgetary allocations to support low-interest or preferential loans that are only available to women.758 These loans are generally underwritten by the ACWF, which expanded its microcredit scheme nationwide in 1994 to include low-income rural women, urban female entrepreneurs, and urban female laid-off job seekers.759 These credit programs are funded by the central government, local people’s governments, and international organizations such as the UNDP.760 Education The total enrollment rate of children in primary schools in 2002 was 98.58%.761 The school attendance rate for girls has steadily improved since the 1990s, reaching 98.53% in 2002.762 The national female illiteracy rate has dropped from 90% in 1949 to 14% in 2002.763 Although women and girls have achieved greater equality in access to education, discrepancies are still prevalent, particularly among the children of migrant workers and in rural areas where there are few means of enforcing antidiscrimination statutes. This is particularly evident in outlying

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mountain regions and areas inhabited by ethnic minorities, where poverty-stricken families cannot afford to send their children to school. Every year, about 1 million students, of whom 70% are girls, are forced to drop out of school to help support their families.764 National statistics show that boys receive an average of 1.07 more years of education than girls— an improvement over the 2.9 years recorded in 1991.765 These issues were addressed in the National Education Development Program and circulars of the Ministry of Education, all of which emphasized the importance of educating girls and outlined measures for narrowing the education gap between boys and girls.766 The constitution explicitly states that citizens have “the duty as well as the right to receive education” and that the government “promotes the all around moral, intellectual, and physical development of children and young people.”767 It also notes that parents have the duty to rear and educate their minor children.768 The Compulsory Education Law and the Education Law reiterate the right of all citizens to an education, irrespective of sex.769 The Compulsory Education Law, introduced in 1986, requires both males and females to complete nine years of education beginning at six years of age and including six years of primary and three years of secondary schooling.770 Once universal primary education has been achieved, the government will seek to make middle school education compulsory as well.771 The Compulsory Education Law stipulates that “the State shall not charge tuition for students receiving compulsory education,” and the Education Law prohibits collection of fees from students in violation of state regulations.772 The State Council and local governments are responsible for covering all expenses associated with compulsory education and must provide subsidies and personnel for the implementation of compulsory education in minority and low-income areas.773 However, official statistics indicate that government funding supported only 53% of education expenditure in 2000, and only 8% of that amount came from the central government, with a mere 2% for compulsory education.774 Ultimately, the financial burden of compulsory education falls upon private citizens, who have shouldered the costs—estimated at CNY 200 billion (USD 24.2 billion) over the past decade—through taxes and public school fees.775 Local people’s governments are required by law to create conditions that are conducive for all school-age children and adolescents to receive compulsory education.776 When children have reached school age, their parents or guardians must send them to receive compulsory education for the entire period required by law and may not withdraw

them,777 except in the event of illness or other special circumstances.778 Parents or guardians who fail to send their school-age children or adolescents to school are subject to official admonishments.779 Organizations and individuals are prohibited from employing school-age children or adolescents who should be enrolled in compulsory education.780 Violators are admonished and ordered by the local people’s government to terminate the illegal employment of minors.781 If the violation is serious, offenders may also be fined, ordered to suspend business operations, or have their business license revoked.782 The law also prohibits religious justifications for withdrawing from compulsory education.783 Individuals or organizations that breach these provisions may be subject to administrative sanctions or penalties, ordered to provide compensation if damage is caused, and assigned criminal responsibility if the circumstances warrant such an investigation.784 The Women’s Rights Law guarantees women equal rights to education.785 Accordingly, parents and guardians must ensure that girl children and adolescent girls receive compulsory education.786 The law parallels the Compulsory Education Law, which maintains that parents or guardians will be criticized by local people’s governments if they fail to send girls to school without an official exemption.787 In recognition of the fact that girls face particular difficulties in receiving an education, the government, society, and schools are all charged with taking effective steps to ensure that girls properly receive compulsory education.788 Beyond compulsory education, the Women’s Rights Law, the Education Law, and the Higher Education Law grant women equal rights to all levels of education.789 The Education Law and the Women’s Rights Law obligate schools and governmental departments of education to ensure that women enjoy equal rights and access to education, specifically in regard to enrollment, admission to institutions of higher education, advancement, practical training, conferment of academic degrees, and opportunities for studying abroad.790 Additionally, schools are directed to take adolescent girls’ physiologies into account and provide appropriate accommodations in order to promote their healthy mental and physical development.791 Local people’s governments are also responsible for including literacy programs for women in their continuing education programs and plans to fight illiteracy.792 The Vocational Education Law and the Law on the Protection of Minors require all levels of government to adopt vocational education and technological training for women and minors.793 Finally, the Women’s Rights Law directs all state organs, social organizations, enterprises, and institutions to afford women equal

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rights with men when engaging in scientific, technological, literary, artistic, and other cultural activities.794 The China Youth Development Foundation (CYDF) is an NGO founded by the All-China Youth Federation in 1989 with the mission of promoting education, science and technology, culture, sports, health, and social welfare for Chinese youth and children.795 Among the programs implemented by the CYDF is Project Hope, a policy initiative launched in 1989 to lower dropout rates and improve education facilities in poverty-stricken areas.796 Since then, the CYDF has assisted more than 2.6 million students from underprivileged families to enroll or return to school and has received more than CNY 2.2 billion (USD 265.8 million) in donations.797 At least 10,000 Hope Primary Schools for rural students have been constructed or rebuilt; 150 of them are equipped with computer labs that have internet access to support distance learning programs.798 Over 20,000 scholarships were awarded to excelling students to facilitate the completion of their high school and university studies, and 113,000 five-year scholarships were granted to elementary school students to cover basic school fees.799 The project is available in 16 provinces and 27 urban cities.800 The foundation has also supported other activities designed to raise literacy, science and technology achievements, and computer knowledge of children and adolescents.801 In 2005, the foundation launched the Jinlongyu Fund to provide education subsidies for the nearly 20 million school-aged children of immigrant workers, 10% of whom are at risk of dropping out due to poverty.802 The ACWF and the China Association for Sciences and Technology (CAST) have implemented education and skillsbuilding programs with the support of UNICEF for women and girls throughout the country.803 The CAST programs provide girls aged 12–17 with life skills training.804 Under the ACWF’s Spring Buds project, female dropouts were reinstated in formal schooling in 29 provinces, and “Spring Buds Classes for Girls” in literacy, mathematics, and adolescent health were established in poverty-stricken areas.805 Launched in 1989, the ACWF’s Double Learning and Double Competing program addresses illiteracy and provides agriculture skills training among rural women. Since its inception, 120 million rural women have participated in the program, and many program facilities have been upgraded to comprehensive schools for women.806 In urban areas, the ACWF has implemented activities for female high school students aiming to strengthen their self-esteem, self-confidence, and independence.807 Sex education Adolescent sex education is a mandatory component of high school curricula in China.808 In the early 1980s, the Chinese government recognized that sex education for young

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people was essential for the effective implementation of its population policy.809 As a result, in 1988 the Ministry of Education and the National Population and Family Planning Commission instructed high schools nationwide to incorporate sex education into their curricula.810 The Ministry of Education reiterated the importance of adolescent sex education, comprising studies of sexual physiology, psychology, and morality, in the 1993 Guidelines to Health Education for University Students.811 Sex education is also addressed in several related policies and laws. The Population and Family Planning Law instructs schools to conduct education in physiology, health, puberty, and sexual health in an age-appropriate manner.812 The Women’s Rights Law requires that schools tailor their educational programs and facilities to meet the physical, mental, and emotional needs of female students.813 The Law on the Protection of Minors also calls for schools to provide “education in puberty knowledge.”814 Despite official support, there is a lack of comprehensive systematic sex education in China815 and resource materials are not readily available, especially to women.816 Censorship of sexual content817 and conservative ideology on sexuality has often meant that sex education programs in Chinese schools are inadequate and discussions are usually limited to adolescent physiology, hygiene, sexual morality, and usage of contraception to limit population growth and promote chastity rather than ensuring safe sex.818 Recently, however, the quality of sex education has improved. The Ministry of Education recently held that all provincial education departments should institute HIV/AIDS prevention curricula in all junior middle schools, senior high schools, and vocational high schools by the end of 2005.819 Provincial departments are employing diverse methods to implement these programs. In Shanghai, for example, lectures begin in fourth grade about HIV/AIDS and how it is transmitted, and continue through senior high school where lessons focus on AIDS prevention and control, and nondiscrimination toward people with HIV/AIDS.820 The first comprehensive domestic sex education textbook for teenagers, entitled Thoughts of Teenagers, was released in 2004. The book covers sexual psychology, sexual physiology, sexual health, sexual morality, marriage, and family planning, as well as culturally taboo topics of masturbation, contraception, sexual harassment, AIDS, and homosexuality.821 In 2003, the first sex education videos were issued to teach primary and high school students about sexual behavior, contraception, and HIV prevention.822 The Shanghai Municipal Education Commission has developed a comprehensive program addressing more than

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200 topics in physiology, psychology, and sociology relating to drug addiction, AIDS prevention, and safe sex.823 The program begins in fourth grade with lectures on the physiological differences between boys and girls and continues through sixth grade, where students are taught to adapt to physiological changes in puberty.824 In middle school, students are given information about HIV/AIDS and by the end of high school are made aware of HIV/AIDS prevention through safe sexual practices such as condom use.825 F. PROTECTIONS AGAINST PHYSICAL AND SEXUAL VIOLENCE

Rape Rape, whether committed by violence, coercion, or other forcible means, is punishable by a minimum of three years’ and a maximum of ten years’ imprisonment.826 Sexual relations with a girl under the age of 14 is regarded as rape and punishable by a more severe sentence—either a minimum of ten years’ imprisonment, life imprisonment, or death.827 Harsher penalties are imposed if rape occurs under several circumstances, including: ■ the rape of a woman “before the public in a public place”; ■ the rape of a woman by “one or more persons in succession”; and ■ causing the victim serious injury, death, or other serious consequences.828 While the general age for criminal responsibility is 18, for certain serious crimes, including rape, the age is lowered to 14.829 A person between the ages of 14 and 18 who commits rape is, however, subject to a reduced sentence.830 The molestation or humiliation of a woman through violence, coercion, or other means is also a crime.831 Molestation or humiliation is punished by a sentence of up to five years’ imprisonment or criminal detention.832 Heavier punishment is meted out in cases of child molestation.833 The sentence is also increased to a minimum of five years’ imprisonment if the perpetrator assembles a crowd to commit the molestation or humiliation, or commits the crime in public.834 A woman who injures or kills her attacker in order to defend herself from rape or physical assault is protected from criminal prosecution. The law provides that there is no criminal responsibility for those who defend themselves in the face of any violent crime, including physical assault or rape, that seriously endangers personal safety.835 There is no law specifically regarding marital rape, but legal scholars have recognized marital rape if the marriage is forced, in certain circumstances such as during separation, or after a divorce has been filed for.836

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Incest There is no specific legislation that prohibits or criminalizes incest. However, the Marriage Law provides that no marriage may be contracted under a circumstance in which the male party and the female party are lineal relatives by blood or collateral relatives by blood up to the third degree of kinship.837 Domestic violence According to reports by the ACWF, domestic violence occurs in three out of every ten families and is cited in threefifths of China’s divorce cases.838 There is no specific national legislation on domestic violence, but the constitution, the Marriage Law, and the Criminal Law address the issue.839 The constitution and the Marriage Law prohibit the “maltreatment of … women and children.”840 The Criminal Law provides that serious mistreatment of a family member is a crime punishable by a maximum of two years’ imprisonment or seven years’ imprisonment if serious injury or death is caused.841 The perpetrator may be given a lesser prison sentence, placed under criminal detention, or subjected to close monitoring by the police with restrictions on his or her mobility and other rights.842 The Supreme People’s Court of China defines domestic violence as “any act that causes physical, psychological, and other kinds of damage to other family members through battering, binding, brutality, forcible restriction to physical freedom, or other means. Frequent or persistent acts of domestic violence constitute abuse.”843 Under the provisions of the current Marriage Law, victims of domestic violence or maltreatment by family members are entitled to assistance from the neighborhood or village committee to dissuade the abuser and provide mediation.844 The police are responsible for stopping the violence and assigning administrative penalties to the perpetrators of domestic violence upon the victim’s request.845 Domestic violence and maltreatment are grounds for divorce according to the Marriage Law, and the victim may request damage compensation.846 Where domestic violence or maltreatment of family members constitutes a criminal offense, the victim may bring a voluntary prosecution in a people’s court in accordance with the Criminal Procedure Law.847 The police must investigate the case and the people’s procuratorates may prosecute the offender as stipulated under the Criminal Law.848 The recent revision to Law on the Protection of Rights and Interests of Women in August 2005 includes new provisions that address domestic violence.849 The Law explicitly forbids domestic violence against women and instructs the State, various government agencies and NGOs to take measures to prevent domestic violence and render assistance

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to female victims of domestic violence.850 The ACWF and women’s NGOs have established shelters, hotlines, and counseling centers for battered women and conduct training sessions about how to stop violence for the police force.851 Sexual harassment The first national legislation against sexual harassment of women was introduced in the 2005 revision of the Women’s Rights Law, which will come into effect on January 1, 2006.852 The law prohibits sexual harassment against women, and victims have the right to file a complaint against the perpetrator with his or her work unit or relevant agency.853 Further definitions and punishments for sexual harassment remain to be determined.854 In 2003, the first sexual harassment lawsuit was tried and the court of first instance ruled in favor of the plaintiff.855 As no sexual harassment legislation existed at the time, the suit was filed on the grounds of “safeguarding [the victim’s] reputation” and the perpetrator was ordered to apologize and pay monetary compensation to the victim for psychological harm.856 However, the appellate court concluded that the harassment did not cumulate in serious effects on the victim and overturned the ruling.857 Of the few sexual harassment cases filed since then, most have been dismissed due to lack of evidence.858 Commercial sex work and sex-trafficking The Chinese government strictly prohibits commercial sex work and penalizes sex workers under the Criminal Law, several NPC decisions, and various administrative measures. People who voluntarily engage in sex work are punished by local police forces under the Regulations on Administrative Penalties for Public Security.859 They may be detained for a maximum of 15 days, given a warning, made to sign a statement of repentance, given custodial “re-education through labor” for six months to two years, and charged concurrent fines of up to CNY 5,000 (USD 604).860 Repeat offenders are subject to re-education through labor and a maximum fine of CNY 5,000 (USD 604).861 Sex workers must undergo mandatory testing and treatment for STIs.862 Those who knowingly engaged in sex work and are found to be infected with a STI can be sentenced to a maximum of five years’ imprisonment, criminal detention, and a concurrent maximum fine of CNY 5,000 (USD 604).863 The Criminal Law, revised by the Decision of the Standing Committee of the NPC on the Strict Prohibition against Prostitution and Whoring of 1991, punishes people who organize, assist, force, lure, shelter, or procure any other person or persons to engage in sex work.864 This is echoed in the Women’s Rights Law.865 People found guilty of these crimes are subject to imprisonment of five to ten years, fines of CNY 5,000 to CNY

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10,000 (USD 604 to USD 1,208), and/or confiscation of property.866 Death, life imprisonment, or a minimum of ten years’ imprisonment shall apply if the violator is found guilty of the following: ■ forcing a girl under age 14 to engage in sex work; ■ forcing many people to engage in sex work or forcing a person to engage in sex work many times; ■ forcing the victim to engage in sex work after raping her; or ■ causing death, serious bodily injury, or other severe consequences to the victim.867 Employees of catering, transportation, or entertainment services who utilize their position to violate prohibitions on sex work are also subject to penalties under the Criminal Law.868 Hotels, caterers, and entertainment and taxi services have a responsibility to prevent sex work within their workplaces, and knowingly failing to stop sex work is punishable by fines of CNY 10,000 to CNY 100,000 (USD 1,208 to USD 12,082), the suspension of business, or the revocation of an operating license.869 Obstructing the police from uncovering sex work through concealing or assisting violators is punishable by up to three years’ imprisonment, criminal detention, public surveillance, or fines.870 The state confiscates any illegal incomes gained through sex work.871 The Women’s Rights Law prohibits abducting, trafficking, kidnapping, buying, and obstructing the rescue of women.872 The people’s governments and various government agencies, including the MOH, are responsible for taking timely measures to assist women victimized by these crimes and shall work in cooperation with women’s federations to provide victims with recovery assistance.873 The NPC issued a decision in 1991 to clarify penalties and disciplinary measures against those who abduct, traffic, or kidnap women and children. Some provisions of the decision were incorporated into the 1997 revised Criminal Law.874 Under the revision, those involved in abducting or trafficking women or children are sentenced to five to ten years’ imprisonment and a concurrent fine of up to CNY 10,000 (USD 1,208).875 Under the following circumstances, the crime is considered especially serious and the offender may concurrently have his property confiscated and be sentenced to death: ■ being a ringleader of a gang engaged in abduction or trafficking of women or children; ■ abducting or trafficking three or more women and/ or children; ■ raping a woman who is being abducted or trafficked; ■ enticing or forcing a victim of trafficking or abduction to engage in sex work, or selling the victim to

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another who would force her into sex work; kidnapping a woman or child by means of violence, coercion, or anesthesia for the purpose of selling the victim; ■ injuring or killing a victim of trafficking, or the victim’s relatives; ■ abducting and trafficking a woman or child abroad; or ■ kidnapping a baby or other person for the purpose of selling the victim or extorting money or property.876 Buyers of trafficking victims are subject to criminal liability, a maximum of three years’ imprisonment, criminal detention, or public surveillance.877 If the buyer violates the rights of the victims through forced sexual relations, restriction of their personal freedom, or maltreatment, they face imprisonment of up to ten years and other penalties under the Criminal Law. 878 In the event that the buyer does not maltreat the victims or obstruct their return to their place of residence, they are exempted from any criminal responsibility.879 The law stipulates that the government has a duty to rescue victims from kidnapping, trafficking, and abduction, and state functionaries who fail to make a rescue effort upon request are sentenced to two to seven years’ imprisonment.880 Anyone who interferes with the government in rescuing a sold woman or child is penalized by up to three years’ imprisonment, criminal detention, public surveillance, and/or fines.881 Between 2001 and 2003, the Chinese government rescued 43,215 women and children and arrested 22,018 traffickers.882 In 2003, the police rescued more than two thousand trafficked women and children who were forced into sex work.883 The Ministry of Public Security (MPS) and international organizations have established several projects to combat the trafficking of women and children. In one project, the MPS, the ACWF, and UNICEF issued instruction booklets for rural girls to teach them relevant laws and regulations, and how to recognize and protect themselves against human traffickers.884 Since 1999, the MPS in cooperation with UNICEF has implemented the Elimination of Trafficking: Zero Tolerance Plan, which seeks to eliminate the high demand for human trafficking through education, advocacy, crackdowns, and intolerance for the practice.885 The project provides protection, recovery assistance, and community reintegration services for victims and trains law enforcement officers about women and children’s rights.886 Future goals of the project include provision of counseling services, life skills training that covers reproductive health and women’s and children’s rights, and opportunities for small income-generating work-tasks for victims.887 Since 2000, the International Labor Organization and the International Program on the Elimination of Child Labor have implemented a project on combating trafficking ■

in women and children, which has successfully eliminated human trafficking in several remote areas in China.888 Sexual offenses against minors The molestation or humiliation of a female minor through violence, coercion, or any other forcible means is punishable by a minimum of five years’ imprisonment, and more if the case involves a child.889 Any instance of sexual relations with a girl under the age of 14 is considered rape under the Criminal Law and is punishable by a minimum of three years’ imprisonment.890 The sentence is raised to a minimum of ten years’ imprisonment if the circumstances are particularly “flagrant,” if the person has had sexual relations with several underage girls, or if the victim suffers injury, death, or other serious consequences.891 Under those circumstances, a sentence of life imprisonment or death may be imposed.892 The trafficking of minor young women is a serious concern in China. Abducting, kidnapping, buying, trafficking in, fetching, sending, or transferring of a minor is punishable by ten years’ to life imprisonment or death if the circumstances are especially atrocious.893

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ENDNOTES 1. Central Intelligence Agency (CIA), U.S. Government, China, in The World Factbook (2005), http://www.cia.gov/cia/publications/factbook/geos/ch.html (last updated June 14, 2005). 2. Bureau of South Asian Affairs, U.S. Department of State, Background Notes: China (2005), http://www.state.gov/r/pa/ei/bgn/18902.htm (last visited June 29, 2005). See also Robert L. Worden et al., Introduction to Federal Research Division, Library of Congress, Country Studies: China ¶¶ 4–5 (Robert L. Worden et al. eds., 1987), http://lcweb2.loc.gov/frd/cs/cntoc.html (last visited Mar. 2, 2005) [hereinafter Library of Congress, Country Studies: China]. 3. Xianfa [Constitution], pmbl. ¶ 5 (2004); U.S. Department of State, supra note 2; Library of Congress, Country Studies: China, supra note 2, ch. 1, The People’s Republic of China. 4. Xianfa [Constitution], pmbl. ¶ 7 (2004); Library of Congress, Country Studies: China, supra note 2, ch. 1, The Transition to Socialism, 1953-57. Id. 5. U.S. Department of State, supra note 2. See also Library of Congress, Country Studies: China, supra note 2, Introduction, ¶¶ 4–5. 6. U.S. Department of State, supra note 2; Library of Congress, Country Studies: China, supra note 2, ch. 1, The Transition to Socialism, 1953-57. 7. U.S. Department of State, supra note 2; Library of Congress, Country Studies: China, supra note 2, ch. 1, The Great Leap Forward, 1958-60, ch. 5, The Great Leap Forward, 1958-60. During the “Leap” (1958-1961), at least 14 million people died of starvation. Id. 8. See Library of Congress, Country Studies: China, supra note 2, ch. 1, The Great Leap Forward, 1958-60. 9. U.S. Department of State, supra note 2; Library of Congress, Country Studies: China, supra note 2, ch. 1, Readjustment and Recovery, 1961-65, ch. 11, MarxismLeninism-Mao Zedong Thought Re-Thought. 10. See Library of Congress, Country Studies: China, supra note 2, ch. 1, The Militant Phase, 1966-68. 11. From the 1970s until the 1990s, Deng served as the de facto leader of China. He was the most influential figure of the CPC and commanded heavy respect from politicians and the public alike. He assumed the responsibilities of Premier Zhou Enlai (term of office from 1949-1976) while Zhou battled cancer, then displaced Mao’s chosen successor Hu Guofeng and ordered the house arrest of Premier Zhou Ziyang (term of office from 1983-1987) until Zhou’s death. See Library of Congress, Country Studies: China, supra note 2, Introduction, ¶¶ 4–5. 12. Ministry of Commerce, Government of the P.R.C., Report on the Development of China’s Market Economy 2003, ch. II, § I–II (2004), www.china. org.cn/english/2003chinamarket/79520.htm (last visited Sept. 2, 2005). 13. Development strategy aimed to achieve advanced industrialization by 2000 through modernization of industry, agriculture, science and technology, and national defense. It was first announced in the Third Five-Year Plan (1966-70) by Premier Zhou Enlai and officially adopted by the CPC in December 1978. Library of Congress, Country Studies: China, supra note 2, glossary, ch. 1, China and the Four Modernizations, 197882. 14. Central Intelligence Agency (CIA), supra note 1; U.S. Department of State, supra note 2. 15. President Jiang Zemin developed the governing theory of the “Three Represents,” where the CPC functions as a “faithful representative of the requirements in the development of advance productive forces, the orientation towards advanced culture, and the fundamental interests of the broadest masses of the people of China. Three Represents: New Thinking, Great Thought, People’s Daily (China), http://english.people.com.cn/ zhuanti/Zhuanti_353.shtml (last visited Mar. 18, 2005). 16. Central Intelligence Agency (CIA), supra note 1; U.S. Department of State, supra note 2. 17. Central Intelligence Agency (CIA), supra note 1 (estimates as of July 2005); U.S. Department of State, supra note 2. 18. National Bureau of Statistics of China, Government of the P.R.C., Statistical Communiqué of the People’s Republic of China on the 2004 National Economic and Social Development (Feb. 28, 2005), http://www.stats.gov.cn/english/ newsandcomingevents/t20050228_402231939.htm. 19. See Central Intelligence Agency (CIA), supra note 1; U.S. Department of State, supra note 2. 20. Central Intelligence Agency (CIA), supra note 1. 21. U.S. Department of State, supra note 2 (estimates of 100 million Buddhists, 20 million Muslims, 5 million Catholics and 15 million Protestants). 22. Id. 23. Central Intelligence Agency (CIA), supra note 1. 24. See United Nations, List of Member States, www.un.org/Overview/unmember. html (last visited Mar. 4, 2005). 25. United Nations Security Council, Member and Presidency of the Security Council in 2005 (2005), http://www.un.org/Docs/sc/unsc_members.html (last visited June 9, 2005). 26. Asia-Pacific Economic Cooperation (APEC), Member Economies (2004), http://www.apec.org/apec/member_economies.html (last visited June 9, 2005); World Trade Organization (WTO), Understanding the WTO: Members and Observers (2005), http://www.wto.org/english/thewto_e/whatis_e/tif_e/org6_e.htm (last visited June 9, 2005).

27. Association of Southeast Asian Nations (ASEAN), Overview, http://www. aseansec.org/147.htm (last visited Apr. 29, 2005). ASEAN members include Brunei, Burma, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam. Id. 28. Xianfa [Constitution], art. 33 (2004), amended by Amendments to the Constitution of the People’s Republic of China of Mar. 14, 2004, art. 24. 29. Id. art. 1 (2004). Guided by “the philosophy of Marxism-Leninism, Mao Zedong Thought, Deng Xiaoping Theory and the important thought of the ‘Three Represents’ ” Id. pmbl. ¶ 7. Mao Zedong Thought consists of the sayings and writings of Mao that adapted Marxism-Leninism according to Chinese circumstances that served as a major national ideology until his death in 1976; Deng Xiaoping Theory encapsulates the reforms and policies Deng initiated that focused on economic development rather than political ideology. Library of Congress, Country Studies: China, supra note 2, glossary. 30. Xianfa [Constitution], art. 3 (2004); Democratic centralism is “a system where the people influence the policies of the government and party members influence the policies of the party while the government and party maintains centralized administrative power. Within representative and executive organizations, the minority abides by the decisions of the majority, and lower bodies obey the orders of the higher level organizations.” Library of Congress, Country Studies: China, supra note 2, glossary. 31. Xianfa [Constitution], art. 2 (2004). 32. Central Intelligence Agency (CIA), supra note 1. 33. China Internet Information Network, China’s Political System, ch. VII, http://www.china.org.cn/english/Political/25060.htm (last visited Mar. 08, 2005); Xianfa [Constitution], arts. 62(4), 79 (2004). 34. Xianfa [Constitution], art. 79 (2004). 35. Id. arts. 80–81. 36. Id. art. 85. 37. Id. art. 88; Ministry of Justice, Government of the P.R.C., The Central Administrative System, ch. I, § 2(1)(2) (2004), http://www.legalinfo.gov.cn/english/ StateOrgans/stateorgans2_1.htm (last visited June 9, 2005). 38. The president nominates the premier, who in turn nominates other State Council members, who are appointed once approved by the National People’s Congress or its Standing Committee. Xianfa [Constitution], art. 86 (2004). 39. Id. art. 87. 40. State Council Institutional Restructuring Plan (2003) (adopted by the Tenth NPC); China’s Government Restructuring Plan Adopted, People’s Daily (China), Mar. 10, 2003; Circular of the State Council Concerning Organizational Structure (1998) (referring to the Restructuring Plan for Component Departments under the State Council adopted by the Ninth NPC). 41. State Council Institutional Restructuring Plan, supra note 40. 42. Id.; China’s Government Restructuring Plan Adopted, supra note 40; Circular of the State Council Concerning Organizational Structure, supra note 40. 43. Xianfa [Constitution], art. 92 (2004). The State Council submits regular reports on its work to the NPC or its Standing Committee. Id. 44. Id. art. 89(1). So long as it is in accordance with the Constitution and the law. Id. 45. Id. arts. 89(3)–(5). 46. Id. arts. 89(1), (6)–(8), (10). 47. Id. art. 89(2); Organic Law of the National People’s Congress of the P.R.C., art. 9 (1982). 48. U.S. Department of State, supra note 2. “[P]ut into practice the guiding principles of the 16th National Congress of the CPC under the leadership of the CPC … in accordance with the [Communist] Party Central Committee’s instructions …” Wen Jiabao, Report on the Work of the Government 2004, Address at the Second Session of the Tenth National People's Congress (Mar. 5, 2004) (Mr. Wen is the State Council premiere) (transcript available at http://www.china.org.cn/english/government/90522. htm). 49. Xianfa [Constitution], art. 5 (2004). 50. Library of Congress, Country Studies: China, supra note 2, ch. 10, The State Council. 51. Id. ch. 10, The Cadre System. 52. Administrative License Law of the P.R.C., Presidential Order No. 7 (2003) (effective July 1, 2004). 53. Xianfa [Constitution], arts. 57–58 (2004); Legislation law of the P.R.C., Presidential Order No. 31, art. 7 (2000). 54. Xianfa [Constitution], arts. 3, 59–60 (2004); Electoral Law of the National People’s Congress and Local People’s Congress of the P.R.C., arts. 15–16, 24 (2004). The zoning of electoral districts is determined by voters’ residence or by their employment units. One to three (based on population) deputies are elected from each electoral district to the local people’s congress, who then elect a number (set by the NPC Standing Committee) of deputies to the NPC. Id. art. 24. 55. The definition for an “appropriate” number of female delegates is non-specific, stating only that it should be “proportional.” Electoral Law of the National People’s Congress and Local People’s Congress of the P.R.C., art. 6 (2004). 56. Xianfa [Constitution], art. 70 (2004). 57. Ministry of Justice, Government of the P.R.C.,The System of People’s Congress, ch. III, § 3 (2004), http://www.legalinfo.gov.cn/english/StateOrgans/ stateorgans1.htm (last visited June 10, 2005). 58. Xianfa [Constitution], art. 61 (2004). NPC sessions may also be convened upon

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the request of at least one-fifth of the NPC. Id. 59. Id. arts. 62(1)–(3); Legislation law of the P.R.C., Presidential Order No. 31, art. 7 (2000). NPC is the only body empowered to enact national law on certain issues, such as matters of state sovereignty; structure and authority of legal and government organs; crimes and criminal sanctions; and deprivation of political rights or personal freedom. Id. arts 8–9. 60. Xianfa [Constitution], arts. 62(4)–(8), 63 (2004). 61. Id. arts. 62(10)–(11), (14). 62. Id. art. 57; Rules of Procedure for the Standing Committee of the NPC of the P.R.C., Presidential Order No. 60, art. 3 (1987). 63. Xianfa [Constitution], arts. 62(5), 65 (2004). Members of the Standing Committee serve for five year terms, except for the chairperson and vice chairpersons who may serve no more than two consecutive two year terms. Id. art. 66. The present NPC Standing Committee is composed of a chairperson, 15 vice chairpersons, a secretary-general and 162 members. See China Internet Information Network, Who’s Who in the Leadership: Leaders of the NPC, http://www.china.org.cn/english/ features/leadership/87697.htm (last visited June 10, 2005). 64. Xianfa [Constitution], art. 68 (2004). 65. Id. arts. 67(1)–(2), (4). Interpretation of national laws may involve clarifying the specific meaning of a provision or its application upon a new situation arising after the law’s enactment. Legislation Law of the P.R.C., Presidential Order No. 31, art. 42 (2000). 66. Xianfa [Constitution], arts. 67(6), (8) (2004). 67. Id. arts. 67(4), (11)–(12); Legislation law of the P.R.C., Presidential Order No. 31, art. 42 (2004) (positions include vice-presidents and judges of the SPC, deputy procuratorsgeneral and procurators of the SPP). 68. Xianfa [Constitution], arts. 67(3), (5), (9)–(10), (18), (20) (2004). 69. Id. art. 30(1); The establishment of provinces, municipalities and autonomous regions is decided by the NPC. Id. art. 62(12). 70. See Central Intelligence Agency (CIA), supra note 1; U.S. Department of State, supra note 2. Municipalities are heavily populated urban centers such as Beijing and Shanghai. 71. Xianfa [Constitution], art. 30 (2004). Establishment and geographical divisions of towns and townships are decided by the people’s governments of provinces and municipalities. Id. art. 107. 72. Id. arts. 30, 95. 73. Id. art. 3. 74. Id. art. 110; Organic Law of the Local People’s Congresses and Local Governments of the P.R.C., Presidential Order No. 37, arts. 54–55 (2004). 75. Xianfa [Constitution], arts. 98, 105 (2004); Organic Law of the Local People’s Congresses and Local Governments of the P.R.C., Presidential Order No. 37, arts. 8(5), 9(7), 58 (2004). 76. Organic Law of the Local People’s Congresses and Local Governments of the P.R.C., Presidential Order No. 37, art. 59(1) (1995) (including the people’s congress at the corresponding division and the people’s government or state administrative organ at the higher level). Id. 77. Xianfa [Constitution], art. 107 (2004); Organic Law for Local People’s Congresses and Local Governments of the P.R.C., Presidential Order No. 37, arts. 59(1), (4), (6)–(9) (2004). 78. Xianfa [Constitution], art. 111 (2004); Organic Law of Urban Resident Committees, Presidential Order No. 21, art. 8 (1989) (effective Jan. 1, 1990); Organic Law of the Villagers Committees of the P.R.C. (For Trial Implementation), Presidential Order No. 59, art. 2 (1988). 79. Xianfa [Constitution], art. 111 (2004); Organic Law of Urban Resident Committees, Presidential Order No. 21, art. 8 (1989) (effective Jan. 1, 1990); Organic Law of the Villagers Committees of the P.R.C. (For Trial Implementation), Presidential Order No. 59, art. 9 (1988). 80. Xianfa [Constitution], art. 111 (2004); Organic Law of Urban Resident Committees, Presidential Order No. 21, arts. 3(1)–(6), 13 (1989) (effective Jan. 1, 1990); Organic Law of the Villagers Committees of the P.R.C. (For Trial Implementation), Presidential Order No. 59, arts. 4–5 (1988). 81. Library of Congress, Country Studies: China, supra note 2, ch. 10, The Cadre System. 82. Civil Servant Law of the P.R.C. (2005) (effective Jan. 1, 2006); Library of Congress, Country Studies: China, supra note 2, ch. 10, The Cadre System (guidelines may also be issued by bureaus of personnel in various ministries, commissions and offices under the State Council and personnel departments in various local government organs). 83. People’s congresses in provinces, municipalities and autonomous regions must also have Standing Committees. Xianfa [Constitution], art. 95 (2004); Organic Law of the Local People’s Congresses and Local Governments of the P.R.C., Presidential Order No. 37, arts. 1–2 (2004). 84. Xianfa [Constitution], art. 97 (2004) (e.g. provincial people’s congresses are elected by prefectural, county, district or city’s people’s congresses, county people’s congresses are elected by people’s congresses of towns and townships); Organic Law of the Local People’s Congresses and Local Governments of the P.R.C., Presidential Order No. 37, art. 5 (2004). 85. Law of the P.R.C. on Regional National Autonomy, Presidential Order No. 13, arts. 2, 12, 14 (1984). 86. Id. arts. 112–113. Other nationalities inhabiting the area are also entitled to appropriate representation in local government. Id. 87. Id. art. 115.

88. Id. art. 6; Xianfa [Constitution], art. 115 (2004); Legislation law of the P.R.C., Presidential Order No. 31, art. 66 (2004). See Information Office of the State Council, Regional Autonomy for Ethnic Minorities in China (2005), http:// www.china.org.cn/e-white/20050301/index.htm (last visited Mar. 9, 2005). 89. Law of the P.R.C. on Regional National Autonomy, Presidential Order No. 13, arts. 6, 19 (1984) (subject to the approval of the Standing Committee of the NPC). 90. Xianfa [Constitution], arts. 31, 62(13) (2004). 91. Decision of the National People’s Congress on the Establishment of the Hong Kong Special Administrative Region, Presidential Order No. 26 (1990), http://www.info.gov. hk/basic_law/fulltext/content0214.htm; Decision of the National People’s Congress on the Establishment of the Macao Special Administrative Region of the P.R.C., arts. 1–2 (1993), http://www.macaudata.com/Macau/jus/jus/e15.html. 92. Ministry of Justice, Government of the P.R.C., Basic System of the State ¶ 7 (2004), http://www.legalinfo.gov.cn/english/LegalKnowledge/LegalKnowledge1.htm (last visited June 27, 2005). 93. Decision of the National People’s Congress on the Basic Law of the Hong Kong Special Administrative Region, Presidential Order No. 26 (1990), http://www.info.gov. hk/basic_law/fulltext/content0213.htm; Decision of the National People’s Congress on the Basic Law of the Macao Special Administrative Region (1993). The Basic Law is the equivalent of a constitution. 94. Decision of the National People’s Congress on the Basic Law of the Hong Kong Special Administrative Region, Presidential Order No. 26 (1990), http://www.info.gov. hk/basic_law/fulltext/content0213.htm; Decision of the National People’s Congress on the Basic Law of the Macao Special Administrative Region (1993). 95. State Council, Government of the P.R.C., Circular Concerning the Authorization of the People’s Governments of the Provinces, Autonomous Regions, Municipalities Directly under the Central Government, Special Economic Zones, and Municipalities Separately Listed on the State Plan to Examine and Approve Applications for the Establishment of Enterprises With Foreign Capital (1988), http://www.bjfao.gov.cn/newsite/english/law/003C/078.asp (translation by the Beijing Foreign Affairs Office). 96. Id. (Zones located in Shenzhen, Zhuhai, Shantou in Guangdong province, Xiamen in Fujian province, and Hainan province); State Council, Government of the P.R.C., Circular Concerning the Approval of the National Development Zones for New and High Technology Industries and the Relevant Policies and Provisions (1991), http://www.bjfao.gov.cn/newsite/english/law/003C/077.asp; State Council, Government of the P.R.C., Circular Concerning the Expansion of the Scope of the Coastal Economic Open Zones (1988), http://www.bjfao.gov.cn/newsite/ english/law/003C/081.asp (translation by P.R.C. government’s Beijing Foreign Affairs Office); Ministry of Commerce, Economic and Technological Development Area, http://english.mofcom.gov.cn/staticpage/bda.shtml (last visited Mar. 9, 2005). See also China Association of Development Zones, National Development Zone Profiles, http://www.cadz.org.cn/en/ (last visited Mar. 14, 2005). 97. See Brian A. Wong & Satyananda J. Gabriel, The Influence of Economic Liberalization on Urban Health Care Access in the People’s Republic of China (1998), http://www.mtholyoke. edu/courses/sgabriel/health.htm (last visited Aug. 31, 2005) (facilitated by economic growth and increased availability of private health-care facilities). 98. Xianfa [Constitution], arts. 123–135 (2004); Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 2 (1983). See also Central Intelligence Agency (CIA), supra note 1; Library of Congress, Country Studies: China, supra note 2, ch. 13, Court Structure and Process. Special people’s courts include military courts at various levels (grassroots, great military region or service and arms, and the PLA), maritime courts and railway transportation courts. Xianfa [Constitution], art. 124 (2004). 99. Xianfa [Constitution], art. 127 (2004) (“…without interference by government agencies, public organizations or individuals”); Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 4 (1983) (“…shall not be subject to interference by any administrative organ, public organization or individual”). 100. Xianfa [Constitution], art. 128 (2004); Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 17 (1983). 101. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 3 (1983). 102. Xianfa [Constitution], art. 127 (2004); Ministry of Justice, Government of the P.R.C.,The Trial System, ch. 3 (2004), http://www.legalinfo.gov.cn/english/ StateOrgans/stateorgans4.htm (last visited Mar. 11, 2005) [hereinafter Ministry of Justice,The Trial System]. 103. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 31 (1983). All people’s courts (higher, intermediate and basic) share the same divisional structure. Id. arts. 19, 24, 27. 104. The NPC also has the authority to remove the SPC president. SPC Presidents are elected for five year terms and limited to a maximum of two consecutive terms. Xianfa [Constitution], arts. 62(7), 63(4), 124 (2004). Judges must fulfill the following criteria: be citizens of the P.R.C.; be at least 23 years of age; support the Constitution; be in good political, professional and moral standing, and in good health; possess a JD or postbachelor degree and practical experience. Judges Law of the P.R.C., arts. 9(1)–(6) (1995). 105. Other members include the vice-presidents, chief justices, associate chief justices of divisions, and judges. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, arts. 31, 35 (1983); Xianfa [Constitution], art. 67(11) (2004). 106. Xianfa [Constitution], art. 127 (2004); Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, arts. 14, 30, 32(2) (1983).

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107. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 32(1) (1983); Criminal Procedure Law of the P.R.C., art. 22 (1996) (amended 2005). 108. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 32(1) (1983); Civil Procedure Law of the P.R.C., Presidential Order No. 44, art. 21 (1991). 109. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 32(1) (1983); Administrative Procedure Law of the P.R.C., Presidential Order No. 16, art. 16 (1989) (effective as of Oct. 1, 1990). 110. Ministry of Justice, The Trial System, supra note 102, ch. 3. 111. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 33 (1983). 112. Id. arts. 2, 26. 113. Id. art. 2. 114. Id. arts. 2, 18, 26. Basic people’s courts are also known as Primary People’s Courts or Grassroots People’s Courts. See Criminal Procedure Law of the P.R.C., art. 19 (1996) (amended 2005); Ministry of Justice,The Trial System, supra note 102, ch. 2. 115. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, arts. 35–37 (1983) (the standing committee of the corresponding people’s congress, upon nominations by the president of the court appoints the court’s vice-presidents, members of the judicial committee, chief judges, associate chief judges and judges); Ministry of Justice,The Trial System, supra note 102, ch. 3, § 2 (primary judges and associate judges selected through open exams). 116. Civil Procedure Law of the P.R.C., Presidential Order No. 44, arts. 18, 19(2), 20 (1991). Territorial jurisdiction is determined by the habitual residence of the defendant (respondent), the plaintiff, or the location where the crime took place. Id. arts. 22–35. 117. Administrative Procedure Law of the P.R.C., Presidential Order No. 16, arts. 14(3), 15 (1989) (effective Oct. 1, 1990). 118. Criminal Procedure Law of the P.R.C., arts. 20, 22 (1996) (amended 2005). 119. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, arts. 25(3), 28(4) (1983). 120. Criminal Procedure Law of the P.R.C., art. 19 (1996) (amended 2005); Civil Procedure Law of the P.R.C., Presidential Order No. 44, art. 18 (1991); Administrative Procedure Law of the P.R.C., Presidential Order No. 16, art. 13 (1989) (effective Oct. 1, 1990). 121. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, arts. 20, 22(2) (1983). People’s tribunals are considered a component of basic people’s courts and its judgments and orders have the same authority as those issued by basic people’s courts. Id. 122. Id. art. 11. 123. Id. art. 14. Presidents of people’s courts who find legal errors in judgments of their court must submit the case to the judicial committee for disposal. If the SPP or a people’s procuratorate finds legal errors in the decision of a subordinate court, it may lodge a protest with the judicial committee. Id. 124. Id. art. 11 (members are first nominated by the president of the relevant court). 125. Regulation on Legal Aid, State Council Order of July 16, 2003, arts. 3, 7, 8 (2003). 126. Id. arts. 10–11. 127. Xianfa [Constitution], art. 125 (2004); Third periodic reports of States parties due in 1997: China, Committee Against Torture, para. 10(d), U.N. Doc. CAT/ C/39/Add.2. (2002), http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/CAT.C.39. Add.2.En?Opendocument (referring to “Provisions for Strict Implementation of the Open Trial System” enacted by the SPC on Mar. 8, 1999) [hereinafter Committee Against Torture, Third periodic reports of States parties: China]. 128. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 7 (1983). 129. Civil Procedure Law of the P.R.C., Presidential Order No. 44, art. 66 (1991). 130. Xianfa [Constitution], art. 111 (2004) (“The residents’ and villagers’ committees establish committees for people’s mediation… [to] mediate civil disputes…”). 131. Mediation practices are outlined in the Law of Succession, Marriage Law, and Labor Law. See Law of Succession of the P.R.C., Presidential Order No. 24, art. 15 (1985); Marriage Law of the P.R.C., art. 25 (2001); Labour Law of the P.R.C., Presidential Order No. 28, arts. 77, 79, 80 (1994) (effective Jan. 1, 1995). 132. Renmin Tiaojie Weiyuanhui Zuzhi Tiaoli [Regulations on the Organization of People’s Mediation Committees], State Council Order of May 5, 1989, art. 6 (1989). See also Ministry of Justice, Government of the P.R.C., Survey on System of People’s Mediation, ch. V, § III ¶ 4 (2004), http://www.legalinfo.gov.cn/english/LegalService/ legalservice3.htm (last visited Mar. 11, 2005) [hereinafter Ministry of Justice, Survey on System of People’s Mediation]. 133. Organic Law of Urban Resident Committees, Presidential Order No. 21, art. 13 (1989) (effective Jan. 1, 1990); Ministry of Justice, Survey on System of People’s Mediation, supra note 132, ch. V, § IV ¶ 2. 134. National Bureau of Statistics of China, Government of the P.R.C., China Statistical Yearbook 2003, ch. 22-9, at 831 (2003) [hereinafter China Statistical Yearbook 2003]. 135. Arbitration Law of the P.R.C., Presidential Order No. 31, art. 1 (1994). 136. Id. art. 2. 137. Id. art. 3. 138. Chen Guangyao, China’s Nongovernmental Organizations: Status, Government Policies, and Prospects for Further Development, Address at the World Congress of Association Executives (Aug. 12, 2002), in 3 Int’l J. Not-for-Profit L., Mar. 2001, http://www.icnl.org/journal/vol3iss3/ar_guangyao.htm.

WOMEN OF THE WORLD:

139. Minban Feiqiye Danwei Dengji Zhanxing Tiaoli [Provisional Regulations for the Registration and Management of Non-Governmental and Non-Commercial Enterprises], State Council Order No. 251, art. 2 (1998); Shiye Danwei Dengji Guanli Zhanxing Tiaoli [Regulations on Registration and Management of Non-Commercial Institutions], State Council Order No. 252, art. 2 (1998); Jijin Guanli Tiaoli [Regulations for the Management of Foundations], State Council Order No. 400, art. 2 (2004). 140. Shehui Tuanti Dengji Guanli Tiaoli [Regulations on Registration and Management of Social Organizations], State Council Order No. 250, art. 3 (1998); Minban Feiqiye Danwei Dengji Zhanxing Tiaoli [Provisional Regulations for the Registration and Management of Non-Governmental and Non-Commercial Enterprises], State Council Order No. 251, arts. 5–7 (1998); Shiye Danwei Dengji Guanli Zhanxing Tiaoli [Regulations on Registration and Management of Non-Commercial Institutions], State Council Order No. 252, art. 3 (1998). Some NGOs have worked around these laws by registering with the Bureau of Industry and Commerce as enterprises. To Serve the People, Roundtable before the Congressional-Executive Commission on China, 108th Cong. Sess. 1 40 (Mar. 24, 2003) (prepared statement of Nancy Yuan, Vice President, The Asia Foundation). 141. Shehui Tuanti Dengji Guanli Tiaoli [Regulations on Registration and Management of Social Organizations], State Council Order No. 250, art. 5 (1998); Minban Feiqiye Danwei Dengji Zhanxing Tiaoli [Provisional Regulations for the Registration and Management of Non-Governmental and Non-Commercial Enterprises], State Council Order No. 251, art. 4 (1998); Jijin Guanli Tiaoli [Regulations for the Management of Foundations], State Council Order No. 400, art. 4 (2004). 142. To Serve the People, supra note 140, 33 n.15, 33–35 (prepared statement of Qiusha Ma, assistant professor of East Asian Studies, Oberlin College) (referring to link between Chinese government and NGOs). 143. Priscilla Jiao, New China Gets Charitable, Sina (China), Mar. 9, 2005. 144. Ministry of Civil Affairs, Government of the P.R.C., Minzhengbu Guanyu Dui Bufen Tuanti Mianyu Shetuan Dengji Youguan Wenti de Tongzhi [Concerning the Question of Social Organizations Exempted from Registration], No. 256, art. 1 (2000), http://www.chinanpo.gov.cn/web/showBulltetin.do?Id=16069&d ictionId=1202 (last visited Mar. 18, 2005); See To Serve the People, supra note 140, 33–35 (prepared statement of Qiusha Ma, assistant professor of East Asian Studies, Oberlin College). 145. To Serve the People, supra note 140, 33 n.15 (prepared statement of Qiusha Ma, assistant professor of East Asian Studies, Oberlin College). 146. All-China Youth Federation (ACYF), China Youth Policy and Youth Work, ¶ 6, http://www.acyf.org.cn/e_doc/policy/02.htm (last visited March 17, 2005). 147. All-China Women’s Federation (ACWF), Brochure (2003), http://www. women.org.cn/english/english/newsletter/ACWF%20brochure.htm (last visited Mar. 18, 2005). 148. Id. 149. Chen Li Ping, Funufa Xiuzhengan Songshengao Yi Baisong Guowuyuan, Mingque Guiding Jinzhi Xingsaorao [Amended Draft of Women’s Law Submitted to State Council, Clear Prohibitions Against Sexual Harassment], China Legal Publicity, Feb. 3, 2005, http:// www.legalinfo.gov.cn/lfqy/2005-02/04/content_186184.htm (source is the official news service of the Ministry of Justice P.R.C.) (translation by Center for Reproductive Rights). 150. Third and fourth periodic reports of State parties under Article 18 of the Convention on the Elimination of All Forms of Discrimination Against Women: China, Committee on the Elimination of Discrimination Against Women, pt. I, ¶ 12, U.N. Doc. CEDAW/C/ CHN/3-4 (1997), http://www.un.org/womenwatch/daw/cedaw/cedaw20/china.htm [hereinafter CEDAW Committee, Third and fourth periodic reports of State parties: China]. 151. Id. pt. I, para. 12. 152. The sponsor is responsible for investigating, monitoring and supervising the work of its NGOs. Shehui Tuanti Dengji Guanli Tiaoli [Regulations on Registration and Management of Social Organizations], State Council Order No. 250, arts. 6, 9 (1998); Minban Feiqiye Danwei Dengji Zhanxing Tiaoli [Provisional Regulations for the Registration and Management of Non-Governmental and Non-Commercial Enterprises], State Council Order No. 251, arts. 3, 8(I), 9(II) (1998). 153. To Serve the People, supra note 140, 30 (prepared statement of Qiusha Ma, assistant professor of East Asian Studies, Oberlin College) (referring to data from National Bureau of Statistics of the P.R.C., Civil Affairs Statistical Yearbook 2001). 154. Xianfa [Constitution], pmbl. ¶ 12 (2004). 155. Id. art. 5 (amended by the Ninth NPC on March 15, 1999). 156. Id. arts. 4, 33. 157. Id. arts. 35–36, 49. 158. Id. arts. 37–38 (arrest requires a court decision or prosecutor’s approval). 159. Id. art. 42. 160. Id. art. 33 (amended by the Tenth NPC on March 14, 2004). 161. Id. arts. 8, 11, 14, 15, 45. 162. Id. arts. 19, 36, 41–42 (rights to education, religious freedom, against libel and for employment). 163. Id. art. 48. 164. Id. arts. 48–49. 165. Id. art. 4. 166. Id. arts. 40, 51; Criminal Law of the P.R.C., arts. 30(2), (5), 54–58, amended by Presidential Order, No. 32 (2005) (some penalties involve deprivation of political rights, right of freedom of speech, of the press, of assembly etc.). 167. Law of the P.R.C. on the Organization of People’s Courts, Presidential Order No. 5, art. 33 (1983); Zhonghua Renmin Gongheguo Zuigao Renmin Jianchayuan [P.R.C.

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Supreme People’s Procuratorate], Zuigao Renmin Jianchayuan Zhuyao Zhiye [Main Functions], art. 12 (May 16, 2005), http://www.spp.gov.cn/site2005/scripts/pageRead. asp?d_id=200105161438415660. 168. Novexcn.com, Cases and Court Decisions in the P.R.C. (2000), http://www. novexcn.com/cases_court_decisions_main.html (last visited Mar. 19, 2005). 169. Xianfa [Constitution], arts. 81, 67(14) (2004). 170. Convention on the Elimination of All Forms of Discrimination against Women, adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981) (ratified by China Dec. 3, 1981); Convention on the Rights of the Child, adopted Nov. 20, 1989, G.A. Res. 44/25, annex, U.N. GAOR, 44th Sess., Supp. No. 49, at 166, U.N. Doc. A/44/49 (1989), reprinted in 28 I.L.M. 1448 (entered into force Sept. 2, 1990) (ratified by China Apr. 1, 1992); International Covenant on Economic, Social and Cultural Rights, G.A. Res. 2200A (XXI), U.N. GAOR, Supp. No. 16, at 49, U.N. Doc. A/6316 (1966), 999 U.N.T.S 3 (entered into force Jan. 3, 1976) (ratified by China June 27, 2001); Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted Dec. 10, 1984, G.A. Res. 39/46, U.N. GAOR, 39th Sess., Supp. No. 51, at 197, U.N. Doc. A/39/51 (1984), 1465 U.N.T.S. 85 (entered into force June 26, 1987) (ratified with reservations and declarations by China Nov. 3, 1988); International Convention on the Elimination of All Forms of Racial Discrimination, 660 U.N.T.S. 195 (entered into force Jan. 4, 1969) (accession with reservation and declaration by China Jan. 28, 1982); Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography, adopted May 25, 2000, G.A. Res. 54/263, U.N. GAOR, 54th Sess., U.N. Doc. A/RES/54/263 (2000) (entered into force Jan. 18, 2002) (ratified by China Jan. 3, 2003). 171. Committee Against Torture, Third periodic reports of States parties: China, supra note 127; Initial reports submitted by State parties under articles 16 and 17 of the Covenant: China, Committee on Economic, Social and Cultural Rights, U.N. Doc. E/1990/5/ Add.59 (2004), http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/E.1990.5.Add.59. En?Opendocument [hereinafter Committee on Economic, Social and Cultural Rights, Initial report of State parties: China]; CEDAW Committee, Third and fourth periodic reports of State parties: China, supra note 150. 172. International Covenant on Civil and Political Rights, G.A. Res. 2200A (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171 (entered into force Mar. 23, 1976) (signed with declaration by China Oct. 5, 1998, not ratified by China as of June 8, 2005); Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict, adopted May 25, 2000, G.A. Res. 54/263, U.N. GAOR, 54th Sess., U.N. Doc. A/RES/54/263 (entered into force Feb. 12, 2002) (signed by China Mar. 15, 2001, not ratifie d by China as of June 8, 2005). 173. Beijing Declaration and the Platform for Action, Fourth World Conference on Women, Beijing, China, Sept. 4-15, 1995, U.N. Doc. A/CONF.177/20 (1995); Programme of Action of the International Conference on Population and Development, Cairo, Egypt, Sept. 5-13, 1994, U.N. Doc. A/CONF.171/13/Rev.1 (1995); Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development, U.N. GAOR, 21st Special Sess., New York, United States, June 30-July 2, 1999, U.N. Doc. A/S-21/5/Add.1 (1999); Further Actions and Initiatives to Implement the Beijing Declaration and the Platform for Action, U.N. GAOR, 23rd Special Sess., New York, United States, June 5-9, 2000, U.N. Doc. A/Res/S-23 (2000). 174. Millennium Declaration, Millennium Assembly, New York, United States, Sept. 6-8, 2000, U.N. GAOR, 55th Sess., U.N. Doc. A/Res/55/2 (2000); United nations Country Team in China, Millennium Development Goals: China’s Progress (2004) [hereinafter Millennium Development Goals: China’s Progress]. 175. Xianfa [Constitution], art. 21 (2004). 176. General Principles of the Civil Law of the P.R.C., Presidential Order No. 37, art. 98 (1986) (effective Jan. 1, 1987) [hereinafter Civil Law of the P.R.C.]. 177. Communist Party of China Central Committee & State Council of the P.R.C., Decision Concerning Public Health Reform and Development (1997), http://www.bjfao.gov.cn/newsite/english/law/004D/003.asp. 178. Law on the Prevention and Treatment of Infectious Diseases (1989), amended by Presidential Order No. 17 (2004) (translation by Center for Reproductive Rights). 179. Ministry of Health, Government of the P.R.C., 2005 Nian Weisheng Gongzuo Yaodian [Year 2005 Health Work Essential Points], arts. 1–4, 6–11 (2005), http://www.moh.gov.cn/public/open.aspx?n_id=9376 (referring to “Guanyu Shenhua Chengshi Yiliao Fuwu Tizhi Gaige Shidian De Jiaodao Yijian” [Directives Concerning Deepening Urban Health-Care Reform]) (translation by the Center for Reproductive Rights) [hereinafter Ministry of Health, Year 2005 Health Work Essential Points]. 180. Ministry of Health, Government of the P.R.C., Zhongguo Nongcun Chuji Weisheng Baojian Fazhan Wangyao (2001-2010 Nian) [National Plan for the Development of Rural Primary Health-Care (2001-2010)] (2002), http://www.moh.gov.cn/public/open.aspx?n_id=8067 (translation by the Center for Reproductive Rights) [hereinafter National Plan for the Development of Rural Primary Health-Care (2001-2010)]; Ministry of Health, Government of the P.R.C., Zhongguo Tigao Chusheng Renkou Shzhi, Jianshao Chusheng Quexian He Canji Xingdong Jihua (2002-2010) [National Action Plan for Raising Quality of Birth Population and Reducing Birth Defects (2002-2010)] (2002), http://www.moh.gov.cn/public/open.aspx?n_id=2731 (translation by the Center for Reproductive Rights) [hereinafter National Action Plan for Raising Quality of Birth Population and Reducing Birth Defects (2002-2010)]; Ministry of Health, Government of the P.R.C., Quanguo Jiankang Jianyu Yu Jiankang Cujin Gongzuo Guihua Wangyao (2005-2010 Nian) [National Plan for Health Education and Promotion (2005-2010)] (2005), http://www.moh.gov.cn/public/

open.aspx?n_id=9283 (translation by the Center for Reproductive Rights) [hereinafter National Plan for Health Education and Promotion (2005-2010)]. 181. National People’s Congress (NPC), Government of the P.R.C., Zhongguo Funu Fazhan Wangyao (2001-2010 Nian) [National Plan for the Development of Chinese Women (2001-2010)] (2000), http://www.moh.gov.cn/public/open. aspx?n_id=2720 (translation by the Center for Reproductive Rights) [hereinafter National Plan for the Development of Chinese Women (2001-2010)]; National People’s Congress (NPC), Government of the P.R.C., Zhongguo Ertong Fazhan Wangyao (2001-2010 Nian) [National Plan for the Development of Chinese Children (2001-2010)] (2001), http://www.moh.gov.cn/public/open.aspx?n_id=2734 (translation by the Center for Reproductive Rights) [hereinafter National Plan for the Development of Chinese Children (2001-2010)]. 182. National Plan for Health Education and Promotion (2005-2010), supra note 180, arts. 3(3), (6). 183. Xianfa [Constitution], art. 21 (2004). 184. The Western Region is composed of the following: Chongqing Municipality, Guizhou Province, Sichuan Province, Yunnan Province, the Tibet Autonomous Region, Shaanxi Province, Gansu Province, the Ningxia Hui Autonomous Region, Qinghai Province, the Xinjiang Uygur Autonomous Region, the Inner Mongolia Autonomous Region, the Guangxi Zhuang Autonomous Region, Xianxi Tujia-Miao Autonomous Prefecture of Hunan Province, the Enshi Tujia-Miao Autonomous Prefecture of Hubei Province, and the Yanbian Korean Autonomous Prefecture of Jilin Province. State Council, Government of the P.R.C., Suggestions on the Implementation of Policies and Measures Pertaining to the Development of the Western Region, arts. 1, 7 (2001), http://www.chinawest.gov.cn/english/asp/showinfo. asp?name=200204180012 [hereinafter State Council, Policies for the Development of the Western Region]. 185. Office of the Leading Group for Western Region Development of the State Council, Government of the P.R.C., Overall Plan of Western Region Development During the Tenth Five-Year Plan Period, art. 1(1)(7) (2002), http:// www.chinawest.gov.cn/English/asp/showinfo.asp?name=200207100002; State Council, Policies for the Development of the Western Region, supra note 184, art. 52. 186. Health System Faces up to Great Challenges, Xinhua News Agency (China), Jan. 10, 2005, http://news.xinhuanet.com/English/2005-01/10/content_2441341.htm. 187. China Statistical Yearbook 2003, supra note 134, ch. 2-1, at 23–24. 188. Figures extrapolated from total population, number of medical and technical personnel in Health Institutions (427 per 10,000 persons), number of doctors (184.4 per 10,000 persons) and number of nurses (124.7 per 10,000 persons). China Statistical Yearbook 2003, supra note 134, ch. 21-34, at 805. 189. Ministry of Health,Year 2005 Health Work Essential Points, supra note 179, art. 3. 190. Id. arts. 1, 9. 191. Yiliao Jigou Guanli Tiaoli [Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35 (1994); Yiliao Jigou Guanli Tiaoli Shishi Xizi [Rules for Implementation of the Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35 (1994) (translation by the Center for Reproductive Rights). 192. Yiliao Jigou Guanli Tiaoli Shishi Xizi [Rules for Implementation of the Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35, art. 3(1)–(12) (1994) (translation by the Center for Reproductive Rights). 193. Yiliao Jigou Guanli Tiaoli [Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35, arts. 8–9, 15, 22 (1994) (annual reassessments or if the facility has over 100 beds, reassessments every three years) (translation by the Center for Reproductive Rights). 194. Ministry of Health, Government of the P.R.C., Guanyu Yunxu Geti Kaiye Xingye Wenti De Qingshi Baogou [Report Concerning Permission for Private Medical Practices], secs. 1–3 (1980), http://www.law-lib.com/law/law_view. asp?id=44304 (reinstating permission for private medical practices originally granted under 1963’s Yisheng Zhanxing Guanli Banfa [Provisional Measures for Management of Doctors]) (translation by Center for Reproductive Rights). 195. Regional Office for the Western Pacific, World Health Organization (WHO), Country Health Info Profile 2004: China 54 (2004). 196. China Statistical Yearbook 2003, supra note 134, ch. 8-1, at 281, ch. 21-46, at 812 (figures extrapolated by dividing total government expenditure (CNY 793.7 billion) and total government public health expenditure (461 million); United Nations Development Programme (UNDP) China,Thematic Areas: Health, http://www. unchina.org/theme/html/health.shtml (last updated Dec., 2001). 197. China Statistical Yearbook 2003, supra note 134, ch. 8-1, at 281, ch. 21-46, at 812 (figures extrapolated by dividing total government expenditure (CNY 1.89 trillion) and total government public health expenditure); Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, Representative Exchange Rates for Selected Currencies (June 15, 2005), http:// www.imf.org/external/np/fin/rates/rms_rep.cfm. 198. UNDP China,Thematic Areas: Health, supra note 196. 199. China Medical Association, Health Care System in China, http://www. chinamed.com.cn/chinamedorg/healthcare.htm (last visited Mar. 24, 2005). 200. Id. 201. Information Office of the State Council, Government of the P.R.C., China’s Social Security and Its Policy, ch. 3 (2004), http://www.china.org.cn/e-

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white/20040907/index.htm (referring to the State Council’s “Decision on Establishing a Basic Medical Insurance System for Urban Employees” promulgated on December 14, 1998) [hereinafter State Council, China’s Social Security and Its Policy]. 202. Id. 203. Id. 204. China Medical Association, supra note 199. 205. State Council, China’s Social Security and Its Policy, supra note 201, ch. 3. 206. Id. 207. Id. 208. Id. 209. Id. 210. Id. 211. Office of the World Health Organization Representative in China,World Health Organization (WHO), Country Cooperation Strategy:WHO China: Strategic Priorities for 2004-2008, at 16 (2004). 212. Exec. Bd. of the United Nations Development Programme (UNDP) & of the UN Population Fund (UNFPA), Country Programme Outline for China, para. 7, U.N. Doc. DP/FPA/CPO/CHN/5 (2002), http://www.unfpa.org/exbrd/2002/ secondsession/dpfpacpochn5.pdf [hereinafter Country Programme Outline for China]. 213. Id. para. 2. 214. Id. para. 7. 215. Id. para. 8. 216. Id. para. 11. 217. China Statistical Yearbook 2003, supra note 134, ch. 21-46, at 812; Calculations based on exchange rate of U.S. Dollar (USD) 1 to Chinese Yuan (CNY) (renmenbi) 8.2765. See International Monetary Fund, supra note 197. 218. China Statistical Yearbook 2003, supra note 134, ch. 10-4, at 345, ch. 10-7, at 348 (figures for 2002). 219. Id. ch.10-23, at 370, ch. 10-25, at 372 (figures for 2002); Calculations based on exchange rate of U.S. Dollar (USD) 1 to Chinese Yuan (CNY) (renmenbi) 8.2765. See International Monetary Fund, supra note 197. 220. Health System Faces up to Great Challenges, supra note 186. 221. Id. 222. State Council, China’s Social Security and Its Policy, supra note 201, ch. 4 (referring to regulations mandating all enterprises and individual business in industry and commerce to provide work-related injury insurance that pay for medical expenditures, subsidies, allowance and nursing fees); Health System Faces up to Great Challenges, supra note 186. 223. China Statistical Yearbook 2003, supra note 134, ch. 22-34. 224. UNDP China,Thematic Areas: Health, supra note 196. 225. Zhonghua Renmin GongheguoYaopin Guanli Fa Shishi Tiaoli [Regulations for the Implementation of the Pharmaceutical Administration Law of the P.R.C.], State Council Order No. 360, arts. 48, 55–56 (2002) (translation by the Center for Reproductive Rights). Certain categories of essential medications are subjected to government-fixed pricing and others to government- guided pricing. Id. art. 48. 226. Id. art. 75 (2002); Price Law of the P.R.C., Presidential Order No. 92, arts. 39–41 (1997) (effective May 1, 1998). 227. Yiliao Jigou Guanli Tiaoli [Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35, art. 37 (1994) (translation by the Center for Reproductive Rights). 228. Id.; Zhonghua Renmin Gongheguo Zhiye Yishi Fa [P.R.C. Medical Practitioner Law], arts. 37(10), 42 (1998) (effective May 1, 1999) (translation by the Center for Reproductive Rights); Price Law of the P.R.C., Presidential Order No. 92, arts. 39–40 (1997) (effective May 1, 1998). 229. State Council, China’s Social Security and Its Policy, supra note 201, ch. 5 (administered by the organ in charge of social insurance). 230. Id. 231. National Plan for the Development of Chinese Women (2001-2010), supra note 181, art. 1(1)(3). 232. Ministry of Labor and Social Security (MOLSS), Government of the P.R.C., Circular on Issuing the Measures (for Trial Implementation) for Maternity Insurance of the Staff and Workers in Enterprises, No. 504, arts. 1, 5–6 (1994) (translation by International Labour Organization) (maternity subsidies are based on a percentage of average month wages) [hereinafter MOLSS, Measures (for Trial Implementation) for Maternity Insurance of the Staff and Workers in Enterprises]; Ministry of Labor and Social Security (MOLSS), Government of the P.R.C., Quanyu Jinyibu Jiqiang Shengyu Baoxian Gongzuo De Zhidao YeYijian [Suggestions Concerning Strengthening Maternity Insurance Work], Lao She Ting Fa [MOLSS Notice] No. 14 (2004) (translation by Center for Reproductive Rights) [hereinafter MOLSS, Suggestions Concerning Strengthing Maternity Insurance Work]. 233. Labor Law of the P.R.C., Presidential Order No. 28, art. 62 (1994) (effective Jan. 1, 1995). 234. MOLSS, Measures (for Trial Implementation) for Maternity Insurance of the Staff and Workers in Enterprises, supra note 232, art. 1. 235. Id. art. 4; MOLSS, Suggestions Concerning Strengthening Maternity Insurance Work, supra note 232 (employers that are unable to provide both maternity insurance and maternity subsidies may be exempted from the latter). 236. MOLSS, Measures (for Trial Implementation) for Maternity Insurance of

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the Staff and Workers in Enterprises, supra note 232, art. 13. 237. Pharmaceutical Administration Law of the P.R.C., Presidential Order No. 45, arts. 1–3, 35–36 (2000) (amended 2001); Zhonghua Renmin GongheguoYaopin Guanli Fa Shishi Tiaoli [Regulations for the Implementation of the Pharmaceutical Administration Law of the P.R.C.], State Council Order No. 360 (2002) (translation by Center for Reproductive Rights). 238. Pharmaceutical Administration Law of the P.R.C., Presidential Order No. 45, art. 1 (2000) (amended 2001). 239. Id. arts. 7, 24, 23; Measures for the Supervision over and Administration of Pharmaceutical Production, State Food and Drug Administration Order No.16, arts. 8, 51 (2004); Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 240. Pharmaceutical Administration Law of the P.R.C., Presidential Order No. 45, art. 31 (2000) (amended 2001). 241. Id. arts. 29–33; Zhonghua Renmin GongheguoYaopin Guanli Fa Shishi Tiaoli [Regulations for the Implementation of the Pharmaceutical Administration Law of the P.R.C.], State Council Order No. 360, arts. 29–31 (2002) (translation by Center for Reproductive Rights). 242. Zhonghua Renmin GongheguoYaopin Guanli Fa Shishi Tiaoli [Regulations for the Implementation of the Pharmaceutical Administration Law of the P.R.C.], State Council Order No. 360, art. 15 (2002) (translation by Center for Reproductive Rights). 243. Pharmaceutical Administration Law of the P.R.C., Presidential Order No. 45, arts. 19, 27 (2000) (amended 2001). 244. Zhonghua Renmin Gongheguo Zhiye Yishi Fa [P.R.C. Medical Practitioner Law], arts. 37(10), 42 (1998) (effective May 1, 1999) (translation by Center for Reproductive Rights); Zhonghua Renmin Gongheguo Hushi Guanli Banfa [P.R.C. Measures for the Management of Nurses], Ministry of Health Order No. 31 (1993) (effective Jan. 1, 1994) (translation by Center for Reproductive Rights); Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33 (1994) (effective June 1, 1995); Chuantong Yixueshi Cheng He Queyou Zhuanchang Renyuan Yishi Zige Kaohe Kaoshi Zhanxing Banfa [Provisional Measures for Administrating Traditional Medical Practitioner and Specialty Medical Practitioner Qualification Exams], Ministry of Health Order No. 6 (1999) (translation by Center for Reproductive Rights); Yiliao Jigou Guanli Tiaoli [Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35 (1994) (translation by Center for Reproductive Rights); Yiliao Jigou Guanli Tiaoli Shishi Xizi [Rules for Implementation of the Regulations on Management of Medical Service Organizations], Ministry of Health Order No. 35 (1994) (translation by Center for Reproductive Rights). 245. Zhonghua Renmin Gongheguo Zhiye Yishi Fa [P.R.C. Medical Practitioner Law], art. 1 (1998) (effective May 1, 1999) (translation by Center for Reproductive Rights). 246. Id. art. 8. 247. Id. arts. 9–10. 248. Id. arts. 13–14. 249. Id. art. 21(6). 250. Id. arts. 22(1)–(5). 251. Ministry of Health,Year 2005 Health Work Essential Points, supra note 179, art. 5. 252. State Council, Government of the P.R.C., Guowuyuan Guanyu Jinyibu Jiaqiang Shipin Anquan Gongzuo de Jueding [State Council Decision Concerning Further Strengthening Food Safety], Order No. 23 (2004), http:// www.tj.xinhuanet.com/shkj/2004-09/29/content_2957607.htm (translation by Center for Reproductive Rights); Ministry of Health,Year 2005 Health Work Essential Points, supra note 179, art. 6. 253. Ministry of Health, Government of the P.R.C., Zhongguo Huli Shiye Fazhan Jihua Wangyao (2005-2010 Nian) [National Plan for the Development of the Nursing Profession (2005-1010)] (2005) (translation by Center for Reproductive Rights). 254. Zhonghua Renmin Gongheguo Hushi Guanli Banfa [P.R.C. Measures for the Management of Nurses], Ministry of Health Order No. 31, art. 1 (1993) (effective Jan. 1, 1994) (translation by Center for Reproductive Rights). 255. Id. 256. Id. art. 3. 257. Id. arts. 12–13, 16–17, 19. 258. Chuantong Yixueshi Cheng He Queyou Zhuanchang Renyuan Yishi Zige Kaohe Kaoshi Zhanxing Banfa [Provisional Measures for Administrating Traditional Medical Practitioner and Specialty Medical Practitioner Qualification Exams], Ministry of Health Order No. 6, art. 3 (1999) (translation by Center for Reproductive Rights). 259. Id. art. 6(1)–(4), 17–18. 260. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 32 (1994) (effective June 1, 1995); Muying Baojian Zhuanxiang Jishu Fuwu Xuke Ji Renyuan Zige Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Specialty Technical Service Permits and Personnel Qualifications], Ministry of Health Order of Aug. 7, 1995, arts. 2, 4 (1995) (translation by Center for Reproductive Rights). 261. Muying Baojian Yixue Jishu Jianding Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Medical Technology Appraisals], art. 4 (1995) (translation by Center for Reproductive Rights). 262. Id. arts. 2, 11, 18. 263. Muying Baojian Zhuanxiang Jishu Fuwu Xuke Ji Renyuan Zige Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Specialty Technical

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Service Permits and Personnel Qualifications], Ministry of Health Order of Aug. 7, 1995, arts. 7–8 (1995) (translation by Center for Reproductive Rights). 264. Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, secs. 1–3 (1995) (translation by Center for Reproductive Rights); Muying Baojian Zhuanxiang Jishu Fuwu Xuke Ji Renyuan Zige Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Specialty Technical Service Permits and Personnel Qualifications], Ministry of Health Order of Aug. 7, 1995, art. 10 (1995) (translation by Center for Reproductive Rights). 265. Muying Baojian Zhuanxiang Jishu Fuwu Xuke Ji Renyuan Zige Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Specialty Technical Service Permits and Personnel Qualifications], arts. 11–12 (1995) (the exams are formulated by the MOH and administered by the local health departments) (translation by Center for Reproductive Rights). 266. Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, secs. 1(1)(3), 1(2)(2) (1995) (translation by Center for Reproductive Rights). 267. Hunqian Baojian Gongzuo Guifan (Xiuding), [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [Department of Maternal and Infant Health-Care Notice] No. 147, sec. 2(1)(2) (2002) (translation by Center for Reproductive Rights). 268. Id. sec. 1(1)(2); Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, arts. 7–13 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 3(2), 9, 14 (2001) (couples “should” go for premarital health exams in regions implementing them) (translation by Center for Reproductive Rights). 269. Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [Department of Maternal and Infant Health-Care Notice] No. 147, sec. 2(1)(1) (2002) (translation by Center for Reproductive Rights). 270. Id. sec. 2(2); Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, secs. 1(1), 2(1) (1995) (translation by Center for Reproductive Rights). 271. Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33, art. 2 (2002) (effective May 1. 2003) (translation by Center for Reproductive Rights). 272. Id. art. 8; Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 33 (1994) (effective June 1, 1995). 273. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 33 (1994) (effective June 1, 1995); Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, secs. 2(2)(2) (1995) (translation by Center for Reproductive Rights). 274. Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33, art. 9 (2002) (effective May 1. 2003) (translation by Center for Reproductive Rights). 275. Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, sec. 3(1) (1995) (must have finished at least elementary school) (translation by Center for Reproductive Rights); Jiating Jiesheng Chenggui (Shixing) [Rules for Home Deliveries (Provisional)], Ministry of Health Order of Feb. 10, 1989, sec. 2(1) (1989) (translation by Center for Reproductive Rights). 276. Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, secs. 3(2)–(5) (1995) (translation by Center for Reproductive Rights); Jiating Jiesheng Chenggui (Shixing) [Rules for Home Deliveries (Provisional)], Ministry of Health Order of Feb. 10, 1989, sec. 2(3) (1989) (translation by Center for Reproductive Rights). 277. Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, sec. 3(6) (1995) (translation by Center for Reproductive Rights). 278. Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], arts. 21–23, 27 (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights). 279. Criminal Law of the P.R.C., art. 335 (1997) amended by Presidential Order No. 32 (2005) (criminal detention lasts up to six months and is administered by the local public security organ). 280. Id. art. 336. 281. Ministry of Health, Government of the P.R.C.,Yiyuan Guanli Pingjia Zhinan (Shixing) [Hospital Administration Appraisal Guide (Trial Implementation)],Wei Yi Fa [Department of Infectious Disease Control and Prevention Notice] No. 104, secs. IV(1)(1)–(6) (2005), http://www.law-lib.com/law/law_view. asp?id=91078 (translation by Center for Reproductive Rights). 282. Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], arts. 14, 18 (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights). 283. Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33, arts. 20, 23–25 (2002) (effective May 1, 2003) (translation by Center for Reproductive Rights). 284. Id. art. 24.

285. Id. art. 25. 286. Hunqian Baojian Gongzuo Guifan (Xiuding) Standards for Premarital HealthCare Work (Revised), Wei Ji Fu Fa No. 147, sec. 3(3)(3) (2002) (translation by Center for Reproductive Rights). 287. Ministry of Health, Government of the P.R.C.,Weishengbu Guanyu Yinfa Dui Aizibing Bingdu Ganranzhe He Aizibing Bingren Guanli Yijian De Tongzhi [Notice on the Administration of HIV Positive People and Patients], Wei Ji Kong Fa [Department of Infectious Disease Control Notice] No. 164, arts. 1(3), 3(3) (1999) (translation by Center of Reproductive Rights) [hereinafter on the Administration of HIV Positive People and Patients]. 288. Wen JiaBao, supra note 48, § 5(1) ¶ 4. 289. Id.; Information Office of the State Council, Government of the P.R.C., Introduction about the System of Social Support for Some Rural Families Practicing Family Planning (2005), http://www.npfpc.gov.cn/en/en2005-06/ enews20050314-2.htm; Pan Guiyu, Speech at the Press Conference on the System of Social Support for Some Rural Families Practicing Family Planning (June 9, 2005) (transcript available at http://www.npfpc.gov.cn/en/en2005-06/enews20050614.htm) (Mme. Pan is the Minister of that NPFPC) (program expansion to cover 23 provinces, autonomous regions and municipalities, 12 counties in Tibet Autonomous Region, 22 counties in Shandong Province, providing benefits for 1.35 million people). 290. Ministry of Health,Year 2005 Health Work Essential Points, supra note 179, art. 5. 291. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 35 (2001) (effective Sept. 1, 2002); Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], art. 18 (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights); Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33, art. 27 (2002) (effective May 1. 2003) (sex-determination may be necessary to detect sex-related genetic disease) (translation by Center for Reproductive Rights); Guanyu Jinzhi Fei Yixue Xuyao De Taier Xingbie Jianding He Xuanze Xingbie De Rengong Zhongzhi Renshen De Guiding [Regulation Prohibiting Non-Medically Necessary Sex-Determinations and Sex-Selective Abortions], art. 6 (2002) (effective Jan. 1, 2003) (medically necessary sexdeterminations may only be conducted upon verification of medical condition by local family planning department and permission from provincial population and family planning department) (translation by Center for Reproductive Rights). 292. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 35 (2001) (effective Sept. 1, 2002); Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], art. 18 (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights); Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33, art. 27 (2002) (effective May 1, 2003) (translation by Center for Reproductive Rights). 293. Hospitals Provide Assisted Reproductive Technology Services, Xinhua News Agency (China), Apr. 2, 2003, http://www.china.org.cn/english/China/60817.htm (referring to figures from Ministry of Health). 294. Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technologies], sec. 1 (2001), amended by Ministry of Health Order No. 176 (2003) (also intracytoplasmic sperm injection, preimplantation genetic diagnosis and donation of sperm or embryos) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproductive Technologies], State Council Order No.14, art. 1 (2001) (amended 2003) (translation by Center for Reproductive Rights). 295. Ministry of Health, Government of the P.R.C.,Weishengbu Guanyu Pizhun De Keyi Fazhan Renlei Fuzhu Shengzhi Jishu He Shebei Renlei Jingziku De Jigou Mingdan [List of Organizations approved for development of Assisted Reproductive Technologies or Establishment of Sperm Banks] (2005), http://www.moh.gov.cn/public/open.aspx?n_id=10019 (translation by Center for Reproductive Rights). 296. Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technology] (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Shishi Renlei Fuzhu Shengzhi Jishu De Lunli Yuanze [Ethical Principles of Assisted Reproductive Technology] (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No.14, art. 3 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights). 297. Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technology], arts. 1(3)(1)(1)–(2) (2001), 2(3)(1)(1)–(2), amended by Ministry of Health Order No. 176 (2003) (conditions eligible to receive artificial, intravaginal, intracervical, intrauterine or intratubal insemination and conditions eligible for intracytoplasmic sperm injection, preimplantation genetic diagnosis, receive sperm/embryo donation) (translation by Center for Reproductive Rights). 298. Shishi Renlei Fuzhu Shengzhi Jishu De Lunli Yuanze [Ethical Principles of Assisted Reproductive Technology], art. 4 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights). 299. Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No.14, art. 22(2) (2001), amended by Ministry of Health Order No. 176 (2003) (punishable by a maximum fine of

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CNY 3000, administrative or criminal penalties) (translation by Center for Reproductive Rights); Shishi Renlei Fuzhu Shengzhi Jishu De Lunli Yuanze [Ethical Principles of Assisted Reproductive Technology], art. 5 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technology], sec. 3(7) (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights). 300. Shishi Renlei Fuzhu Shengzhi Jishu De Lunli Yuanze [Ethical Principles of Assisted Reproductive Technology], art. 5 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No. 14, art. 22(1) (2001) (amended 2003) (translation by Center for Reproductive Rights). 301. Shishi Renlei Fuzhu Shengzhi Jishu De Lunli Yuanze [Ethical Principles of Assisted Reproductive Technology], art. 1 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No. 14, art. 14 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technology], secs. 1(2)(1), 3(1), (4) (2001), amended by Ministry of Health Order No. 176 (2003) (national and local permits for sperm banks) (translation by Center for Reproductive Rights). 302. Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technology], secs. 3(5), (8) (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Jingziku Jishu Guifan [Standards for Sperm Banks], sec. 3(4) (2001). 303. Renlei Jingziku Jishu Guifan [Standards for Sperm Banks], sec. 3(4) (2001); Shishi Renlei Fuzhu Shengzhi Jishu De Lunli Yuanze [Ethical Principles of Assisted Reproductive Technology], art. 4 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights); Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No. 14, art. 22(4) (2001), amended by Ministry of Health Order No. 176 (2003) (punishable by a maximum fine of CNY 3000, administrative or criminal penalties) (translation by Center for Reproductive Rights). 304. Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No. 14, art. 22 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights). 305. Id. arts. 3, 8–12 (MOH issues ART permits to qualified facilities); Renlei Fuzhu Shengzhi Jishu Guifan [Standards for Assisted Reproductive Technology], secs. 1(1)(1)(2)–(3), 1(2)(2) (2001), amended by Ministry of Health Order No. 176 (2003) (specific national and local permits required for sperm banks) (translation by Center for Reproductive Rights). 306. Renlei Fuzhu Shengzhi Jishu Guanli Banfa [Measures for the Management of Assisted Reproduction Technology], State Council Order No. 14, arts. 21–22 (2001), amended by Ministry of Health Order No. 176 (2003) (translation by Center for Reproductive Rights). 307. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, arts. 7–13 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 3(2), 9, 14 (2001) (couples “should” go for premarital health exams in regions implementing them) (translation by Center for Reproductive Rights); Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [MOH Department of Maternal and Infant Health-Care Notice] No. 147, sec. 1(1)(2) (2002) (translation by Center for Reproductive Rights). 308. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 10 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 3(2), 9–16 (2001) (translation by Center for Reproductive Rights); Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [MOH Department of Maternal and Infant Health-Care Notice] No. 147, sec. 1(1)(2) (2002) (translation by Center for Reproductive Rights); Xiao Shitan, Pre-marital Medical Exams Only for Giving “Suggestions”?, Jiangnan Times (China), Apr. 13, 2003, http://www.china-aids.org/ english/News/News055.htm. 309. Hunyin Dengji Tiaoli [Regulation on Marriage Registration], State Council Order No. 387 (2003) (translation by Center for Reproductive Rights); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 10, 16 (2001) (couples “should” go for premarital exams and marriage registration offices “should” inspect the couple’s premarital certificates in regions implementing premarital exams). 310. See e.g. Hangzhou City’s People’s Government, Regulations on Marriage Registration, http://english.hangzhou.gov.cn/english/Citizens/Marriage/ userobject8ai21.html (last visited July 1, 2005). 311. Ministry of Health, Government of the P.R.C.,Weishengbu Guanyu Mianfei Fazhan Hunqian Baojian Zixun He Zhidao De Tongzhi [Notice Concerning Development of Free Premarital Health Care Consultation and Guidance] (2004), http://www.moh.gov.cn/public/open.aspx?n_id=8338 (translation by Center

WOMEN OF THE WORLD:

for Reproductive Rights). 312. Id.; Hunyin Dengji Tiaoli [Regulation on Marriage Registration], State Council Order No. 387 (2003) (translation by Center for Reproductive Rights); See National Action Plan for Raising Quality of Birth Population and Reducing Birth Defects (2002-2010), supra note 180, § 4(3)(1)(1). National Plan for the Development of Chinese Children (2001-2010)], supra note 180, § 1(1)(1) (goals of the Plan include premarital health exams for 80% of premarital couples in urban areas, and 50% in rural areas). 313. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, arts. 9–10 (1994) (effective June 1, 1995). 314. Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [MOH Department of Maternal and Infant Health-Care Notice] No. 147, sec. 1(1)(4)(1)–(2) (2002) (translation by Center for Reproductive Rights). 315. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 10 (1994) (effective June 1, 1995). 316. Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [MOH Department of Maternal and Infant Health-Care Notice] No. 147, sec. 1(1)(4)(3) (2002) (translation by Center for Reproductive Rights). 317. Id. 318. Id. sec. 1(3). 319. Id.; Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 11 (1994) (effective June 1, 1995). 320. Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [MOH Department of Maternal and Infant Health-Care Notice] No. 147, sec. 1(3) (2002) (translation by Center for Reproductive Rights). 321. Id. sec. 1(3). 322. Xianfa [Constitution], art. 49 (2004) (“… husband and wife have the duty to practice family planning.”) 323. Marriage Law of the P.R.C., art. 16 (2001). 324. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, arts. 30–31, 33–34 (2001) (effective Sept. 1, 2002). 325. Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], arts. 1, 5 (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights). 326. Id. arts. 1, 3. 327. Id. arts. 7(1)–(3), 8(1)–(4), 9(1)–(4). 328. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, arts. 10, 12, 18 (2001) (effective Sept. 1, 2002). 329. Id. arts. 2, 18. 330. See Hubei Provincial People’s Congress, Hubeisheng Renkou Yu Jihuashengyu Tiaoli [Hubei Province Population and Family Planning Regulations], art. 19 (2003) (translation by Center for Reproductive Rights). 331. Id. art. 23; Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], art. 17 (2004) (translation by Center for Reproductive Rights); Tianjin Provincial People’s Congress;Tianjinsheng Renkou Yu Jihuashengyu Tiaoli [Tianjin Province Population and Family Planning Regulations], art. 20 (2003) (translation by Center for Reproductive Rights). 332. Hubei Provincial People’s Congress, Hubeisheng Renkou Yu Jihuashengyu Tiaoli [Hubei Province Population and Family Planning Regulations], art. 29 (2003) (translation by Center for Reproductive Rights); Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], art. 25 (2004) (translation by Center for Reproductive Rights). 333. Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], art. 25 (2004) (translation by Center for Reproductive Rights). 334. Shanghai Municipal People’s Congress, Shanghaishi Renkou Yu Jihuashengyu Tiaoli [Shanghai Municipal Population and Family Planning Regulations], arts. 43(1)–(3) (2003) (translation by Center for Reproductive Rights). Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 335. Shanghai Municipal People’s Congress, Shanghaishi Renkou Yu Jihuashengyu Tiaoli [Shanghai Municipal Population and Family Planning Regulations], arts. 43(1)–(3) (2003) (translation by Center for Reproductive Rights); Beijing Municipal People’s Congress, Beijingshi Renkou Yu Jihuashengyu Tiaoli [Beijing Municipal Population and Family Planning Regulations], arts. 38–40 (2003) (only applicable to civil servants and employees of state-owned enterprises) (translation by Center for Reproductive Rights). 336. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 21 (2001) (effective Sept. 1, 2002). See Shanghai Municipal People’s Congress, Shanghaishi Renkou Yu Jihuashengyu Tiaoli [Shanghai Municipal Population and Family Planning Regulations], arts. 36–41 (2003) (translation by Center for Reproductive Rights); Beijing Municipal People’s Congress, Beijingshi Renkou Yu Jihuashengyu Tiaoli [Beijing Municipal Population and Family Planning Regulations], arts. 21(1)–(6) (2003) (translation by Center for Reproductive Rights); Tianjin Provincial People’s Congress;Tianjinsheng Renkou Yu Jihuashengyu Tiaoli [Tianjin Province Population and Family Planning Regulations], art. 24 (2003) (translation by Center for Reproductive Rights); Hubei Provincial

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People’s Congress, Hubeisheng Renkou Yu Jihuashengyu Tiaoli [Hubei Province Population and Family Planning Regulations], art. 29 (2003) (translation by Center for Reproductive Rights). 337. Hubei Provincial People’s Congress, Hubeisheng Renkou Yu Jihuashengyu Tiaoli [Hubei Province Population and Family Planning Regulations], arts. 30, 34–36 (2003) (translation by Center for Reproductive Rights). 338. National Population and Family Planning Commission of China (NPFPC), Government of the P.R.C., Project Initiatives: Quality of Care of Reproductive Health in China Today, http://www.npfpc.gov.cn/en/rhpro.htm (last visited Feb. 9, 2005) [hereinafter NPFPC, Project Initiatives]. Until 2002, the NPFPC was known as the State Family Planning Commission (SFPC). 339. Id. 340. Id. 341. Id.; Zhang Weiqing, Address at the Fifth Asian Pacific Population Conference (Dec. 16, 2002) (Mr. Zhang is the Minister of Health of the P.R.C.) (transcript available at http://www.cpirc.org.cn/en/enews20021225-1.htm). 342. NPFPC, Project Initiatives, supra note 338. 343. Department of Planning and Accounting, National Population and Family Planning Commission of China (NPFPC), National Family Planning and Reproductive Health Survey (2001), § 3 (2002) [hereinafter National Family Planning and Reproductive Health Survey (2001)]. 344. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 19 (2001) (effective Sept. 1, 2002). 345. Id. art. 20. 346. Glasier, A. et al., Case Studies in Emergency Contraception from Six Countries, 22 Int’l Family Planning Perspectives 57–61 (1996). See also National Population and Family Planning Commission of China (NPFPC), Government of the P.R.C., Main Achievements of Population and Family Planning Program of China, http://www.npfpc.gov.cn/en/fpcn01-en.htm (last visited June 12, 2005) [hereinafter NPFPC, Main Achievements]. 347. International Consortium for Emergency Contraception, Dedicated Emergency Contraception Products Worldwide, http://www.cecinfo.org/html/ res-product-issues.htm#table1 (last updated Feb. 14, 2005). 348. China Population Information and Research Center, China/unfpa: Reproductive Health/Family Planning End of Project – Women Survey Report 16 (2004). 349. National Population and Family Planning Commission of China (NPFPC), Government of the P.R.C., Progress since the ICPD, http://www.npfpc.gov. cn/en/fpcn02-en.htm (last visited April 15, 2005) [hereinafter NPFPC, Progress since the ICPD]. See China Population Information and Research Center, supra note 348, at 13–16. 350. China Population Information and Research Center, supra note 348, at 16. 351. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 13 (2001) (effective Sept. 1, 2002). 352. State Administration for Industry and Commerce, Government of the P.R.C., Guanyu Yinjin Kanbo Youguan Xingshenghuo Chanpin Guangguo De Guiding [Regulations on Prohibition against Publishing or Broadcasting Advertisements for Sex Products] (1989) (translation by Center for Reproductive Rights). 353. State Administration for Industry and Commerce, Government of the P.R.C., Guanyu Fabu Yu Xingshenghuo Youguan De Chanpin He Fuwu Guangguo Wenti De Daan [Concerning the Answer to the Question of Advertisements for Sex Products and Services] (1998) (translation by Center for Reproductive Rights). 354. Ministry of Health et al., Guanyu Yufang Aibibing Tuiguang Shiyong Anquantao (Biyuntao) De Shishi Yijian [Suggestions Concerning HIV Prevention by Promotion of Condom Use],Wei Ji Kong Fa [MOH Department of Infectious Disease Control Notice] No. 248, § 3(1) (2004) (translation by Center for Reproductive Rights) [hereinafter Ministry of Health, Suggestions Concerning HIV Prevention by Promotion of Condom Use]. 355. Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], arts. 7(1)–(3), 8(1)–(4), 9(1)–(4) (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights). 356. NPFPC, Progress since the ICPD, supra note 349 (referring to figures from the NPFPC/CPDRC, Handbook of Commonly Used Data on Population and Family Planning, 2003). 357. NPFPC, Project Initiatives, supra note 338. 358. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 19 (1994) (effective June 1, 1995). 359. Id.; Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], art. 17 (2001), amended by State Council Order No. 428 (2004) (consent of person undergoing sterilization required) (translation by Center for Reproductive Rights). 360. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 34 (2001) (effective Sept. 1, 2002). 361. See Id. arts. 4, 36 (family planning personnel “shall perform their … duties strictly in accordance with law, and enforce the law in a civil manner, and they may not infringe upon legitimate rights and interests of citizens”) (criminal liability or administrative penalty for state functionaries who “infringes on citizens’ personal rights … abuse his power … ”); Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management

of Family Planning Technical Services], art. 17 (2001), amended by State Council Order No. 428 (2004) (consent of person undergoing sterilization required) (translation by Center for Reproductive Rights). 362. Bureau of Democracy, Human Rights, and Labor, U.S. Department of State, Country Reports on Human Rights Practices 2004: China (2005), http://www. state.gov/g/drl/rls/hrrpt/2004/41640.htm (Released Feb. 28, 2005) [hereinafter Country Reports on Human Rights Practices 2004: China]. 363. Id. 364. Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], art. 3 (2001), amended by State Council Order No. 428 (2004) (translation by Center for Reproductive Rights). 365. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 41 (2001) (effective Sept. 1, 2002); Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], art. 45 (2004) (translation by Center for Reproductive Rights); Beijing Provincial People’s Government, [Beijingshi Shehui Fuyang Fei Zhengshou Guanli Banfa [Beijing Province Measures on the Administration of Social Compensation Fees Collection], art. 5 (2002) (translation by Center for Reproductive Rights). 366. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 25 (2001) (effective Sept. 1, 2002). 367. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 10 (1994) (effective June 1, 1995). 368. NPFPC, Main Achievements, supra note 346. 369. Id.; NPFPC, Project Initiatives, supra note 338. 370. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 19 (2001) (effective Sept. 2002). 371. Women’s Rights and China’s New Family Planning Law: Roundtable before the Congressional-Executive Commission on China, 107th Cong. Sess. 2, at 36 (2002) (prepared statement of Robert Aird, former chief, China Branch and senior research specialist on China, U.S. Bureau of the Census). 372. Id. at 37 (prepared statement of Robert Aird, former chief, China Branch and senior research specialist on China, U.S. Bureau of the Census); Nancy E. Riley, China’s Population: New Trends and Challenges, 59 Population Bull. 12–13 (2004) (the shift in policy was announced in the 1984 “Document No. 7”). 373. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 19 (2001) (effective Sept. 2002). 374. Id. art. 21; Hubei Provincial People’s Congress, Hubeisheng Renkou Yu Jihuashengyu Tiaoli [Hubei Province Population and Family Planning Regulations], art. 31 (2003) (translation by Center for Reproductive Rights). 375. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, arts. 23, 27 (2001) (effective Sept. 2002); National Family Planning and Reproductive Health Survey (2001), supra note 343, § 7; U.S. Department of Justice, U.S. Government, Perspective Series: Chinese State Birth Planning in the 1990s and Beyond 12–13 (2001), http://uscis.gov/graphics/services/asylum/ric/documentation/ pschn01001.pdf [hereinafter Chinese State Birth Planning in the 1990s and Beyond]. 376. Xu Qian et al., Unintended Pregnancy and Induced Abortion Among Unmarried Women in China: A Systematic Review, 4 BioMed Central Health Services Research (2004), http://www.biomedcentral.com/1472-6963/4/1; UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Young Female Migrant Workers in China in Need of Reproductive Health and Services (Social Science Research Policy Briefs, Series 2, No. 2, 2002) (migrant workers are not registered residents and therefore ineligible to receive public health and welfare benefits). 377. CEDAW Committee, Third and fourth periodic reports of State parties: China, supra note 150, Part I, ¶ 12. 378. China Family Planning Association (CFPA), Ziehui Ziyuan [Association Resources], http://www.chinafpa.org.cn/xhjs05.asp (last visited June 30, 2005) (translation by the Center for Reproductive Rights) [hereinafter CFPA Resources]. 379. Id. 380. Id.; China Family Planning Association (CFPA), Zhongguo Jihua Shengyu Ziehui Fazhan Zhanlue [CFPA Development Strategy (1996-2010)], http://www. chinafpa.org.cn/xhjs03.asp (last visited June 30, 2005) (translation by Center for Reproductive Rights) [hereinafter CFPA Development Strategy (1996-2010)]. 381. China Family Planning Association (CFPA), Shengzhi Jiankang Xiwun Fuwu Zhongxin [Reproductive Health Consultation Service Cnters], http://www. chinafpa.org.cn/szjk01.asp (last visited June 30, 2005) (translation by the Center for Reproductive Rights). 382. Government of the P.R.C., National Report of the P.R.C. to the Fifth Asian and Pacific Population Conference 32 (2002) [hereinafter National Report of the P.R.C. to the Fifth Asian and Pacific Population Conference]; NPFPC, Progress since the ICPD, supra note 349. 383. CFPA Development Strategy (1996-2010), supra note 380. 384. Id. 385. Chinese Women Working Network, Projects in China, http://www.cwwn. org/eng/eng_main.html (last visited June 30, 2005). 386. Xu Qian et al., supra note 376; Ministry of Health, Suggestions Concerning HIV Prevention by Promotion of Condom Use, supra note 354, § 3(1). 387. Ministry of Health, Suggestions Concerning HIV Prevention by Promotion

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of Condom Use, supra note 354, § 3(1); China to Issue Condoms Nationwide, China Radio International, July 30, 2005, http://english1.people.com.cn/200407/30/ print20040730_151381.html. 388. Red Cross Society of China, Services, http://www.chineseredcross.org.cn/ hhsy/hhsy_scfw.htm (last visited July 1, 2005); Population Services International, Country Programs: China (2005), http://www.psi.org/where_we_work/china.html (last updated May 26, 2005). 389. Regional Office of the Western Pacific,World Health Organization, Country Health Information Profile: China (1999); Country Programme outline for China, supra note 212, para. 4; Regional Office for the Western Pacific,World Health Organization, Country Health Information Profile 2004: China 58 (2004) (referring to figures furnished by the Ministry of Health on Oct. 9, 2003) [hereinafter WHO Country Health Profile 2004: China]; NPFPC, Main Achievements, supra note 346. 390. WHO Country Health Profile 2004: China, supra note 389, at 59 (including pregnancy, childbirth and puerperium causes) (referring to figures furnished by the Ministry of Health on Oct. 9, 2003); China Statistical Yearbook 2003, supra note 134, ch. 21-43, at 810, ch. 21-44, at 811 (tenth cause of death of women in urban areas and ninth cause of death of women in rural areas in 2002). 391. Ministry of Health et al., Guanyu Biaozhang “Jiangdi Yunchanfu Siwanglu He Xiaochu Xinshenger Poshangfeng” Xiangmu Gongzuo Xianjin Jiti He Xianjin Geren De Jueding [Decision Concerning Recognition of Excellence of Organizations and Persons in Implementing the “Safe Motherhood Program to Decrease Maternal Mortality and Neonatal Tetanus”], Wei Ji Fu Fa [Department of Maternal and Infant Health Care Notice] No. 80 (Mar. 15, 2004) (translation by Center for Reproductive Rights) [hereinafter Notice on Recognition of Excellence in Implementing the Safe Motherhood Program]; Millennium Development Goals: China’s Progress, supra note 174, at 24; Ministry of Health, Government of the P.R.C.,Weishengbu Guanyu Renzhen ZuoHao Jianxiao Xiangmu Gongzuo De Tongzhi [Concerning Serious Implementation of the Safe Motherhood Program],Wei Fu She Fa [Department of Maternal and Infant Health-Care Notice] No. 9 (2005) (program coverage currently spans 22 provinces, municipalities, and autonomous regions, over 1000 counties and covers about 3 hundred million Chinese citizens) (translation by Center for Reproductive Rights) [hereinafter Notice Concerning Serious Implementation of the Safe Motherhood Program]. 392. Notice Concerning Serious Implementation of the Safe Motherhood Program, supra note 391, §§ 3(1), (3); The World Bank, China Comprehensive Maternal and Child Health Project (Health VI), Implementation Completion Report 26–27, 30 (2003), http://www-wds.worldbank.org/servlet/ WDSContentServer/WDSP/IB/2003/03/22/000094946_0303111102363/Rendered/ PDF/multi0page.pdf [hereinafter The World Bank, Comprehensive Maternal and Child Health Project Report]. 393. CEDAW Committee, Third and fourth periodic reports of State parties: China, supra note 150, Part I, ¶ 11; State Council, Government of the P.R.C.,Tenth Five-Year Plan for National Economic and Social Development (2001-2005) (2001), http://www. logos-net.net/ilo/150_base/en/init/chn_1.htm [hereinafter Tenth Five-Year Plan for National Economic and Social Development (2001-2005)]; National Plan for the Development of Chinese Women (2001-2010), supra note 181; National Plan for the Development of Chinese Children (2001-2010), supra note 180. 394. The World Bank, China Comprehensive Maternal and Child Health Project Report, supra note 392, at 26, 28; CEDAW Committee, Third and fourth periodic reports of State parties: China, supra note 150, Part I, ¶ 12. 395. CEDAW Committee, Third and fourth periodic reports of State parties: China, supra note 150, Part II, art. 12, para. 1.1. 396. Ministry of Health, Government of the P.R.C., Jicent Weisheng Fuyou Baojian Si Zhineng Peizhi He Nishe Jigou [Primary Level Health and Maternal and Infant Health-care Equipment and Internal Organization], secs. I(1), (5)–(7), (9)–(13), II(4)(1)–(9), II(5)(1)–(8) (2001), http://61.49.18.68/zzjgyzz/1200207160015. htm (last visited Mar. 28, 2005) [hereinafter Maternal and Infant Health-Care Department Organization]; Ministry of Health, Government of the P.R.C., Fuyou Baojian Yu Shequ Weisheng Si: Zhuyao Zhineng [Department of Maternal and Infant Health-Care and Community Health: Main Objectives] (2004), http://www.moh.gov.cn/public/open.aspx?n_id=7576 (last visited Mar. 28, 2005). 397. Maternal and Infant Health-Care Department Organization, supra note 396, secs. II(1), (4)–(5). 398. Id. sec. II(4)(7). 399. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 15 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, art. 19 (2001) (translation by Center for Reproductive Rights). 400. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 16 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, art. 17 (2001) (translation by Center for Reproductive Rights). 401. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 17 (1994) (effective June 1, 1995). Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33 (2002) (effective May 1. 2003) (translation by Center for Reproductive Rights).

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402. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 18 (1994) (effective June 1, 1995). 403. Chanqian Zhenduan Jishu Guanli Banfa [Measures for the Management of Prenatal Diagnostic Technology], Ministry of Health Order No. 33, art. 19(1)–(4) (2002) (effective May 1. 2003) (translation by Center for Reproductive Rights); Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 18 (1994) (effective June 1, 1995). 404. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 20 (1994) (effective June 1, 1995). 405. Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, art. 24 (2001) (translation by Center for Reproductive Rights); Concerning Serious Implementation of the Safe Motherhood Program, supra note 391, § 3(1). 406. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 22 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, art. 24 (2001) (translation by Center for Reproductive Rights). 407. Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, art. 24 (2001) (translation by Center for Reproductive Rights). 408. Maternal and Infant Health-Care Department Organization, supra note 396, sec. II(4)(1). 409. Muying Baojian Zhuanxiang Jishu Jiben Biaozhun [Basic Standards for Specialty Maternal and Infant Health-Care Technical Services], Ministry of Health Order of Aug. 7, 1995, secs. 1–3 (1995) (translation by Center for Reproductive Rights); Muying Baojian Zhuanxiang Jishu Fuwu Xuke Ji Renyuan Zige Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Specialty Technical Service Permits and Personnel Qualifications], Ministry of Health Order of Aug. 7, 1995 (1995) (translation by Center for Reproductive Rights); Muying Baojian Yixue Jishu Jianding Guanli Banfa [Measures for the Management of Maternal and Infant Health-Care Medical Technology Appraisals], Ministry of Health Order of Aug. 7, 1995 (1995) (translation by Center for Reproductive Rights); Hunqian Baojian Gongzuo Guifan (Xiuding) [Standards for Premarital Health-Care Work (Revised)], Wei Ji Fu Fa [Ministry of Health Department of Maternal and Infant Health-Care Notice] No. 147, sec. 2(1)(1) (2002) (translation by Center for Reproductive Rights). 410. Information Center of the State Council, China’s Human Rights Progress 2003, ch. 5 (Mar. 2004), http://www.china.org.cn/e-white/20040330/index.htm [hereinafter China’s Human Rights Progress 2003]. 411. National Plan for the Development of Rural Primary Health-Care (20012010), supra note 180, arts. 1, 2(3). 412. National Plan for the Development of Chinese Women (2001-2010), supra note 181, § 4(2)(2). 413. Qinghai Offers Free Midwifery Service for Peasant, Herder Women, Xinhua News Agency (China), Nov. 1, 2004, http://english.peopledaily.com.cn/200411/01/ print20041101_162365.html. 414. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 7 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 9(1)–(6), 10, 13–14 (2001) (translation by Center for Reproductive Rights). 415. Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, art. 17 (2001) (translation by Center for Reproductive Rights); Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 7 (1994) (effective June 1, 1995). 416. NPFPC, Main Achievements, supra note 346. 417. National Family Planning and Reproductive Health Survey (2001), supra note 343, § 5. 418. NPFPC, Main Achievements, supra note 346. 419. Id. 420. CFPA Resources, supra note 378. 421. China Development Brief, Directory of International NGOs: Zigen Fund, http://www.chinadevelopmentbrief.com/dingo/entry.asp?mode=toc&start=229&co unt=25&org=1560&letter=Z (last visited June 30, 2005); Tibet Poverty Alleviation Fund, Maternal Mortality Reduction, http://www.tpaf.org/mortalityreduction. htm (last visited June 30, 2005); The Terma Foundation, Healthy Mother, Healthy Babies: Prenatal and Postnatal Care (2003), http://www.terma.org/motherchild. html (last visited June 30, 2005); China Development Brief, Directory of International NGOs: Swiss Red Cross, http://www.chinadevelopmentbrief.com/ dingo/entry.asp?mode=toc&start=185&count=25&org=1552&letter=S (last visited June 30, 2005); ProLiteracy, Literacy in Action: Spreading the Light, International Programs Update 2004-05, at 9 (2004), http://www.proliteracy.org/downloads/ IP_04.pdf 422. China Development Brief, Directory of International NGOs: Plan, http:// www.chinadevelopmentbrief.com/dingo/entry.asp?mode=toc&start=159&count=25& org=1501&letter=P (last visited July 1, 2005) [hereinafter Plan]. 423. Tibet Poverty Alleviation Fund, supra note 421. 424. Id. 425. The Terma Foundation, Healthy Mother, Healthy Babies: Prenatal and

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Postnatal Care (2003), http://www.terma.org/motherchild.html (last visited June 30, 2005). 426. Plan, supra note 422; PATH, China Adolescent Health Project, http://www. path.org/projects/china_adolescent_health_project.php (last visited July 1, 2005). 427. Health Unlimited, China, http://www.healthunlimited.org/china/index.htm (last visited June 29, 2005). 428. Id. 429. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, arts. 14, 24 (1994) (effective June 1, 1995). 430. Id. art. 14. 431. The World Bank, China Comprehensive Maternal and Child Health Project Report, supra note 392, at 28; Notice on Recognition of Excellence in Implementing the Safe Motherhood Program, supra note 391. 432. National Report of the P.R.C. to the Fifth Asian and Pacific Population Conference, supra note 382, at 6. 433. Henk Bekedam, Address at the Beijing Forum: Diet, Health and Development (Apr. 22, 2005) (transcript available at http://www.wpro.who.int/chn/news/ drbekedamspeech32.htm) (referring to findings from the Ministry of Health and the World Health Organization Report “The Vitamin and Mineral Deficiency: A Damage Assessment Report for China”); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 28–29 (2001) (e.g., infant formulas must have a label that clearly indicates breast milk is superior to formula, and manufacturers are strictly prohibited from giving promotional goods in terms of sample products, equipment, funding or information to any medical or health facilities) (translation by Center for Reproductive Rights); Ministry of Health, Government of the P.R.C.,Weishengbu Bangongting Guanyu Fazhan “Shijie Muru Weiyang Zhou” Huodong De Tongzhi [Notice of the Ministry of Health General Office Concerning Development of “World Breastfeeding Week” Activities], art. 2 (2002), http://www.moh.gov.cn/public/open.aspx?n_id=2730 (translation by the Center for Reproductive Rights). 434. China Population Information and Research Center, supra note 348, at 41 (referring to estimates by the NPFPC based on abortion statistics from the Ministry of Health); National Report of the P.R.C. to the Fifth Asian and Pacific Population Conference, supra note 382, at 4. 435. UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Use of Emergency Contraceptive Pills could Halve the Induced Abortion Rate in Shanghai, China (Social Science Research Policy Briefs, Series 1, No. 4, 2001), http:// www.who.int/reproductive-health/hrp/Policy_briefs/pb4.pdf. 436. Id. 437. U.N. Population Division (UNFPA), U.N. Department of Economic and Social Affairs, Abortion Policies: A Global Review 95, 95–96 (2002), http://www. un.org/esa/population/publications/abortion/doc/chinas1.doc [hereinafter UNFPA, Abortion Policies]; Wang Duolao et al., Contraceptive failure and its subsequent effects in China: a two-stage event history analysis, 13 Asia-Pacific Population J. 45, 45–64 (1998) (89.5% contraceptive failure resulted in abortions in urban areas and 54.6% in rural areas). 438. Chen Wei, Socio-Economic Determinants of Induced Abortion in China, 19 Asia-Pacific Population J. 5, 5–6 (2004). 439. Id. at 11. The government can usually exert more control over urban, well-educated and higher income people through household registration and work units with which to monitor their lives, consequently, leading to greater adherence with the family planning policies. Id. at 5. The incidence of abortions is eight times greater among women residing in urban areas as compared to rural women, six times higher in college-educated women than illiterate women and increases exponentially along with salaries. Id. at 11. 440. Criminal Law of the P.R.C. (1997), amended by Presidential Order No. 32 (2005). 441. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 35 (2001) (effective Sept. 1, 2002); China to Make Sex-Selective Abortions a Crime, China Daily, Jan. 7, 2005, http://english.people.com.cn/200501/07/print20050107_169986. html; China Intends to Redress Sex Ratio Imbalance by Amending Criminal Law, People’s Daily Online, Jan. 10, 2005, http://english1.people.com.cn/200501/10/print20050110_ 170200.html. 442. U.S. Department of State, Country Reports on Human Rights Practices 2004, supra note 362. 443. Ministry of Health & National Population and Family Planning Commission of China (NPFPC), Jieyu Shoushu Guichang [Rules for Birth Control Surgeries] 59, 72 (3rd ed. 2004), http://www.moh.gov.cn/uploadfile/2004 07/20047318849142.doc (Mifepristone is administered to women between 18-40 within 49 days of conception and vacuum aspiration is used on pregnancies under 10 weeks) (translation by the Center for Reproductive Rights) [hereinafter MOH & NPFPC, Rules for Birth Control Surgeries]; Guanyu Jinzhi Fei Yixue Xuyao De Taier Xingbie Jianding He Xuanze Xingbie De Rengong Zhongzhi Renshen De Guiding [Regulation Prohibiting Non-Medically Necessary Sex-Determinations and SexSelective Abortions], art. 3 (2002) (effective Jan. 1, 2003) (facilities performing abortions must be licensed to perform abortions by the health or family planning department) (translation by Center for Reproductive Rights). 444. Heather Boonstra, Voicing Concern for Women, Abortion Foes Seek Limits on Availability of Mifepristone, 4 The Guttmacher Rep. On Pub. Pol’y 3, 3 (2001). 445. Guanyu Jinzhi Fei Yixue Xuyao De Taier Xingbie Jianding He Xuanze Xingbie De Rengong Zhongzhi Renshen De Guiding [Regulation Prohibiting Non-Medically

Necessary Sex-Determinations and Sex-Selective Abortions], arts. 9–10 (2002) (effective Jan. 1, 2003) (only available at facilities licensed to perform abortions and must be administered under the supervision and guidance of a physician) (translation by Center for Reproductive Rights); China Reiterates Ban on Abortion Pill Sale, Eastday.com (Shanghai, China), Oct. 11, 2001, http://www.china.org.cn/english/DO-e/20356.htm. 446. MOH & NPFPC, Rules for Birth Control Surgeries, supra note 443, at 65, 82, 90 (Rivanol is used for medical abortions in the second trimester). 447. Id. 448. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, arts. 18(1)–(3) (1994) (effective June 1, 1995). 449. Guanyu Jinzhi Fei Yixue Xuyao De Taier Xingbie Jianding He Xuanze Xingbie De Rengong Zhongzhi Renshen De Guiding [Regulation Prohibiting Non-Medically Necessary Sex-Determinations and Sex-Selective Abortions], art. 7 (2002) (effective Jan. 1, 2003) (“sanctioned” pregnancy is one where a family planning license for reproduction has been issued) (translation by Center for Reproductive Rights). 450. Id.; Anhui Province People’s Congress, Anhuisheng Jinzhi Fei Yixue Xuyao Jianding Taier Xingbie He Xuanze Xingbie Zhongzhi Renshen De Guiding [Regulations on Prohibiting Non-Medically Necessary Sex-Determinations and SexSelective Abortions], art. 9 (2000) (ordered to undergo “long-term birth reduction”) (translation by the Center for Reproductive Rights). Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 451. Guanyu Jinzhi Fei Yixue Xuyao De Taier Xingbie Jianding He Xuanze Xingbie De Rengong Zhongzhi Renshen De Guiding [Regulation Prohibiting Non-Medically Necessary Sex-Determinations and Sex-Selective Abortions], art. 7 (2002) (effective Jan. 1, 2003) (translation by Center for Reproductive Rights); Guiyang Municipality People’s Congress, Guizhou Province People’s Congress, Guizangshi Jinzhi Xuanze Xing Zhongzhi Renshen Guiding [Regulations Prohibiting SexSelective Abortions], arts. 9–10 (2004) (effective Jan.1, 2005) (translation by the Center for Reproductive Rights); Hunan Province People’s Government, Hunansheng Jinzhi Fei Yixue Xuyao Jianding Taier Xingbie He Xuanze Xingbie Zhongzhi Renshen Guiding [Regulations Prohibiting Non-Medically Necessary SexDeterminations and Sex-Selective Abortions], Order No. 194, arts. 11–14 (2004) (effective Mar. 1, 2005) (requires verification of threat to women’s life or health by two physicians) (translation by the Center for Reproductive Rights); Anhui Province People’s Congress, Anhuisheng Jinzhi Fei Yixue Xuyao Jianding Taier Xingbie He Xuanze Xingbie Zhongzhi Renshen De Guiding [Regulations on Prohibiting Non-Medically Necessary Sex-Determinations and Sex-Selective Abortions], art. 9 (2000) (also allows abortion to comply with provincial population and family planning department regulations) (translation by the Center for Reproductive Rights); FuJian Province People’s Congress, Fujiansheng Jinzhi Fei Yixue Xuyao Jianding Taier Xingbie He Xuanze Xingbie Zhongzhi Renshen Tiaoli [Regulations Prohibiting Non-Medically Necessary Sex-Determinations and Sex-Selective Abortions] art. 8(4) (2003) (allows for abortion if divorced or widowed). See also China Intends to Redress Sex Ratio Imbalance by Amending Criminal Law, supra note 441 (NPFPC statistics indicate 29 provinces, autonomous regions and municipalities have local rules banning sex identification and sex-selective abortions). 452. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 19 (1994) (effective June 1, 1995). 453. Id. 454. Id. art. 36. 455. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 17 (2001) (effective Sept. 1, 2002). 456. See Abortion Dispute Unveils Contradictions in Law, Eastday.com (Shanghai, China), Sept. 18, 2002, http://www.china.org.cn/english/2002/Sep/43485.htm (hospital refused to perform abortion without husband’s consent, the abortion was performed only when she falsified her status as single, estranged husband brought suit against his wife on the basis that his right to decide whether or not to abort the fetus was ignored). 457. UNFPA, Abortion Policies, supra note 437, at 95-96. 458. Id. 459. Jihua Shengyu Jishu Fuwu Guanli Tiaoli [Regulations for the Management of Family Planning Technical Services], State Council Order No. 428, arts. 7(3), 8(3), 9(4), 10(1) (2004) (translation by Center for Reproductive Rights). 460. See Population and Family Planning Law of the P.R.C., Presidential Order No. 63, arts. 4, 36, 39, 44 (2001) (effective Sept. 1, 2002) (family planning personnel “shall perform their … duties strictly in accordance with law, and enforce the law in a civil manner, and they may not infringe upon legitimate rights and interests of citizens”) (criminal, administrative penalties and/or heavy fines for state functionaries who illegally perform a family planning procedure on another person, “infringe[] on a citizen’s personal rights … [or] abuse his power … ”) (citizens may sue state family planning agencies for infringement of their legitimate rights and interests); See also State Indemnity Law of the P.R.C., Presidential Order No. 23, art. 2 (1994) (effective Jan. 1, 1995) (citizens may sue officials for infringement of their rights); U.S. Department of State, Country Reports on Human Rights Practices 2004, supra note 362 (senior government officials and several NPFPC circulars repeatedly state that family planning officials are prohibited from coercing women into sterilizations or abortions). 461. U.S. Department of State, Country Reports on Human Rights Practices 2004, supra note 362. 462. Id. 463. Id. (Seven provinces require abortions and ten provinces require unspecified

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“remedial measures” for pregnancies in violation of family planning regulations). E.g. Anhui Province People’s Congress, Anhuisheng Jinzhi Fei Yixue Xuyao Jianding Taier Xingbie He Xuanze Xingbie Zhongzhi Renshen De Guiding [Regulations on Prohibiting Non-Medically Necessary Sex-Determinations and Sex-Selective Abortions], art. 10 (2000) (“pregnancies not in accordance with reproductive laws should be immediately aborted”) (translation by Center for Reproductive Rights). 464. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, A Joint Assessment of HIV/AIDS Prevention,Treatment and Care in China 1 (2003) (survey conducted by the China Center for Disease Control and Prevention and supported by World Health Organization (WHO), The Joint United Nations Programme on HIV/AIDS (UNAIDS) and U.S. Center for Disease Control). 465. Id. at 11. 466. Id. at 9–10 (referring to data from the China HIV/AIDS Case Report, December 2002). 467. Id. at 9–10, 12; Edmund Settle, Legalize Prostitution in China, South China Morning Post (Hong Kong), July 29, 2004. 468. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 12. 469. Id. at 11. 470. Id. at 14. 471. Id. at 10. 472. Id. at 13–14. 473. Id. 474. Id. at 14. In a social attitude survey, 75% of respondents reported avoiding contact with people with HIV/AIDS, 30% thought they belonged in closed sanatoriums, 88% though they should be isolated from society and 45% believed that HIV/AIDS resulted from low morals. Id. 475. Xiao Tang, Blushing in the Dark, 43 Beijing Review 26, 26–27 (2004), http://www. bjreview.com.cn/200443/Nation-200443(A).htm; Edmund Settle, Yes, Gay Men are at Risk in China, International Herald Tribune, Jan. 21, 2005, http://www.iht.com/ bin/pring_ipub.php?file=/articles/2005/01/20/opinion/edsettle.html. 476. Xiao Tang, supra note 475, at 26–27 (e.g. Zhejiang Provincial Health Bureau and the Howard Brown Health Center offers free HIV testing and counseling at gay entertainment venues); Edmund Settle, Yes, Gay Men are at Risk in China, supra note 475. 477. A Battle of Survival for AIDS Orphans, China Daily, Dec. 29, 2004, http://www. china.org.cn/english/features/aids/116227.htm (UNICEF estimates and estimates by China Center for Disease Control). 478. Law on the Prevention and Treatment of Infectious Diseases, Presidential Order No. 15, art. 1 (1989), amended by Presidential Order No. 17 (2004) (translated by Center for Reproductive Rights). 479. Id. art. 12. 480. Id. art. 39(3) (HIV/AIDS and STIs are considered class B infectious diseases). 481. Id. arts. 3, 31, 33 (STIs addressed in the Law include, among others, gonorrhea, syphilis, hepatitis) (reports are forwarded to the local health department, the local people’s government, and the superseding health department). 482. Id. art. 16 (prohibited jobs are determined by the central government and the Ministry of Health). 483. Criminal Law of the P.R.C., art. 330 (1997), amended by Presidential Order No. 32, art. 330 (2005). 484. Law on the Prevention and Treatment of Infectious Diseases, art. 77 (1989), amended by Presidential Order No. 17 (2004) (translated by Center for Reproductive Rights). 485. Rules for the Implementation of Frontier Health and Quarantine Law of the P.R.C., State Council Order of Feb. 10, 1989, art. 6 (1989). 486. Id. art. 99; Rules Governing the Implementation of the Law of the P.R.C. on the Entry and Exit of Aliens, State Council Order of July 13, 1994, art. 7(4) (1994). 487. Criminal Law of the P.R.C., art. 332 (1997), amended by Presidential Order No. 32 (2005) (also punishable by criminal detention by the local public security organ up to six months). 488. Blood Donation Law of the P.R.C., Presidential Order No. 93, art. 1 (1997) (effective Oct. 1, 1998). 489. Id. arts. 8–10. 490. Id. art. 9; Notice on the Administration of HIV Positive People and Patients, supra note 287, art. 3(2)(5) (prohibits HIV positive people and patients from donating blood). 491. Xueyi Zhipin Guanli Tiaoli [Regulations on the Management of Blood Products], State Council Order of Dec. 30, 1996, art. 1 (1996). 492. Criminal Law of the P.R.C., art. 333 (1997), amended by Presidential Order No. 32 (2005). 493. See Rupert Wingfield Hayes, China Court Orders AIDS Compensation, Sept. 11, 2001, http://news.bbc.co.uk/2/hi/asia-pacific/1536876.stm (the Jiangsu Provincial People’s Court ordered a hospital to pay CNY 1 million in compensation to the patient’s family). 494. See Law on the Prevention and Treatment of Infectious Diseases, art. 3 (1989), amended by Presidential Order No. 17 (2004) (list of infectious diseases). 495. Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, art. 9 (1994) (effective June 1, 1995). 496. Hunyin Dengji Tiaoli [Regulation on Marriage Registration], State Council Order No. 387 (2003) (translation by Center for Reproductive Rights). 497. Official: HIV Carriers Have Right to Marry, China Daily, Nov. 28, 2002, http:// service.china.org.cn/link/wcm/Show_Text?info_id=113348&p_qry=marriage (various news agencies reported that persons living with HIV/AIDS cannot get marriage

WOMEN OF THE WORLD:

certificates in the provinces of Hunan and Jiangsu). 498. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 20. 499. State Council, Government of the P.R.C.,The China Medium and Long Term Plan for HIV/AIDS Prevention (CMLTP) 1998-2010, Doc. No. 38, sec. 4 (Nov. 12, 1998), http://www.unchina.org/unaids/ekey15.html. 500. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 18. 501. State Council, Government of the P.R.C.The China HIV/AIDS Containment, Prevention and Control Action Plan (2001-2005), pmbl. (2001), http://www.unchina.org/unaids/ekey16.html. 502. Id. secs. I(2)–(4). 503. Id. sec. II(2). 504. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 18–19. 505. Id. at 21. Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 506. Yiwu Renyuan Aizibing Bingdu Zhiye Pulu Fanghu Gongzuo Jiaodao Yuanze (Shixing) [Principles for Prevention and Protection of Medical Personnel to HIV Exposure], Ministry of Health Order of June 4, 2004, arts. 1–19 (2004). 507. China Enhances Efforts to Prevent Mother-to-Child AIDS Transmission, People’s Daily, Nov. 9, 2004, http://english.peopledaily.com.cn/200411/09/eng20041109_163213.html. 508. Zhang Fujie, Chinese Center for Disease Control and Prevention & National Center for AIDS/STD Prevention and Control, Progress of the China National Free Antiretroviral Therapy Program 17–18 (2003) (powerpoint presentation). 509. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 23 (the exemption period began in 2002). 510. Id. at 23 (the State Food and Drug Commission set up a fast track system for ARVs) 511. Id. 512. Ministry of Health, Suggestions Concerning HIV Prevention by Promotion of Condom Use, supra note 354, §§ 1, 3(1) (free condoms distributed by MOH and NPFPA); China to Issue Condoms Nationwide, supra note 387. 513. Notice on the Administration of HIV Positive People and Patients, supra note 287, art. 3(4)(2). 514. Id. art. 3(4)(3). 515. Id.; Nation to Invest Hugely in HIV/AIDS Prevention, Control, Xinhua News Agency (China), Sept. 8, 2004, http://english1.people.com.cn/200409/08/print_ 20040908_156265.html; Xiao Tang, supra note 475, at 26–27 (free HIV testing for gay men is offered by Guangdong and Zhejiang provincial governments). 516. State Council, Government of the P.R.C., Notice on Strengthening HIV/ AIDS Prevention and Control, Doc. No. 7, sec. II ¶ 2 (2004) [hereinafter Notice on Strengthening HIV/AIDS Prevention and Control]. 517. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 27. 518. Zhang Fujie, supra note 508, at 6; Notice on Strengthening HIV/AIDS Prevention and Control, supra note 516, sec. VI ¶ 1 (free education for AIDS orphans) (program is co-sponsored by the China Family Welfare Fund). 519. Ministry of Health, Government of the P.R.C., Guanyu Jibing Yufang Kongzhi Tixi Jianshe De Ruogao Guiding [Regulations Concerning the Establishment of Disease Prevention and Control System], Order No. 40, art. 9 (2005); Zhang Fujie, supra note 508, at 6; E.g. The Shenzhen Municipal Center for Disease Control and Prevention provides counseling, prevention advice, clinical treatment and follow-up for HIV/AIDS patients. HIV Infections Jump by 180% in Shenzhen, Shenzhen Daily (China), Mar. 30, 2005, http://news.xinhuanet.com/ english/2004-03/30/content_2762002.htm. 520. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 23 (referring to the MOH’s “Guidelines for Management of ARV Drugs Used on HIV/AIDS (Temporary)”); Zhang Fujie, supra note 508, at 7–10. 521. Notice on Strengthening HIV/AIDS Prevention and Control, supra note 516, sec. II(1) ¶ 2. 522. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 25. 523. Id. at 22. 524. Id. at 25. 525. Id. at 19, 22 (among the departments involved are the Ministry of Justice, the Trade Unions, the Women’s Federation, the Youth League and the Ministry of Education). 526. Ministry of Health, Suggestions Concerning HIV Prevention by Promotion of Condom Use, supra note 354, §§ 2, 3(1); Beijing Promotes Condom Use to Fight HIV/AIDS, People’s Daily (China), Nov. 25, 2004, http://english1.people.com. cn/200411/25/print20041125_165078.html. 527. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 22. 528. Notice on Strengthening HIV/AIDS Prevention and Control, supra note 516, sec. II(1) ¶ 4. 529. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 22; Notice on Strengthening HIV/AIDS Prevention and Control, supra note 516, sec. II(1) ¶ 5. Migrant workers are also referred to as “floating population” which comprises mainly of redundant workers from rural areas that migrated to urban cities for employment.

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530. Ministry of Health & U.N.Theme Group on HIV/AIDS in China, supra note 464, at 22. 531. Notice on the Administration of HIV Positive People and Patients, supra note 287, arts. 1(2), 3(2)(1). 532. Id. art. 3(2)(1). 533. Id. art. 2(4). 534. Notice on Strengthening HIV/AIDS Prevention and Control, supra note 516, sec. VI. 535. Notice on the Administration of HIV Positive People and Patients, supra note 287, art. 3(2)(2). 536. Official: HIV Carriers Have Right to Marry, supra note 497. 537. A Battle of Survival for AIDS Orphans, supra note 477; More Concern Over Orphans of AIDS Victims, Xinhua News Agency (China), June. 25, 2005, http://www.china.org. cn/english/2005/Jun/133167.htm (40 schools, hotels and hostels in Beijing refused to host AIDS orphans and no action was taken by the government against these facilities). China Hotels, Schools Turn Away AIDS Orphans, Radio Free Asia, Aug. 12, 2004, http://www.rfa.org/english/news/social/2004/08/12/143552/ (reports of local officials detaining and harassing organizers of schools and orphanages for AIDS orphans). 538. Sexual Health Center for Young People Opens, Xinhua News Agency (China), Oct. 25, 2005, http://www.china.org.cn/english/China/78348.htm (referring to the fifth national census in 2000). 539. See Regional Office for the Western Pacific,World Health Organization (WHO), Demographic Tables for the Western Pacific Region 2005-2010, tlb.4a, at 175, 179, 181 (2005), http://www.wpro.who.int/information_sources/databases/ demographic_tables/ (last visited Sept. 2, 2005). 540. Programme of Action of the International Conference on Population and Development, supra note 173, paras. 7.46–7.47; Beijing Declaration and Platform for Action, Fourth World Conference on Women, supra note 173, paras. 107(e), 108(k); Twenty-first special session of the General Assembly for an overall review and appraisal of the implementation of the Programme of Action of the International Conference on Population and Development: Report of the Secretary-General, paras. 73(a), (e), U.N. GAOR, 54th Sess., Agenda Item 99 (h), U.N. Doc. A/54/442 (1999), http://www.un.org/popin/unpopcom/32ndsess/gass/54442e.pdf. 541. China Internet Information Center, Beijing Hospital to Host Nation’s First Teen-age Health Outpatient Service (Feng Shu trans., 2002), http://www. china.org.cn/english/2002/Feb/27758.htm (last visited Aug. 10, 2005). 542. Id. 543. Sexual Health Center for Young People Opens, supra note 538 (teen sexual health center opens in Qingdao, Shandong Province); Health Services Grow to Meet Increase in Teen Pregnancies, People’s Daily (China), Aug. 7, 2003, http://english1.people.com. cn/200308/07/eng20030807_121839.shtml (clinic for pregnant teenagers in Chengdu, Sichuan Province); Abortion Center Opens to Help Girls, Xinhua News Agency (China), Dec. 3, 2003, http://www.china.org.cn/english/China/81451.htm (abortion/maternity clinics in Chongqing municipality, Hangzhou, Jinan, Harbin). 544. Rachel Hou, Funded Abortion Program Receives Little Interest, Shanghai Daily News, Oct. 26, 2004, http://english.eastday.com/eastday/englishedition/specials/node20814/ userobject1ai608117.html; Sexual Health Center for Young People Opens, supra note 538; Health Services Grow to Meet Increase in Teen Pregnancies, supra note 543 (“confidentiality is the guiding principle of the agency”); Abortion Center Opens to Help Girls, supra note 543 (permits anonymous abortions for minors). 545. CFPA Development Strategy (1996-2010), supra note 380. 546. Country Programme outline for China, supra note 212, para. 9. 547. Id. 548. Id. 549. Id. para. 10. 550. Id. 551. Id. 552. International Federation of Red Cross and Red Crescent Societies, Program Update No. 1: China 3–5 (2005); David Parker, United Nations Children’s Fund (UNICEF) Beijing, Adolescent and Youth Related Programs Supported by UNICEF in China, http://www.acyf.org.cn/e_doc/viewpoint/26.htm (last visited June 24, 2005). 553. Parker, supra note 552. 554. International Federation of Red Cross and Red Crescent Societies, supra note 552, at 3. 555. More Concern Over Orphans of AIDS Victims, supra note 537; A Battle of Survival for AIDS Orphans, supra note 537. 556. Communist Party of China Central Committee & the State Council of the P.R.C., Decision on Strengthening Population and Family Planning Work and Stabilizing Low Birth Rate, Zhong Fa No. 8, art. 5 (2000), reprinted in U.S. Department of Justice, Chinese State Birth Planning in the 1990s and Beyond, supra note 375, at 177–186; Nancy E. Riley, supra note 372, at 11. 557. Nancy E. Riley, supra note 372, at 12. 558. Id. 559. Id. 560. Id. 561. Id. 562. Id. 563. Id. at 13 (quoting Edwin A. Wincker, Chinese Reproductive Policy at the Turn of the Millennium: Dynamic Stability, 28 Population & Dev. Rev. 399, 399–403 (2002)). 564. Id. at 17–20.

565. Lawmakers Call on Ban of Fetus Sex, Xinhua News Agency (China), Feb. 27, 2005, http://www.chinadaily.com.cn/english/doc/2005-02/27/content_419843.htm. 566. Id. 567. China Statistical Yearbook 2003, supra note 134, ch. 4-2, at 97 (birth rates reflect the average annual number of births during a year per 1,000 persons in the population). 568. China Statistical Yearbook 2003, supra note 134, ch. 4-12, at 111 (figures vary between regions with a low of 0.73 in Beijing and a high of 1.46 in Ningxia). 569. United Nations Population Fund (UNFPA), UNFPA Global Reach: China Overview, http://www.unfpa.org/profile/china.cfm?Section=1 (last visited Apr. 1, 2005); Zhang Weiqing, supra note 341. 570. Zhang Weiqing, supra note 341. 571. Communist Party of China Central Committee & the State Council of the P.R.C., Decision on Strengthening Population and Family Planning Work and Stabilizing Low Birth Rate, Zhong Fa No. 8, art. 5 (2000), reprinted in U.S. Department of Justice, Chinese State Birth Planning in the 1990s and Beyond, supra note 375, at 177–186; Nancy E. Riley, supra note 372, at 12. 572. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 2 (2001) (effective Sept. 1, 2002). 573. National Population and Family Planning of China (NPFPC), Government of the P.R.C., Panorama: Future Goals, http://www.npfpc.gov.cn/en/fpcn04en.htm (last visited Mar. 31, 2005). 574. Population and Family Planning Law of the P.R.C., Presidential Order No. 63 (2001) (effective Sept. 1, 2002). 575. Id. art. 1. 576. Id. art. 18. 577. Guangdong Provincial People’s Congress, Guangdongsheng Renkou Yu Jihuashengyu Tiaoli [Guangdong Province Population and Family Planning Regulations], arts. 19, 22 (2002); Hubei Provincial People’s Congress, Hubeisheng Renkou Yu Jihuashengyu Tiaoli [Hubei Province Population and Family Planning Regulations], art. 19 (2003); Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], arts. 18–19 (2004); Anhui Provincial People’s Congress, Anhuisheng Renkou Yu Jihuashengyu Tiaoli [Anhui Province Population and Family Planning Regulations], art. 20 (2002) (amended 2004); Jiangsu Provincial People’s Congress, Jiangsusheng Renkou Yu Jihuashengyu Tiaoli [Jiangsu Province Population and Family Planning Regulations], arts. 22–24 (2004); Shanghai Municipal People’s Congress, Shanghaishi Renkou Yu Jihuashengyu Tiaoli [Shanghai Municipal Population and Family Planning Regulations], arts. 25–28 (2003); Jilin Provincial People’s Congress, Jilinsheng Renkou Yu Jihuashengyu Tiaoli [Jilin Province Population and Family Planning Regulations], arts. 20–25 (2003); Beijing Municipal People’s Congress, Beijingshi Renkou Yu Jihuashengyu Tiaoli [Beijing Municipal Population and Family Planning Regulations], arts. 17–18 (2003); Tianjin Provincial People’s Congress; Tianjinsheng Renkou Yu Jihuashengyu Tiaoli [Tianjin Province Population and Family Planning Regulations], arts. 16–18 (2003). 578. Nancy E. Riley, supra note 372, at 19–20. 579. Communist Party of China Central Committee & the State Council of the P.R.C., Decision on Strengthening Population and Family Planning Work and Stabilizing Low Birth Rate, Zhong Fa No. 8, art. 5 (2000), reprinted in U.S. Department of Justice, Chinese State Birth Planning in the 1990s and Beyond, supra note 375, at 177–186. 580. Tenth Five-Year Plan for National Economic and Social Development (2001-2005), supra note 393. As non-residents of the urban district, migrants have limited access to housing, health care and other social benefits. 581. Information Office of the State Council, Government of the P.R.C., Introduction about the System of Social Support for Some Rural Families Practicing Family Planning (2005), http://www.npfpc.gov.cn/en/en2005-06/ enews20050314-2.htm; Pan Guiyu, Speech at the Press Conference on the System of Social Support for Some Rural Families Practicing Family Planning (June 9, 2005) (transcript available at http://www.npfpc.gov.cn/en/en2005-06/enews20050614.htm) (Mme. Pan is the Minister of that NPFPC). 582. System of Social Support for Some Rural Families Practicing Family Planning, supra note 581. 583. ‘Care for Girls’ Gaining Momentum, China Daily, June 7, 2004, http://www. chinadaily.com.cn/english/doc/2004-07/08/content_346700.htm; Women of China, China Faces Shortage of Girls (Zhang Ze & Christina Lionnet, eds.), http://www. womenofchina.com.cn/WOC/ShowArticle_En.asp?ID=1513&BigClassId=1 (last visited July 5, 2005). 584. ‘Care for Girls’ Gaining Momentum, supra note 583; Women of China, supra note 583. 585. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, arts. 23–29 (2001) (effective Sept. 1, 2002). 586. Id. art. 41. 587. Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], arts. 45(5)–(6) (2004); Beijing Provincial People’s Government, [Beijingshi Shehui Fuyang Fei Zhengshou Guanli Banfa [Beijing Province Measures on the Administration of Social Compensation Fees Collection], art. 5(4) (2002). 588. See Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations],

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art. 45 (2004) (one-half to ten times annual income); Beijing Provincial People’s Government, Beijingshi Shehui Fuyang Fei Zhengshou Guanli Banfa Beijing Province Measures on the Administration of Social Compensation Fees Collection], art. 5 (2002) (one-fifth to ten times annual income). 589. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 41 (2001) (effective Sept. 1, 2002). E.g. Beijing Provincial People’s Government, Beijingshi Shehui Fuyang Fei Zhengshou Guanli Banfa [Beijing Province Measures on the Administration of Social Compensation Fees Collection], arts. 11–12 (2002) (payment within 30 days or 2% monthly interest). 590. Population and Family Planning Law of the P.R.C., Presidential Order No. 63, art. 42 (2001) (effective Sept. 1, 2002). 591. Id. 592. Information Office of the State Council, Government of the P.R.C., National Minorities Policy and its Practice in China, ch. 5 (Dec. 28, 2000), http://www.china.org.cn/e-white/4/index.htm [hereinafter National Minorities Policy and its Practice in China]. 593. Id. 594. See Population and Family Planning Law of the P.R.C., Presidential Order No. 63, arts. 4–13 (2001) (effective Sept. 1, 2002). 595. See Liaoning People’s Congress, Liaoningsheng Renkou Yu Jihuashengyu Tiaoli [Liaoning Province Population and Family Planning Regulations], art. 49 (2004). 596. U.S. Department of Justice, Chinese State Birth Planning in the 1990s and Beyond, supra note 375, at 75. 597. National Population and Family Planning Commission of China (NPFPC), Government of the P.R.C., Institutional Chart, http://www.npfpc.gov.cn/en/ inst1.htm (last visited Feb. 28, 2005). 598. National Population and Family Planning Commission of China (NPFPC), Government of the P.R.C., Organizational Structure of the NPFPC, http:// www.npfpc.gov.cn/en/inst2.htm (last visited Mar. 31, 2005). 599. Id. 600. U.S. Department of Justice, Chinese State Birth Planning in the 1990s and Beyond, supra note 375, at 75. 601. Id. at 76. 602. National Population and Family Planning Commission of China (NPFPC), Government of the P.R.C., China’s NGOs on Population and Family Planning, http://www.npfpc.gov.cn/en/inst3.htm (last visited Mar. 31, 2005). 603. Country Programme outline for China, supra note 212, para. 7; Don Hinrichsen, China’s Quiet Revolution in Reproductive Health, People & the Planet, Jan. 7, 2004, http://www.peopleandplanet.net/pdoc.php?id=309. 604. Xianfa [Constitution], arts. 33, 48 (2004). 605. Id. art. 48 (2004). 606. Id. art. 49 (2004). 607. Concluding observations of the Committee on the Elimination of Discrimination Against Women: China, Committee on the Elimination of Discrimination against Women, 20th Sess., paras. 254, 272, U.N. Doc . A/54/38 (1999); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 2 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 608. Edmund Settle, Yes, Gay Men are at Risk in China, supra note 475 (e.g. director of the National Institute of Health Education was dismissed in 1993 for promoting gay civil rights). 609. National Working Committee on Children and Women (NWCCW), Government of the P.R.C., NWCCW under the State Council: About Us, http://www.cinfo.org.cn/language/english/aboutus/001.jsp (last visited Feb. 28, 2005) [hereinafter NWCCW, About us] 610. Id. 611. Id.; See also Committee on Economic, Social and Cultural Rights, Initial report of State parties: China, supra note 171, at 9–10. 612. NWCCW, About Us, supra note 609. 613. Id. 614. All-China Women’s Federation (ACWF), Facts and Data, http://www.women. org.cn/english/english/fact/mulu.htm (last visited June 22, 2005). 615. All-China Women’s Federation (ACWF), Brochure 2003, supra note 147. 616. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 7 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 617. Chen Li Ping, supra note 149. 618. All-China Women’s Federation (ACWF), Organizational System, http:// www.women.org.cn/english/english/aboutacwf/orgsystr.htm (last visited Mar. 18, 2005). 619. Id. 620. East Asia Environment and Social Development Unit,The World Bank, China Country Gender Review 12 (2000). 621. Nationality Law of the P.R.C., Order No. 8 (1980). 622. Xianfa [Constitution], art. 49 (2004); General Principles of the Civil Law of the P.R.C., Presidential Order No. 37, arts. 103–104 (1986) (effective Jan. 1, 1987); Marriage Law of the P.R.C., art. 25 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 44 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 623. Xianfa [Constitution], art. 49 (2004). 624. Marriage Law of the P.R.C., arts. 2–3, 5 (2001); Law of the P.R.C. on the Protection

WOMEN OF THE WORLD:

of Rights and Interests of Women, arts. 43–44 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 625. Marriage Law of the P.R.C., art. 1 (2001). 626. Id. art. 6. 627. Law of the P.R.C. on the Protection of Minors, art. 11 (1991) (effective Jan. 1, 1992). 628. Marriage Law of the P.R.C., art. 6 (2001); Population and Family Planning Law of the P.R.C, Presidential Order No. 63, art. 25 (2001) (effective Sept. 1, 2002). 629. Xianfa [Constitution], art. 49 (2004); Marriage Law of the P.R.C., art. 5 (2001); General Principles of the Civil Law of the P.R.C., Presidential Order No. 37, art. 103 (1986) (effective Jan. 1, 1987). 630. Marriage Law of the P.R.C., art. 11 (2001). 631. Supreme People’s Court of the P.R.C. Judicial Committee, Government of the P.R.C., Zuigao Renmin Fayuan Guanyu Shiyong “Zhonghua Renmin Gongheguo Hunyin Fa” Ruogan Wenti De Jieshi (I) [Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I)], art. 10, (2001), http://www.court.gov.cn/lawdata/explain/etc/200303200053.htm (translation by Center for Reproductive Rights) [hereinafter Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I)]. 632. Marriage Law of the P.R.C., arts. 3, 7(1)–(2) (2001). 633. Criminal Law of the P.R.C., art. 257 (1997), amended by Presidential Order No. 32 (2005). Criminal detention is executed by the local police and ranges from 1 to 6 months. Id. arts. 42–43. 634. Id. (this stipulation is waived if the victim was killed). 635. Marriage Law of the P.R.C., art. 30 (2001). 636. Press Briefing, Ministry of Education, Jieshao Xiu “Putong Gaodeng Xuexiao Xuesheng Guanli Guiding” Youguan QingKuang [Introducing the New “Regulations on Management of Higher Education Students”] (Mar. 29, 2005), http://www.edu. cn/20050329/3132615.shtml (translation by Center for Reproductive Rights). 637. Id. 638. Marriage Law of the P.R.C. (2001); Hunyin Dengji Tiaoli [Regulation on Marriage Registration], State Council Order No. 387 (2003) (P.R.C.) (translation by Center for Reproductive Rights). 639. China Not to Legalize Same-Sex Marriages, China Daily, Aug. 20, 2003, http:// www.chinadaily.com.cn/en/doc/2003-08/20/content_256578.htm. 640. Marriage Law of the P.R.C., art. 8 (2001). 641. Hunyin Dengji Tiaoli [Regulation on Marriage Registration], State Council Order No. 387, art. 5 (2003) (P.R.C.) (repealing the 1985 and 1994 Regulations on Marriage Registration) (translation by Center for Reproductive Rights). 642. Regulations on Marriage Registration, arts. 9–10 (1985) (repealed 2003); Law of the P.R.C. on Maternal and Infant Health Care, Presidential Order No. 33, arts. 7–13 (1994) (effective June 1, 1995); Zhonghua Renmin Gongheguo Muying Baojian Fa Shishi Banfa [Implementation Measures for the P.R.C. Law on Maternal and Infant Health Care], State Council Order No. 308, arts. 3(2), 9–16 (2001) (translation by Center for Reproductive Rights). 643. Jiehunzheng Lihunzheng Jiang Tongyi Wei Shenhongse Bianxingren Dengji Shou Baozheng [Marriage and Divorce Licenses to be Uniformly Dark Red, Transgender People’s Marriage Registration Protected], Sina (China), Sept. 25, 2005, http://news.sina.com. cn/c/2003-09-25/1438819299s.shtml (translation by Center for Reproductive Rights). 644. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 47 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 645. Marriage Law of the P.R.C., arts. 17, 19 (2001). 646. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, arts. 17(1)–(2). 647. Marriage Law of the P.R.C., arts. 4, 13 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 43 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 648. Marriage Law of the P.R.C., art. 15 (2001). 649. Id. arts. 16, 21, 23. 650. Id. art. 20. 651. Id. art. 50. 652. National Minorities Policy and Its Practice in China, supra note 592, ch. 3. 653. Marriage Law of the P.R.C., arts. 31–32 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 44 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 654. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 23. 655. Marriage Law of the P.R.C., art. 34 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 45 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 656. Marriage Law of the P.R.C., art. 34 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 45 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 657. Marriage Law of the P.R.C., art. 34 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 45 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 658. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 5(1). 659. Marriage Law of the P.R.C., art. 31 (2001). 660. Id. art. 32. 661. Id.

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662. Civil Procedure Law of the P.R.C., Presidential Order No. 44, arts. 21, 62 (1991). 663. Supreme People’s Court of the P.R.C. Judicial Committee, Government of the P.R.C., Zuigao Renmin Fayuan Guanyu Shiyong “Zhonghua Renmin Gongheguo Hunyin Fa” Ruogan Wenti De Jieshi (II) [Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (II)], arts. 11(a), (c), 19 (2003) (effective Apr. 1, 2004), http://www.court.gov.cn/lawdata/ explain/civilcation/200312290019.htm (translation by Center for Reproductive Rights) [hereinafter Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (II)]. 664. Id. art. 22. 665. Marriage Law of the P.R.C., art. 19 (2001). 666. Id. art. 39. 667. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 48 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 668. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 41 (1992). 669. Id. art. 41. 670. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 47 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 671. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (II), supra note 663, art. 27; Marriage Law of the P.R.C., art. 42 (2001). 672. Marriage Law of the P.R.C., art. 46 (2001). 673. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, arts. 30(1), 31(2); Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (II), supra note 663, art. 27. 674. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 29. 675. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (II), supra note 663, arts. 8–9. 676. Marriage Law of the P.R.C., art. 47 (2001). 677. Id. art. 48; Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 32. 678. General Principles of the Civil Law of the P.R.C., Presidential Order No. 37, art. 147 (1986) (effective Jan. 1, 1987). 679. Id. art. 148. 680. Supreme People’s Court of the P.R.C. Judicial Committee, Zuigao Renmin Fayuan Guanyu Renmin Fayuan Shouli Shenqing Chengren Waiguo Fayuan Lihun Panjue Anjian Youguan Wenti De Guiding [Regulations Concerning the Question of Recognition of Foreign Divorces in People’s Courts], arts. 1–3 (1999) (effective Mar. 1, 2000), http://www.court.gov.cn/lawdata/explain/etc/200303200124. htm. 681. Law of the P.R.C. on the Protection of Rights and Interests of Women, arts. 48, 50 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 682. Marriage Law of the P.R.C., art. 36 (2001). 683. Id.; Law of the P.R.C. on the Protection of Minors, art. 45 (1991) (effective Jan. 1, 1992). 684. Marriage Law of the P.R.C., art. 36 (2001). 685. Id. art. 30; Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 21. 686. Marriage Law of the P.R.C., art. 37 (2001). 687. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 32; Regulations on Legal Aid, State Council Standing Committee Order of July 17, 2003, art. 10(4) (2003). 688. Marriage Law of the P.R.C., art. 38 (2001). 689. Id. art. 38. 690. Id. arts. 26, 38. 691. Adoption Law of the P.R.C., art. 4 (1998). 692. Id. art. 10. 693. Id. art. 11. 694. Id. art. 10. 695. Id. art. 18. 696. Marriage Law of the P.R.C., art. 50 (2001). 697. CEDAW Committee, Third and fourth periodic reports of State parties: China, supra note 150, Part II, art. 16(c). 698. General Principles of the Civil Law of the P.R.C., Presidential Order No. 37, arts. 75–76, 105 (1986) (effective Jan. 1, 1987). 699. Law of the P.R.C. on the Protection of Rights and Interests of Women, arts. 32, 33 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 700. Id. art. 34–35. 701. Law of Succession of the P.R.C., Presidential Order No. 24, art. 9 (1985). 702. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 34 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights); Law of Succession of the P.R.C., Presidential Order No. 24, art. 10 (1985). 703. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 35 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights); Law of Succession of the P.R.C., Presidential Order No. 24, art. 12 (1985). 704. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 34 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights).

705. Marriage Law of the P.R.C., art. 24 (2001); Law of Succession of the P.R.C., Presidential Order No. 24, arts. 10, 30 (1985); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 34 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 706. Law of the P.R.C. on the Protection of Rights and Interests of Women, arts. 31, 47 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights); Marriage Law of the P.R.C., art. 13 (2001). 707. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 47 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 708. Marriage Law of the P.R.C., art. 13 (2001). 709. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 32–33 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights); Zhonghua Renmin Gongheguo Nongcun Tude Chengbao Fa [P.R.C. Rural Land Contract Law], Presidential Order No. 73, art. 30 (2002). 710. Zhonghua Renmin Gongheguo Nongcun Tude Chengbao Fa [P.R.C. Rural Land Contract Law], Presidential Order No. 73, arts. 3, 5, 20 (2002) (these bodies include rural economic cooperatives, villagers’ committees) (all land belongs to the government and the right to land is contracted to citizens for 30 to 70 years); Nongcun Funu Tude Chengbaoquan Weiti De Zhidao Fenzi [Rural Women’s Land Succession Rights Policy Analysis], Zhongguo Funu Wang [China Women’s Network], Sept. 17, 2002, http:// www.china.org.cn/chinese/funv/205567.htm. 711. Zhonghua Renmin Gongheguo Nongcun Tude Chengbao Fa [P.R.C. Rural Land Contract Law], Presidential Order No. 73, art. 6 (2002). 712. Nongcun Funu Tude Chengbaoquan Weiti De Zhidao Fenzi [Rural Women’s Land Succession Rights Policy Analysis], Zhongguo Funu Wang [China Women’s Network], Sept. 17, 2002, http://www.china.org.cn/chinese/funv/205567.htm. 713. China’s Human Rights Progress 2003, supra note 410, ch. 5. 714. Id. 715. Xianfa [Constitution], art. 42 (2004). 716. Id. art. 48. 717. Labour Law of the P.R.C., Presidential Order No. 28, art. 46 (1994) (effective Jan. 1, 1995). 718. Id. arts. 12–13. 719. Id. art. 13 (unsuitable as stipulated by the government). 720. Id. arts. 13, 59–63. 721. Id. art. 59 (prohibition on work with Grade IV physical labor intensity). 722. Jiang Jing Jing, Nuzhigong Weiquan Zhuanxiang Yiju Tuixing, Nuzhigong Yunji Bude Jiang Gongzi [Promoting Protections of Female Workers Rights, Prohibit Cutting Salary of Pregnant Female Workers], Jin Ling Wan Bao (Nanjing, P.R.C.), Mar. 18, 2005, http:// www.china.org.cn/chinese/funv/814908.htm (referring to Nuzhigong Quanyi Baohu Zhuanxiang Xieyi [Nanjing Agreement for the Protection of Female Workers’ Rights and Interests] promulgated by the Nanjing People’s Congress on Dec. 22, 2004). 723. Regulations Concerning Labor Protection of Female Staff and Workers, State Council Order of July 21, 1988, art. 4 (1988); Labour Law of the P.R.C., Presidential Order No. 28, art. 29(3) (1994) (effective Jan. 1, 1995). 724. Labour Law of the P.R.C., Presidential Order No. 28, arts. 61, 63 (1994) (effective Jan. 1, 1995) (prohibition on work with Grade III physical labor intensity). 725. Id.; Regulations on Labor Protection in Workplaces Where Toxic Substances are Used, State Council Order No. 352, art. 63 (2002). 726. Regulations Concerning Labor Protection of Female Staff and Workers, State Council Order of July 21, 1988, art. 7 (1988). 727. Id. arts. 7, 9. 728. Id. art. 8. 729. Id. art. 8. 730. Id. art. 8. 731. Id. art. 7; E.g. In Nanjing, female workers are entitled to 11 prenatal visits, each lasting half a day. Jiang Jing Jing, supra note 722 (referring to Nuzhigong Quanyi Baohu Zhuanxiang Xieyi [Nanjing Agreement for the Protection of Female Workers’ Rights and Interests] promulgated by the Nanjing People’s Congress on Dec. 22, 2004). 732. Regulations Concerning Labor Protection of Female Staff and Workers, State Council Order of July 21, 1988, art. 7 (1988); Jiang Jing Jing, supra note 722 (referring to Nuzhigong Quanyi Baohu Zhuanxiang Xieyi [Nanjing Agreement for the Protection of Female Workers’ Rights and Interests] promulgated by the Nanjing People’s Congress on Dec. 22, 2004). 733. Labour Law of the P.R.C., Presidential Order No. 28, art. 73(5) (1994) (effective Jan. 1, 1995). 734. Regulations Concerning Labor Protection of Female Staff and Workers, State Council Order of July 21, 1988, art. 11 (1988). 735. Jiang Jing Jing, supra note 722 (referring to Nuzhigong Quanyi Baohu Zhuanxiang Xieyi [Nanjing Agreement for the Protection of Female Workers’ Rights and Interests] promulgated by the Nanjing People’s Congress on Dec. 22, 2004). 736. Labour Law of the P.R.C., Presidential Order No. 28, art. 95 (1994) (effective Jan. 1, 1995). 737. Id. arts. 92–93, 95. 738. Regulations on Labor Protection in Workplaces Where Toxic Substances are Used, State Council Order No. 352, art. 63 (2002). 739. Labour Law of the P.R.C., Presidential Order No. 28, arts. 77–84 (1994) (effective Jan. 1, 1995); Regulations of the P.R.C. on Settlement of Labour Disputes in Enterprises, arts. 1, 2(1)–(4) (1993). 740. Labour Law of the P.R.C., Presidential Order No. 28, art. 56 (1994) (effective Jan. 1,

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1995). 741. Id. arts. 79–80; Regulations of the P.R.C. on Settlement of Labour Disputes in Enterprises, arts. 6–8 (1993). 742. Regulations of the P.R.C. on Settlement of Labour Disputes in Enterprises, arts. 12–13, 17 (1993). 743. Labour Law of the P.R.C., Presidential Order No. 28, art. 79 (1994) (effective Jan. 1, 1995); Regulations of the P.R.C. on Settlement of Labour Disputes in Enterprises, art. 6 (1993). 744. Law of the P.R.C. on the Protection of Rights and Interests of Women, arts. 22, 24 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 745. Id. art. 23. 746. Id. art. 26. 747. Id. art. 27. 748. Id. art. 27. 749. Trade Union Law of the P.R.C., art. 4 (2001); Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 5 (1992). 750. Id. art. 3. Trade union membership is voluntary and no organization or individual may obstruct or restrict workers’ rights to join a trade union. Id. arts. 2–3. 751. Id. art. 10. 752. Id. art. 22(4). 753. Laodong Baozhang Jiancha Li [Regulation on Labor and Social Security Inspection], State Council Order No. 423, arts. 11(3)–(4), 23(1)–(6) (2004) (P.R.C.) (fines of CNY 1000 to 5000 for each victim) (translation by Center for Reproductive Rights). 754. Law of the P.R.C. on Safety in Mines, Presidential Order No.65, art. 29 (1993). 755. Special Issue of the Ninth National Women’s Congress of China, All-China Women’s Federation (ACWF) Newsl. (ACWF, Beijing, P.R.C.), Sept. 2003, http://www. women.org.cn/english/english/newsletter/September.htm (last visited Feb. 16, 2005). 756. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 27 (2005) (effective Jan. 2006) (translation by Center for Reproductive Rights). 757. Fifth and sixth periodic reports of State parties under Article 18 of the Convention on the Elimination of All Forms of Discrimination Against Women: China, Committee on the Elimination of Discrimination Against Women, at 49, U.N. Doc. CEDAW/C/CHN/5–6 (2004) [hereinafter CEDAW Committee, Fifth and sixth periodic report of State parties: China]. 758. Id. at 49. 759. Wu Xiaoling, An Innovative and Inspiring Experience--Micro Credit Supported Poverty Reduction and Women’s Development in China, Address at Forum on Women’s Financial Education 1–2 (Nov. 2, 2004) (Mme. Wu is the Deputy Governor of the People’s Bank of China). 760. CEDAW Committee, Fifth and sixth periodic report of State parties: China, supra note 757, at 49–50. 761. China’s Human Rights Progress 2003, supra note 410, ch. 5. 762. Id. 763. Id.; NPFPC, Main Achievements, supra note 346. 764. Project Hope Helps 100,000 Dropouts Return to School, Xinhua News Agency (China), Mar. 28, 2005, http://news.xinhuanet.com/english/2005-03/28/content_ 2753718.htm; Zhang Jianmin, All-China Women’s Federation, Be Concerned with Women, http://www.acyf.org.cn/e_doc/CY/19.htm (last visited June 24, 2005). 765. Committee on Economic, Social and Cultural Rights, Initial report of State parties: China, supra note 171, at 10–11. 766. United Nations Educational, Scientific and Cultural Organization (UNESCO) & United Nations Development Programme (UNDP), Assessment of Resources, Best Practices, Gaps in Gender, Science, & Technology in People’s Republic of China 21 (2001), http://www.unesco.or.id/apgest/pdf/china/03-reportchina.pdf. 767. Xianfa [Constitution], art. 46 (2004). 768. Id. art. 49. 769. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 5 (1986); Zhonghua Renmin Gongheguo Jianyu Fa [P.R.C. Education Law], Presidential Order No. 45, art. 9 (1995) (translation by Center for Reproductive Rights). 770. Compulsory Education Law of the P.R.C., Presidential Order No. 38, arts. 2, 5, 7 (1986); Zhonghua Renmin Gongheguo Jianyu Fa [P.R.C. Education Law], Presidential Order No. 45, art. 18 (1995) (translation by Center for Reproductive Rights). 771. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 7 (1986). 772. Id. art. 10 (1986); Zhonghua Renmin Gongheguo Jianyu Fa [P.R.C. Education Law], Presidential Order No. 45, art. 74 (1995) (translation by Center for Reproductive Rights). 773. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 5 (1986); Zhonghua Renmin Gongheguo Jianyu Fa [P.R.C. Education Law], Presidential Order No. 45, art. 56 (1995) (translation by Center for Reproductive Rights). 774. Economic, Social and Cultural Rights, The Right to Education, Report submitted by the Special Rappoteur, Katarina Tomasevski, Addendum: Mission to China, U.N. Commission for Human Rights, 16th Sess., Provisional Agenda Item 10, at 8, U.N. Doc. E/CN.4/2004/45/Add.1 (2003) (figures differentiate between budgetary funds and four other sources: (1) funds of social organizations and citizens, (2) donations and fund-raising, (3) tuition and other fees, and (4) unspecified “other educational funds”) (referring to statistics from the Department of Development & Planning, Ministry of Education, Educational Statistics Yearbook of China, 2001, at 366 (2002)) [hereinafter U.N. Commission for Human Rights, Special Rapporteur Report on the Right to Education in China]. 775. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 12 (1986);

WOMEN OF THE WORLD:

Zhonghua Renmin Gongheguo Jianyu Fa [P.R.C. Education Law], Presidential Order No. 45, art. 57 (1995) (translation by Center for Reproductive Rights); U.N. Commission for Human Rights, Special Rapporteur Report on the Right to Education in China, supra note 774, at 8. 776. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 15 (1986). 777. Id. art. 11; Law of the P.R.C. on the Protection of Minors, art. 9 (1991) (effective Jan. 1, 1992). Parents of children or adolescents who postpone enrollment or wish to be exempt from compulsory schooling must submit an application to the local people’s government for approval. 778. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 11 (1986). 779. Id. art. 15. 780. Id. art. 11; Law of the P.R.C. on Protection of Minors, arts. 28, 49 (1991) (effective Jan. 1, 1992) (illegal to hire minors under age 16, jobs with limited time and intensity permitted for 16-18 year olds). 781. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 15 (1986); Law of the P.R.C. on Protection of Minors, art. 49 (1991) (effective Jan. 1, 1992). 782. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 15 (1986); Law of the P.R.C. on Protection of Minors, art. 49 (1991) (effective Jan. 1, 1992) (illegal to hire minors under age 16). 783. Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 16 (1986). 784. Id. art. 5. 785. Law of the P.R.C. on the Protection of Rights and Interests of Women, arts. 15–16 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 786. Id. art. 18. 787. Id. 788. Id. 789. Higher Education Law of the P.R.C., Presidential Order No. 8, art. 9 (1998). 790. Zhonghua Renmin Gongheguo Jianyu Fa [P.R.C. Education Law], Presidential Order No. 45, art. 36 (1995) (translation by Center for Reproductive Rights); See also Compulsory Education Law of the P.R.C., Presidential Order No. 38, art. 15 (1986). 791. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 17 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 792. Id. arts. 19–20. 793. Vocational Education Law of the P.R.C., Presidential Order No. 69, art. 7 (1996); Law of the P.R.C. on the Protection of Minors, art. 37 (1991) (effective Jan. 1, 1992). 794. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 21 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 795. China Youth Development Foundation (CYDF), Brochure, http://www.cydf. org.cn/gb/english/cydf.zip (last visited Mar. 17, 2005). 796 Id. 797. Id.; Project Hope Helps 100,000 Dropouts Return to School, supra note 764. Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 798. Programme Works to Change the Destiny of the Under Privileged, China Daily, June 08, 2004, at 14, http://www.cydf.org.cn/gb/english/new_08_02.htm. 799. Id.; China Youth Development Foundation (CYDF), Brochure, supra note 795. 800. Programme Works to Change the Destiny of the Under Privileged, supra note 798; One year anniversary of Project Hope’s immigrant workers’ children subsidization program (in Chinese), CYDF Newsletter No. 2 (March 2, 2005), available at http://www.cydf.org. cn/gb/tongxun/database/showfocus.asp?newsid=3467 (last visited Mar. 17, 2005). 801. All-China Youth Federation (ACYF), China Youth Policy and Youth Work, supra note 146. 802. All-China Youth Federation (ACYF), Project Hope Launches Scheme of Study Aid for Urban Migration (Jan. 2004), http://www.acyf.org.cn/e_ info/200401/07.htm. 803. Parker, supra note 552. 804. Id. 805. Zhang Jianmin, supra note 764. 806. Id. 807. Id. 808. Fang-fu Ruan & M.P. Lau, China, in 1 The International Encyclopedia of Sexuality 344, 344–399 (Robert T. Francoeur, ed., 1997), www2.rz.hu-berlin.de/ sexology/gesund/archiv/ies/china.htm; Ying Li et al., Needs and Preferences Regarding Sex Education Among Chinese College Students: A Preliminary Study, 30 Int’l Family Planning Perspectives 128, 128–129 (2004), http://www.agi-usa.org/pubs/journals/3012804.pdf. 809. Fang-fu Ruan & M.P. Lau, supra note 808. 810. Id.; Ying Li et al., supra note 808, at 128–129. 811. Ying Li et al., supra note 808, at 129; Students Find Sex Education Inadequate, China Daily, Apr. 22, 2004, http://www.china.org.cn/english/China/93721.htm. 812. Population and Family Planning Law of the P.R.C, Presidential Order No. 63, art. 13 (2001) (effective Sept. 1, 2002). 813. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 17 (2005) (effective Jan. 2006) (translation by Center for Reproductive Rights). 814. Law of the P.R.C. on the Protection of Minors, art. 13 (1991) (effective Jan 1, 1992). 815. Fang-fu Rang & M.P. Lau, supra note 808. 816. Id. (referring to findings from the Zhongguo Dangdai Xingivenhua - Zhongguo Lian-wanii “Xingwenming” Diaoza Baogao [Sexual Behavior in Modern China - A Report of the Nationwide “Sex Civilization” Survey on 20,000 Subjects in China] which was conducted without any government interference.). 817. Id. (for example, information on sexual positions and nude illustrations were banned

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from textbooks). 818. Id.; Ying Li et al., supra note 808, at 128 (study showed that 47% of students at a large Chinese university had received no school-based education on sexual behavior before college); Students Find Sex Education Inadequate, supra note 811. 819. Yufang Aibibingke Zhongxue Bixu Xiu [HIV/AIDS Prevention Classes Mandatory for High School Students], Jiankang Bu [Health News] (China), Feb. 28, 2005, http://www. nwccw.gov.cn/show/showxwbdNews.jsp?belong=%E6%96%B0%E9%97%BB%E6%8 A%A5%E9%81%93&alias=xwbd_xwbdd&news_id=3572. 820. Jiaoyu Zhidaowang Yao Chutai Liaojie Biyunfa Chang Zhongxuesheng “Biyaoke” [Education Plan Released, Understanding Contraceptive Methods Becomes Mandatory for High School Students], Xin Wen Chen Bu [Morning News] (China), Mar. 15, 2005, http://sh.news.sina.com.cn/20050315/090248480.shtml; HIV/AIDS Prevention Classes Mandatory for High School Students, supra note 819. 821. Tan Yingzi, Sex-ed Text Ready for Use in Classes, China Daily, Sept. 7, 2004, http:// www.chinadaily.com.cn/english/doc/2004-09/07/content_372336.htm. 822. China Issues First Sex Education VCD Series, Xinhua News Agency (China), Mar. 3, 2003, http://www.china.org.cn/english/culture/57172.htm; First Sex Education VCD for Youngsters Released, Xinhua News Agency (China), May 31, 2002, http://www.china. org.cn/english/LI-e/33619.htm. 823. Li Cao, Students to be Lectured on Drugs, AIDS and Sex, China Daily, Dec. 30, 2004, http://www.chinadaily.com.cn/english/doc/2004-12/30/content_404773.htm. 824. Id. 825. Id. 826. Criminal Law of the P.R.C., art. 236 (1997), amended by Presidential Order No. 32 (2005). 827. Id. art. 236. 828. Id. art. 236. 829. Id. art. 17. 830. Id. art. 17. 831. Id. art. 237. 832. Id. art. 237. Criminal Detention is executed by the local public security organ and lasts up to 6 months. Id. arts. 42–43. 833. Id. art. 237. 834. Id. art. 237. 835. Id. art. 20. 836. Rangita de Silva-de Alwis, Remarks to the U.S. Congressional Executive Commission on China (Feb. 24, 2003) (transcript available at http://www.cecc. gov/pages/roundtables/022403/silva.php) (Referencing The Center for Women’s Law Studies and Legal Services of Peking University, Theory and Practice of Protection of Women’s Rights and Interests in Contemporary China, Investigation and Study on the Enforcement of the U.N. CEDAW in China 468). 837. Marriage Law of the P.R.C., art. 7 (2001). 838. Marriage Law to Better Protect Women and Children, China Daily, Apr. 30, 2001, http://www.china.org.cn/english/12157.htm. 839. As of May 2002, ten provinces have enacted local laws and regulations to ban domestic violence. China Says “No” to Domestic Violence, Xinhua News Agency (China), July 25, 2002, http://en.chinacourt.org/public/detail.php?id=563. 840. Xianfa [Constitution], art. 49 (2004); Marriage Law of the P.R.C., art. 43 (2001). 841. Criminal Law of the P.R.C., art. 260 (1997), amended by Presidential Order No. 32 (2005). The crime of maltreating a family member “shall be handled only upon complaint.” This stipulation is irrelevant if the victim is seriously injured or killed. Id. 842. Id. This type of monitoring is known as “public surveillance” which lasts from 3 months to 2 years during which the individual is under observation of the police, must report his activities to the police, cannot leave or change his residing city or county without approval and has limited rights. Id. art. 38–39. 843. Supreme People’s Court Judicial Interpretation on the Application of the Marriage Law of P.R.C. (I), supra note 631, art. 1 (referring to the meaning of domestic violence under arts. 3, 32, 43, 45 and 46 of the Marriage Law). 844. Marriage Law of the P.R.C., art. 43 (2001). 845. Id. art. 43. 846. Id. arts. 32(2), 46. 847. Id. art. 45. 848. Id. art. 45. 849. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 46 (2005) (effective Jan. 2006) (translation by Center for Reproductive Rights). 850. Id. 851. All-China Women’s Federation (ACWF),What’s New (Mar. 2003), http:// www.women.org.cn/english/english/whatisnws/2003-3.htm (last visited Apr. 22, 2005); China Says “No” to Domestic Violence, supra note 839. 852. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 40 (2005) (effective Jan. 2006) (translation by Center for Reproductive Rights). 853. Id. 854. Protect Women from Sexual Harassment, People’s Daily, Nov. 11, 2003, http://english. peopledaily.com.cn/200311/11/print20031111_128030.html. 855. Female Teacher wins Sexual Harassment Law Suit, Xinhua News Agency (China), June 22, 2003, http://en.chinacourt.org/public/detail.php?id=2743; Li Weiwei et al., WoGuo Lifa De Xingsaorao Shuo Bu Yongren Danwei You Ze Fangzhi [Country Enacts Statute to Prohibit Sexual Harassment, Employing Units responsible to Prevent], Xinhua News Agency (China), June 26, 2005, http://www.legalinfo.gov.cn/zfsf/2005-06/27/ content_160084.htm (translation by Center for Reproductive Rights).

856. Female Teacher wins Sexual Harassment Law Suit, supra note 855; Li Weiwei et al., supra note 855; Protect Women from Sexual Harassment, supra note 854. 857. Protect Women from Sexual Harassment, supra note 854. 858. Id.; China Amends Law to Ban Sexual Harassment, Xinhua News Agency (China), June 27, 2005, http://en.chinacourt.org/public/detail.php?id=3905; Li Weiwei et al., supra note 855 (according to the NPC Standing Committee, less than ten sexual harassment cases have been brought before the court since 2001) (translation by Center for Reproductive Rights). 859. Regulation on Administrative Penalties for Public Security, Presidential Order No. 43, art. 30 (1986) (effective Jan. 1, 1987); Decision of the Standing Committee of the National people’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 4 (1992). 860. Regulation on Administrative Penalties for Public Security, Presidential Order No. 43, art. 30 (1986) (effective Jan. 1, 1987); Maiyin Piaochang Renyuan Shourong Jiaoyu Banfa [Measures on Re-Education through Labor for Prostitutes and Patrons of Prostitutes], State Council Order No. 127, art. 9 (1993) (persons subject to re-education through labor are held at re-education centers and given compulsory education in law and morality and/or productive labor) (translation by Center for Reproductive Rights); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 4 (1991) (effective Sept. 4, 1992); Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 861. Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 4 (1991) (effective Sept. 4, 1992); Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 862. Maiyin Piaochang Renyuan Shourong Jiaoyu Banfa [Measures on Re-Education through Labor for Prostitutes and Patrons of Prostitutes], State Council Order No. 127, arts. 10–11 (1993) (translation by Center for Reproductive Rights); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 4 (1991) (effective Sept. 4, 1992). 863. Criminal Law of the P.R.C., art. 360 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 5 (1991) (effective Sept. 4, 1992). Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 864. Criminal Law of the P.R.C., arts. 358–359 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, arts. 1–3 (1991) (effective Sept. 4, 1992). 865. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 41 (2005) (effective Jan. 2006) (translation by Center for Reproductive Rights). 866. Criminal Law of the P.R.C., arts. 358–359 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, arts. 1–3 (1991) (effective Sept. 4, 1992); Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 867. Criminal Law of the P.R.C., art. 358 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 2 (1991) (effective Sept. 4, 1992). 868. Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 6 (1991) (effective Sept. 4, 1992); Criminal Law of the P.R.C., art. 361 (1997), amended by Presidential Order No. 32 (2005). If the violator is in a leadership position of the work place, they are given harsher punishment. Id. 869. Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 7 (1991) (effective Sept. 4, 1992). 870. Criminal Law of the P.R.C., arts. 310, 362 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 7 (1991) (effective Sept. 4, 1992). 871. Decision of the Standing Committee of the National People’s Congress on the Strict Prohibition Against Prostitution and Whoring, art. 10 (1991) (effective Sept. 4, 1992). 872. Law of the P.R.C. on the Protection of Rights and Interests of Women, art. 39 (2005) (effective Jan. 1, 2006) (translation by Center for Reproductive Rights). 873. Id. 874. Decision of the Standing Committee of the National People’s Congress Regarding the Severe Punishment of Criminals Who Abduct and Traffic in or Kidnap Women or Children, Presidential Order No. 52 (1991) (provisions on criminal liability were incorporated into the Criminal Law in 1997 while administrative penalties and administrative measures of the Decision continue to be in force). 875. Id. art. 1; Abducting and Trafficking in a women or child refers to the acts of abducting, kidnapping, buying, trafficking in, fetching, sending, or transferring a woman or child, for the purpose of selling the victim. Criminal Law of the P.R.C., art. 240 (1997), amended by Presidential Order No. 32 (2005). Calculations based on exchange rate of 1 U.S. Dollar (USD) to 8.2765 CNY (renmenbi). See International Monetary Fund, supra note 197. 876. Criminal Law of the P.R.C., arts. 239–240 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress Regarding the Severe Punishment of Criminals Who Abduct and Traffic in or Kidnap Women or Children, Presidential Order No. 52, arts. 1–2 (1991).

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877. Criminal Law of the P.R.C., art. 241 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress Regarding the Severe Punishment of Criminals Who Abduct and Traffic in or Kidnap Women or Children, Presidential Order No. 52, art. 3 (1991). 878. Criminal Law of the P.R.C., arts. 236, 240–241 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress Regarding the Severe Punishment of Criminals Who Abduct and Traffic in or Kidnap Women or Children, Presidential Order No. 52, art. 3 (1991). 879. Criminal Law of the P.R.C., art. 241 (1997), amended by Presidential Order No. 32 (2005); Decision of the Standing Committee of the National People’s Congress Regarding the Severe Punishment of Criminals Who Abduct and Traffic in or Kidnap Women or Children, Presidential Order No. 52, art. 3, ¶ 6 (1991). 880. Decision of the Standing Committee of the National People’s Congress Regarding the Severe Punishment of Criminals Who Abduct and Traffic in or Kidnap Women or Children, Presidential Order No. 52, art. 5 (1991). 881. Criminal Law of the P.R.C., arts. 242, 277 (1997), amended by Presidential Order No. 32 (2005). 882. Office to Monitor and Combat Trafficking in Persons, U.S. Department of State,Trafficking in Persons Report, Country Narratives: P.R.C. (2004), http:// www.state.gov/g/tip/rls/tiprpt/2004/33191.htm (Released June 14, 2004). 883. China’s Human Rights Progress 2003, supra note 410, ch. 5. 884. China, UNICEF Join Hands to Protect Girls, Xinhua News Agency (China), June 2, 2004, http://www.china.org.cn/english/China/97138.htm. 885. Program to Cut Human Trafficking, China Daily, Sept. 25, 2002, http://www.china. org.cn/english/China/44085.htm. 886. Parker, supra note 552. 887. Id. 888. Project Helps Prevent Human Trafficking, China Daily, Nov. 4, 2002, http://www. china.org.cn/english/2002/Nov/47767.htm. 889. Criminal Law of the P.R.C., art. 237 (1997), amended by Presidential Order No. 32 (2005). 890. Id. art. 236. 891. Id. 892. Id. 893. Id. art. 240.

WOMEN OF THE WORLD:

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

2. Malaysia Statistics GENERAL

Population ■

Total population (millions): 25.3.1

■

Population by sex (thousands): 12,251.4 (female) and 12,625.0 (male).2

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Percentage of population aged 0–14: 33.3.3

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Percentage of population aged 15–24: 18.2.4

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Percentage of population in rural areas: 36.5

Economy ■

Annual percentage growth of gross domestic product (GDP): 6.2.6

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Gross national income per capita: USD 3,780.7

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Government expenditure on health: 2% of GDP.8

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Government expenditure on education: 4.1% of GDP.9

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Percentage of population below the poverty line: Information unavailable.

WOMEN’S STATUS ■

Life expectancy: 76.0 (female) and 71.4 (male).10

■

Average age at marriage: 23.5 (female) and 26.6 (male).11

■

Labor force participation: 39.4 (female) and 35.7 (male).12

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Percentage of employed women in agricultural labor force: Information unavailable.

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Percentage of women among administrative and managerial workers: 23.13

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Literacy rate among population aged 15 and older: 87% (female) and 93% (male).14

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Percentage of female-headed households: 18.15

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Percentage of seats held by women in national government: 10.16

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Percentage of parliamentary seats occupied by women (2005): 9.17

CONTRACEPTION ■

Total fertility rate: 2.78.18

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Contraceptive prevalence rate among married women aged 15–49: 55% (any method) and 30% (modern method).19

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Prevalence of sterilization among couples: 6.8% (total); Gender breakdown unavailable.20

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Sterilization as a percentage of overall contraceptive prevalence: 14.1.21

MATERNAL HEALTH ■

Lifetime risk of maternal death: 1 in 630 women.22

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Maternal mortality ratio per 100,000 live births: 41.23

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Percentage of pregnant women with anemia: 56.24

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Percentage of births monitored by trained attendants: 97.25

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WOMEN OF THE WORLD:

ABORTION ■

Total number of abortions per year: Information unavailable.

■

Annual number of hospitalizations for abortion-related complications: Information unavailable.

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Rate of abortion per 1,000 women aged 15–44: Information unavailable.

■

■

Breakdown by age of women obtaining abortions: 10.2% (under 20); 22.3% (age 20–24); 25.0% (age 25–29); 14.2% (age 30–34); 12.2% (age 35–39); 16.2% (40 or older).26 Percentage of abortions that are obtained by married women: 91.2.27

SEXUALLY TRANSMISSIBLE INFECTIONS (STIS) AND HIV/AIDS ■

Number of people living with sexually transmissible infections: Information unavailable.

■

Number of people living with HIV/AIDS: 52,000.28

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Percentage of people aged 15–49 living with HIV/AIDS: 0.1 (female) and 0.7 (male).29

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Estimated number of deaths due to AIDS: 2,000.30

CHILDREN AND ADOLESCENTS ■

Infant mortality rate per 1,000 live births: 10.31

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Under five mortality rate per 1,000 live births: 11 (female) and 15 (male).32

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Gross primary school enrollment ratio: 93% (female) and 93% (male).33

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Primary school completion rate: 87% (female) and 87% (male).34

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Number of births per 1,000 women aged 15–19: 18.35

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Contraceptive prevalence rates among married female adolescents: Information unavailable.

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Percentage of abortions that are obtained by women younger than age 20: 10.2.36

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Number of children under the age of 15 living with HIV/AIDS: Information unavailable.

MALAYSIA

ENDNOTES 1. See United Nations Population Fund (UNFPA),The State of World Population 2005, at 112 (estimate for 2005). 2. See United Nations Population Fund (UNFPA), Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003 (2003), http://www.unfpa.org/profile/default.cfm. [hereinafter UNFPA, Country Profiles ] 3. See The World Bank,World Development Indicators 2004, at 39 (2004), http:// www.worldbank.org/data/ (estimate for 2002). [hereinafter The World Bank]. 4. See UNFPA, Country Profiles, supra note 2. 5. See UNFPA,The State of World Population 2005, supra note 1, at 112. 6. See The World Bank, supra note 3, at 183 (estimate for 1990-2002). 7. See The World Bank,World Development Indicators 2004: Data Query, http://devdata.worldbank.org/data-query/ (statistical figure obtained through the Atlas method) (estimate for 2003). 8. See UNFPA,The State of World Population 2005, supra note 1, at 112. 9. United Nations CyberSchoolBus, InfoNation: Government Education Expenditure (2004), http://www.un.org/Pubs/CyberSchoolBus/infonation/e_infonation.htm (estimate for 1997). 10. See UNFPA,The State of World Population 2005, supra note 1, at 108. 11. See UNFPA, Country Profiles, supra note 2. 12. See Id. 13. See Social and Demographic Statistics Branch, United Nations Statistics Division,The World’s Women 2000:Trends and Statistics (2000) (estimate for 2003). 14. See UNFPA, Country Profiles, supra note 2. 15. See Social and Demographic Statistics Branch, supra note 13, at 48 (estimate for 1991/1997). 16. See Save the Children, State of World’s Mothers 2004, at 38 (2004), http:// www.savethechildren.org/mothers/report_2004/images/pdf/SOWM_2004_final.pdf (estimate for 2004). 17. See United Nations Statistics Division, Millennium Indicators Database (2005), http://unstats.un.org/unsd/mi/mi_series_results.asp?rowId=557 (last updated Mar. 16, 2005) (estimate for 2005). 18. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimate for 2000-2005). 19. See Id. at 108. 20. See Engenderhealth, Contraceptive Sterilization: Global Issues and Trends, tbl. 2.2, at 47 (2002) (estimates for 1988). 21. See Id. at tbl. Supp. 2.5, at 56. 22. See World Health Organization et al., Maternal Mortality in 1995: Estimates Developed by WHO, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) 44 (2000) (estimate for 1995). 23. See UNFPA,The State of World Population 2005, supra note 1, at 108. 24. See Save the Children, supra note 16, at 38 (estimate for 1989-2000). 25. See UNFPA,The State of World Population 2005, supra note 1, at 112. 26. See Akinrinola Bankole et al., Characteristics of Women who Obtain Induced Abortion: A Worldwide Review, 25 Int’l Fam. Planning Persp. 68–77 (1999), http://www.guttmacher.org/pubs/journals/2506899.html (statistical figure obtained through ad hoc surveys and hospital records) (estimates for 1981). 27. See Id. 28. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., UNAIDS/World Health Organization (WHO) Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 Update:Vietnam 3 (2004), http://www.who.int/GlobalAtlas/PDFFactory/HIV/EFS_PDFs/EFS2004_ MY.pdf (estimates for 2003). 29. See UNFPA,The State of World Population 2005, supra note 1, at 108. 30. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., supra note 28 (estimates for 2003). 31. See UNFPA,The State of World Population 2005, supra note 1, at 108. 32. See UNFPA, Country Profiles, supra note 2. 33. See UNFPA,The State of World Population 2005, supra note 1, at 108. The ratio may be more than 100 because the figures remain uncorrected for individuals who are older than the level-appropriate age due to late starts, interrupted schooling or grade repetition. 34. See Id. 35. See Id. 36. See Bankole et al., supra note 26.

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M

alaysia lies in the heart of central Southeast Asia; Peninsular Malaysia (directly south of Thailand) and East Malaysia (the northern third of the island of Borneo) are separated by approximately 400 miles of the South China Sea.1 The Malays were ruled by the Buddhist kingdom of Srivijaya from the ninth through the thirteenth centuries, and by the Hindu kingdom of Majapahit in the fourteenth century; they were converted to Islam with the rise of the state of Malacca in the fifteenth century.2 With its strategic maritime location along the Pacific trade routes, Malaysia was the target of conquest first by the Portuguese empire in 1511, then by the Dutch empire in 1641, and by the British empire in 1795.3 British colonial rule lasted well into the twentieth century, although it was temporarily interrupted by the Japanese occupation in 1942–1945 during World War II.4 In 1957, Malaysia negotiated independence from Britain, and joined the former British colonies of Singapore (an island located just to the south of Peninsular Malaysia) and Sabah and Sarawak (territories in the northern third of the island of Borneo) in 1963 to form the Federation of Malaysia.5 Singapore subsequently withdrew from the federation in 1965 to become an independent state.6 In 2003, Abdullah Badawai succeeded Mahathir Mohamed as prime minister and initiated a series of changes, including stricter policies against corruption in the public sector (i.e., among police and government officials); greater judicial independence; and a more moderate and progressive interpretation of Islam (Hadhari) that emphasizes religious tolerance.7 Malaysia has one of the more prosperous economies in the region. Despite a brief recession during the Asian financial crisis in 1998,8 Malaysia’s economy once again boasts a robust growth rate.9 The total population of Malaysia is over 26 million,10 approximately half (49.4%) of whom are female.11 Ethnic groups include, among others, Malays (50.3%), Chinese (23.8%), non-Malay indigenous peoples (11.0%), and Indians (7.1%).12 The official language is Bahasa Melayu (Malay), although English, various Chinese dialects, Tamil, Telugu, Malayalam, Punjabi, Thai, and several indigenous languages are also spoken.13 Islam, the national religion,14 is practiced by about 60% of the population;15 other faiths include Buddhism, Taoism, Hinduism, Christianity, Sikhism, and Shamanism.16 Malaysia has been a member of the United Nations since 1957.17 It is a member of the Commonwealth of Nations, the Organization of the Islamic Conference, the Non-Aligned Movement, Asia-Pacific Economic Cooperation, the World Trade Organization, and the Association of Southeast Asian Nations.18

WOMEN OF THE WORLD:

I. Setting the Stage: The Legal and Political Framework of Malaysia Fundamental rights are rooted in a nation’s legal and political framework, as established by its constitution. The principles and goals enshrined in a constitution, along with the processes it prescribes for advancing them, determine the extent to which these basic rights are enjoyed and protected. A constitution that upholds equality, liberty, and social justice can provide a sound basis for the realization of women’s human rights, including their reproductive rights. Likewise, a political system committed to democracy and the rule of law is critical to establishing an environment for advancing these rights. The following section outlines important aspects of Malaysia’s legal and political framework. A. THE STRUCTURE OF NATIONAL GOVERNMENT

The Federal Constitution of Malaysia, enacted in 1957 and amended in 1963, establishes Malaysia as a constitutional monarchy and a federal parliamentary democracy with a separation of powers between the executive, legislative, and judicial branches of government.19 The federal constitution states that Islam is the religion of Malaysia, but other religions may also be practiced.20 It provides for a division of powers between federal and state authorities.21 Executive branch Executive power is vested in the Yang di-Pertuan Agong (the king), who is the supreme head of the federation and commander of the armed forces.22 The consort of the Yang di-Pertuan Agong, known as the Raja Permaisuri Agong (queen of Malaysia), comes after the Yang di-Pertuan Agong in the hierarchy of the federation.23 The Yang di-Pertuan Agong is elected by the Majlis Raja-Raja (Conference of Rulers), a body made up of the state rulers (sultans) and state Yang di-Pertua Negeri (governors), for a term of five years.24 In the event of vacancy or inability to serve in the office of the Yang di-Pertuan Agong, the Timbalan Yang di-Pertuan Agong (deputy supreme head) assumes the position.25 The Yang di-Pertuan Agong has sole discretion in appointing a Perdana Menteri (prime minister) from among members of the majority party in the House of Representatives.26 The Perdana Menteri advises the Yang di-Pertuan Agong in selection of the Jemaah Menteri (Cabinet of Ministers) from among members of either house in Majlis (Parliament), and presides over this body.27 The Jemaah Menteri advises the Yang di-Pertuan Agong in the exercise of his functions and is collectively responsible to Parliament.28

MALAYSIA

Among other powers, the Yang di-Pertuan Agong may convene, prorogue, or dissolve the Parliament,29 and grant pardons, reprieves, and respites for offenses that are tried by courts-martial, in Syariah courts (courts that apply Muslim law), or are committed in the Federal Territories (Kuala Lumpur, Labuan, and Putrajaya).30 The Yang di-Pertuan Agong is not liable to judicial proceedings in regular courts of law.31 Legislative branch Majlis (Parliament) consists of two houses—the Dewan Rakyat (House of Representatives) and the Dewan Negara (Senate).32 The Dewan Rakyat, the lower house, has 219 elected members serving five-year terms,33 of whom about 10% are women.34 The Dewan Negara, the upper house, consists of 26 members who are elected by the state Legislative Assemblies (two per state), and 44 members who are appointed by the king.35 In 2004, women comprised about 35% of the Dewan Negara.36 Senate members serve no more than two consecutive three-year terms.37 The Majlis has the authority to make laws for the whole or part of the federation.38 Bills may originate in either house, with the exception of money bills, which must originate in the lower house.39 Once a bill passes in the originating house, it is sent to the other house for approval.40 Bills passed by both houses are presented to the king; they then may pass into law either upon his approval or by his failure to act on the bill for 30 days.41 The king may also object to the bill within 30 days and remand it to the originating house, where the process begins again.42 The federal constitution provides for “legislative lists” enumerating the scope of federal, state, and concurrent legislative powers. Matters exclusive to the federal legislature include external affairs (international treaties and their implementation); civil and criminal law and the administration of justice (under the federal constitution and all courts except Syariah courts, and the ascertainment of Islamic law and other personal laws for purposes of federal law); citizenship and naturalization; surveys, record keeping (registration of births and deaths; registration of marriages; registration of adoptions), and research (censuses and vital statistics registration); education; medicine and health (health facilities and maternal and child welfare); labor and social security (health insurance, pensions, and maternity benefits); and the welfare of indigenous peoples.43 The federal legislature shares concurrent jurisdiction with states in matters of social welfare; social services in accordance with federal and state legislative lists; protection of women and children; and public health, sanitation, and disease prevention.44 Judicial branch The Malaysian judicial system is based upon the English model of common law.45 The federal constitution provides

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for a Federal Court (Mahkamah Agung, or Supreme Court), a Court of Appeal, a Special Court, two High Courts (one in Peninsular Malaysia and one in Sabah and Sarawak), and lower courts as decreed by federal laws.46 There is also a separate system of Syariah courts at the state level. The Federal Court is the highest judicial authority and the final court of appeal.47 It has original jurisdiction over constitutional matters,48 disputes between states or between the federal government and a state,49 and appellate jurisdiction over the Court of Appeal and the two High Courts.50 The Federal Court is headed by the chief justice51 and consists of the president of the Court of Appeal, two chief justices from each High Court, and seven other judges.52 Judges serve until the age of 65.53 The Court of Appeal consists of a president and 15 judg54 es and serves as the “final court of appeal” for decisions of the High Court on civil and criminal matters.55 Of the two High Courts, the one in Peninsular Malaysia consists of a chief judge and 47 judges, and the other in Sabah and Sarawak consists of a chief judge and ten judges.56 High Courts hear appeals from lower courts57 and also have original jurisdiction over serious felonies and major civil cases.58 Judges of the Federal Court, the Court of Appeal, and the High Courts are appointed by the Yang di-Pertuan Agong on the advice of the Perdana Menteri in consultation with the Majlis Raja-Raja.59 The Special Court was established pursuant to an amendment to the federal constitution in 1993, and has exclusive jurisdiction over civil and criminal actions against the Yang di-Pertuan Agong or any of the nine state rulers.60 The court is chaired by the chief justice of the Federal Court, the chief judges of the two High Courts, and two appointees by the Majlis Raja-Raja.61 Decisions of the Special Court are final and cannot be challenged in any court for any reason.62 Below these are subordinate courts consisting of the Sessions Courts and the Magistrates’ Courts, which are courts of first instance for criminal and civil cases.63 In 2001, a Court for Children was established for adjudicating criminal proceedings of persons under the age of 18 years.64 The federal constitution provides for a system of Syariah courts with exclusive jurisdiction over the application of Islamic laws for Muslims.65 Syariah courts exist in all states within Malaysia;66 their makeup, organization, and procedures are determined solely by the states.67 Such courts have jurisdiction over family matters relevant to succession and wills; marriage (including betrothals and dowries) and divorce; child and spousal maintenance; custody, guardianship, and adoption; matrimonial property and trusts (gifts); and certain matrimonial and religious criminal offenses, such

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WOMEN OF THE WORLD:

C. THE ROLE OF CIVIL SOCIETY AND

as polygamy, illicit sex (i.e., incest and sodomy), indecent dress and behavior, violations of the pillars of Islam, and apostasy.68 Such courts do not have jurisdiction in criminal matters, which belong solely to federal courts.69 Islamic law falls under the purview of the states and, thus, the power to enact legislation pertaining to Islam and the well-being of Muslims falls under the state authorities.70 Each state has its own set of Islamic laws as well as its own Islamic court system.71 Under this feature of Malaysian Islamic law, which is unique among Muslim countries, states differ in their enforcement and interpretations of Muslim law. Consequently, the decision of one state’s Syariah court is not enforceable in another.72 In addition, Syariah law does not apply to nonMuslims,73 and a court order issued by a Syariah court is not enforceable by a civil court.74 Other state-level courts are native courts, which exist in Sabah and Sarawak.75 They have jurisdiction only in cases arising from indigenous or customary law, and where the parties are indigenous peoples.76

Nonprofit organizations in Malaysia are governed by the Societies Act 1966, the Societies Regulations 1984, and the Societies (Application for Vesting Order) Regulations 1993, as implemented and enforced by the Registry of Societies under the Ministry of Home Affairs, which has the primary task of registering NGOs.87 In 1998, 29,574 societies were registered,88 including religious groups, clubs, charities, political parties, mutual benefit societies, and advocacy groups.89 NGOs may receive government funds or incentives to provide public services. In the national budget for 2005, RM 141.6 million (USD 37,269,000) was appropriated to finance various NGO activities in AIDS prevention, women and family development, health programs, and services for the disabled.90 Furthermore, the government provided RM 66.7 million (USD 17,555,000) for upgrading and maintaining institutions run by NGOs that offer social services to families, children, the elderly, and the disabled.91

B. THE STRUCTURE OF LOCAL GOVERNMENTS

D. SOURCES OF LAW AND POLICY

The Federation of Malaysia comprises 13 states and the federal territories of Kuala Lumpur, Labuan, and Putrajaya.77 The three Federal Territories are centrally administrated by the federal government. Nine of the 13 Malaysian states are headed by hereditary Islamic rulers, while the remaining four—Malacca, Penang, Sabah, and Sarawak—are headed by Yang di-Pertua Negeri (governors), who are appointed by the Yang di-Pertuan Agong for four-year terms.78 The ruler of each state acts in accordance with the advice of the Executive Council, which is made up of four to eight members from the state’s legislative body, called the Legislative Assembly, and is directly accountable to that body.79 The ruler appoints a Menteri Besar (chief executive) from among the members of the majority in the state Legislative Assembly to preside over the Council and advise on the appointment of its members.80 The legislature at the state level consists of the ruler or the governor and the Legislative Assembly.81 Members are elected for five-year terms, at the end of which the entire body dissolves, unless the ruler dissolves it sooner.82 The number of members of each Legislative Assembly is determined by law.83 In 2004, about 5% of the state legislature members were women.84 As enumerated in the federal constitution, state legislatures have exclusive power in their territories over matters, among others, that involve Islamic law and personal and family law; land; agriculture, including agricultural loans; and local government.85 If a state law contravenes a federal law, the federal law shall prevail.86

Domestic sources Sources of domestic law include the federal and state constitutions, federal and state legislation and regulations, case law, Syariah (Islamic) and Hindu personal laws, adat (customary law applicable to Malays), English common law, and numerous government policies, such as the Eighth Malaysia Plan.92 The federal constitution is the supreme law of Malaysia.93 It guarantees a number of fundamental rights, including protection from arbitrary deprivation of life or liberty;94 freedom from slavery and all forms of forced labor;95 equality before the law and equal protection of the law;96 freedom of religion, subject to permissible restrictions on the propagation of Islam;97 and protection against the deprivation of property except in accordance with the law.98 The federal constitution was amended in 2001 to include gender-based discrimination among the prohibited types of discrimination.99 The revised article provides that “there shall be no discrimination against citizens on the ground only of religion, race, descent, place of birth, or gender … in any law relating to the acquisition, holding or disposition of property, or the establishment or carrying on of any trade, business, profession, vocation, employment, or in public education.”100 The nondiscrimination article, however, does not extend to provisions regulating personal laws, the employment of persons of a certain religious group, or any provision for the protection, well-being, or advancement of indigenous peoples, including issues of ancestral domain and quotas for public office.101 The federal constitution also guarantees all citizens

NONGOVERNMENTAL ORGANIZATIONS (NGOS)

MALAYSIA

the right to freedom of speech, expression, assembly, and association, subject to restrictions in the interest of national security or “public order or morality.”102 Under the federal constitution, legislative powers over different matters are designated to the federal government, the state government, or both. Matters pertaining to civil and criminal laws and procedures, such as codification of the penal code and the Criminal Procedure Code, fall under the authority of the federal government.103 Among areas under the legislative authority of states are Syariah laws for Muslims, and native personal or customary laws for indigenous peoples and tribal groups.104 Although Malaysia’s legal system is structured according to English common law, Islamic law and customary law form a vital part of the legal system.105 Syariah law applies only to Muslims with regard to issues that come under family law; non-Muslims are subject to the civil law in all instances. Thus, Muslims in Malaysia must refer to Syariah courts for adjudication of matters concerning marriage, divorce, inheritance, maintenance, custody of children, child support, and in some cases, sexuality, sexual acts, and rape. (See “Judicial branch” for more information on Syariah courts.) Under the Administration of Islamic Law (Federal Territories) Act 1993, religious fatwas (Islamic decrees) issued by the National Council for Islamic Affairs may become legally binding if they are adopted by state governments through implementing legislation.106 The National Council for Islamic Affairs coordinates the Islamic Councils of each state.107 Islamic law is dominant in the peninsular states, while customary law plays an important role in the eastern states of Sarawak and Sabah.108 Due to the complicated nature of the legal system, there are numerous discrepancies and inconsistencies in the way the laws are applied. Syariah law is applied inconsistently because of diverse enactments of laws by various states. Furthermore, there is some overlap between Syariah law on the one hand, and civil and criminal law on the other, which causes complications, particularly when laws are adapted and amended.109 Malaysia’s legal framework is complemented by national and state policies enumerated in successive long-term (10 to 20 years) Outline Perspective Plans, and medium-term (five years) development plans. Currently, the Third Outline Perspective Plan (OPP3) for 2001–2010 and the Eighth Malaysia Plan for 2001–2005 are operative.110 The OPP3 outlines Malaysia’s development strategies and policies for the current decade, and is based upon the National Vision Policy (NVP), which was adopted in 1991 and sets forth strategic development goals for 2020.111 The Eighth Malaysia Plan is the first phase in the implementation of the OPP3.112

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International sources The federal constitution authorizes the federal legislature to ratify treaties, agreements, and conventions with other countries.113 Treaties become part of Malaysian law only upon passage of implementing legislation by the Parliament.114 Ratification of a treaty does not allow it to take precedence over national laws. Rather, once ratified, a treaty is often accepted with reservations, and the treaty may eventually be modified to accommodate coexisting national laws.115 Malaysia has ratified the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW),116 and the Convention on the Rights of the Child.117 Malaysia ratified CEDAW with reservations to several articles on the grounds that they conflict with Syariah law and the federal constitution.118 Although the government partially withdrew its reservations in 1998, it upheld reservations on the articles on eliminating social and cultural discrimination against women;119 on providing women equal rights to participate in government120 and to extend citizenship to their children;121 and on assuring equal rights in marriage, divorce, and custody.122 The government of Malaysia has not signed or ratified other major treaties, such as the International Covenant on Civil and Political Rights; the International Covenant on Economic, Social and Cultural Rights; the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment; and the International Convention on the Elimination of All Forms of Racial Discrimination. Malaysia has participated in several key international conferences, and endorsed the development goals and human rights principles contained in the resulting consensus documents. International consensus documents the government has adopted include the 1993 Vienna Declaration and Programme of Action; the 1994 International Conference on Population and Development (ICPD); the 1995 Beijing Declaration and Platform for Action; and the 2000 United Nations Millennium Declaration and the Millennium Development Goals.123

II. Examining Reproductive Health and Rights In general, reproductive health matters are addressed through a variety of complementary, and sometimes contradictory, laws and policies. The scope and nature of such laws and policies reflect a government’s commitment to advancing the reproductive health status and rights of its citizens. The following sections highlight key legal and policy provisions that

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together determine the reproductive rights and choices of women and girls in Malaysia. A. GENERAL HEALTH LAWS AND POLICIES

The federal constitution of Malaysia does not formally guarantee the right to health. It provides that the federal and state governments share legislative powers over public health, sanitation, and disease prevention.124 However, the federal government has exclusive authority over legislative and regulatory matters relating to hospitals, clinics, and dispensaries; health insurance; the medical profession; prescription drugs; and maternal and child welfare.125 Malaysia’s health policies are formulated as part of the federal government’s five-year development plans and its annual budget. They may also be shaped by programs designed to address specific concerns or problems in greater detail than do the plans or budgets.126 The Eighth Malaysia Plan contains the country’s current health policy.127 The plan’s health objectives fit within the broader framework of the OPP3.128 The Ministry of Health formulated the Vision for Health for 2020, in tandem with its National Vision Policy, as a guiding principle for all its strategies.129 Objectives According to the OPP3, the objectives of health services are to alleviate the negative consequences of poverty on health; improve quality of life; promote and develop health tourism; and contribute to better health, longevity, and citizens’ wellbeing.130 The plan sets forth various goals and strategies to improve health services, including the following: ■ expanding health services in both urban and rural areas; ■ emphasizing promotive and preventive health care and healthy lifestyle campaigns in the public, private and nongovernmental sectors; ■ strengthening programs on immunization, food and nutrition, water quality, and sanitation;131 ■ continuing to ensure that the needs of poor and lowincome households are met in implementing health programs;132 ■ facilitating the entry of foreigners and their families seeking medical services in Malaysia; and ■ increasing foreigners’ use of Malaysian health facilities and expanding clientele bases through the promotion overseas of Malaysian private hospitals and health facilities.133 Strategies for implementing the health goals of the OPP3 are outlined in the Eighth Malaysia Plan, which provides that the objective of health services is to raise and continuously improve “the health status of individuals, families and com-

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munities,” paying special attention to those in straitened circumstances; the plan also calls for the optimal use of resources in the provision of health care.134 As with prior development plans, the Eighth Malaysia Plan focuses on developing the primary health-care system and improving the quality and equity of health services.135 To that end, priority is placed on the following areas: ■ developing and expanding the service capacity of primary, secondary, and tertiary health facilities; ■ enhancing the delivery of health services through information technology; ■ improving the quality and quantity of health-care personnel; and ■ furthering medical research and development.136 The plan also sets forth strategies for health-sector development, including the following: ■ provide affordable and quality health care; ■ expand the wellness (healthy lifestyle) program; ■ coordinate and collaborate between public- and private-sector health-care providers; ■ increase the number of health-care workers; ■ strengthen the telehealth system137 to further Malaysia’s reputation as a regional center for health services; ■ improve health-care research capacity and capability; ■ develop and institute a health-care financing scheme; and ■ strengthen governance over the health sector (e.g., implement regulations for traditional practitioners and medical products).138 The agenda within the plan’s strategies for health-sector development covers the following specific areas: ■ provide promotive and preventive health services that include national health education and awareness campaigns, such as the healthy lifestyle campaign, and programs on immunization, school health services, food and nutrition, safe water, and occupational health and safety;139 ■ offer medical services, such as the treatment of noncommunicable diseases (e.g., cardiovascular diseases, diabetes mellitus, and cancer); upgrade trauma management and maternal and perinatal health services; strengthen diagnostic pathology and imaging services; construct specialized hospitals and health facilities in urban and rural areas; expand private-sector medical services; promote health tourism; and introduce cost-sharing concepts through health-care financing schemes; ■ raise the quality of health services manpower by improving health professionals’ education and train-

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ing; encouraging postgraduate specialization in various areas of medicine; and recruiting all types of health personnel in the public health sector; and ■ raise the level of medical research and development by intensifying research in clinical health systems, health management and promotion, epidemiology, and biomedical technology; and by strengthening the research capacity of the National Institutes of Health.140 The long-term goal of Vision for Health 2020 is to create “a nation of healthy individuals, families, and communities through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally adaptable, and consumer friendly.”141 The vision statement emphasizes quality, innovation, health promotion, and respect for human dignity, and encourages individual responsibility and community participation in the enhancement of the quality of life.142 Infrastructure of health-care services Government facilities The Ministry of Health is the main government agency responsible for formulating health policies and delivering health care.143 At the federal level, the ministry develops policies, programs, procedural standards, and techniques for various medical specialties.144 The ministry is headed by the minister of health, who is assisted by a deputy minister, the parliamentary secretary, and the director general of health.145 The director general of health manages the overall administration of the ministry and reports directly to the minister.146 The Public Health Department of the Ministry of Health has several divisions, including those covering family health development, disease control, dental services, food quality, and health education.147 The Family Health Development Division is further subdivided into subsections of family health, nutrition, and primary health care.148 The primary function of the Family Health Development Division is to manage the delivery of health services through planning, implementing, monitoring, and evaluating activities related to family health at all levels of the health system, including matters of reproductive health.149 The Medical Services Department of the ministry includes divisions for medical development and medical practice.150 The Research and Technical Support Services component of the ministry includes several agencies: among them are the Institute for Medical Research, which is the research arm of the ministry, as well as the National Pharmaceutical Control Bureau, which oversees quality control of pharmaceutical products.151 At the state level, a director of medical and health services is responsible for planning and executing medical and

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health programs in accordance with federal health policies and objectives.152 All state health plans and programs must undergo review by the federal Ministry of Health prior to being submitted to the government for approval.153 At the district level, the deputy director of health (medical) oversees the medical officer for health or the senior health official who is responsible for the administration of all healthrelated programs and matters in the district.154 The ministry recently took over the provision of some areas of primary, secondary, and tertiary public health care from local authorities.155 Services are provided through a nationwide network of hospitals; community, mobile, and maternal and child health clinics; and specialized institutions.156 Service provision is facilitated through a hierarchical referral system with hospitals providing the highest level of care.157 The Ministry of Health operates 124 government hospitals throughout the country.158 Other government health facilities include 172 urban health clinics, 94 maternal and child health clinics, 168 mobile health units,159 and 2,620 rural community health clinics.160 Secondary and tertiary medical services delivered through the country’s network of public health facilities include emergency services; outpatient and ambulatory services; and diagnostic, curative, and rehabilitative services.161 One of the key goals and strategies of the OPP3 for improving health services in Malaysia is to create an efficient and client-friendly network of hospitals and clinics by incorporating information and communication technology.162 The plan also aims to address the shortage of health professionals by prioritizing human resource development through investments in education and training, and by stemming the flow of health professionals from the public to the private sector by improving working conditions and career prospects in the public sector.163 The National Population and Family Development Board (NPFDB), which is under the purview of the newly created Ministry of Women, Family and Community Development, is the main government body providing sexual and reproductive health services, including family planning.164 (See “Reproductive Health Laws and Policies” for more information.) The board is also responsible for implementing population and development activities. (See “Population” for more information.) Health facilities are generally equally distributed among all states, with the exception of the eastern states of Sabah and Sarawak.165 The National Health Morbidity Survey II of 1996 revealed that 97% of the overall population had access to health facilities.166

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Although regional variations exist,167 there were approximately 8,946 doctors in the public sector nationwide as of 2003, with a doctor-to-population ratio of about 1 to 2,800.168 Unofficial sources indicate that as of March 2004, 23% of medical officer posts and 30% of specialist posts in publicsector health facilities were unfilled because of shortages of qualified medical personnel.169 There are similar shortages of nurses in public hospitals. As a temporary measure, the government is recruiting hundreds of foreign doctors and specialists to serve in public facilities.170 Retired specialists, private practitioners, surgeons, and anesthesiologists are also being employed in public-sector health facilities on a contractual or consultancy basis.171 In addition, the Eighth Malaysia Plan provides for the construction of 11 new nursing colleges and 16 allied health professional training centers, and the expansion of eight existing colleges and centers.172 Thus far, four private institutions of higher education and 14 private sector training institutions have been set up or expanded to provide training for medical undergraduates and allied health personnel.173 Ultimately, the government’s long-term goal under the OPP3 is to achieve a target doctor-to-population ratio of 1 to 800 by 2010.174 Privately run facilities Expanding curative care services in the private sector and strengthening the regulation of private-sector health providers are two key strategies of the OPP3 for improving health services in Malaysia.175 To realize these goals, one of the main thrusts of the Eighth Malaysia Plan is to integrate health services across the private and public sectors, with complementary referral systems that ensure efficiency and optimal utilization of resources.176 There were 219 private hospitals in Malaysia in 2002, with a capacity of 10,405 beds.177 Most (97.8%) of these hospital beds are located in urban areas.178 There are also about 9,245 private practitioners in the health sector, with a doctor-topopulation ratio of 1 to 2,709.179 Estate hospitals are private hospitals or dispensaries maintained by employers on large agricultural estates or plantations for their laborers’ treatment.180 Such work sites must have their own health facilities, as most are located in isolated areas far from the nearest government health facilities. Traditional medicine in the Malay, Chinese, and Indian traditions is also widely practiced in Malaysia. As of 2001, there were 3,374 registered traditional practitioners.181 However, the actual number of such practitioners may be higher, given the popularity of traditional medicine for its accessibility and the long-held belief in the curative powers of traditional practitioners.182 The Private Healthcare Facilities and Services Act 1998183

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governs the private health sector with regulations on the development, standards, quality, and activities of all types of private health-care facilities and services.184 The act defines the types of private health-care facilities that can be established and the services they may provide. The act further stipulates that private health-care facilities must be planned and approved by the Ministry of Health.185 The act will become effective pending finalization of its implementing regulations.186 Once ready, the act will include a fee schedule that regulates both professional and hospital charges. The act will also impose zoning requirements to provide a more equitable distribution of private health facilities and services.187 Financing and cost of health-care services Government financing About 6.9% of the national budget, or RM 7.55 billion (USD 1.99 billion) was allocated to the Ministry of Health in 2002.188 In the same year, government funds accounted for 53.8% of overall national expenditure on health. In the Midterm Review of the Eighth Malaysia Plan in 2003, the federal government increased its budgetary allocation to the Ministry of Health for implementing the health sector component of the plan from RM 5.5 billion (USD 1.45 billion) to RM 9.5 billion (USD 2.5 billion), which makes up about 6% of the entire plan’s budget.189 About 80% of these funds go toward construction of new hospitals, and upgrading and renovating public health facilities.190 This represents an increase from the RM 2.6 billion (USD 684 million) committed in the Seventh Malaysia Plan (1996–2000).191 In an effort to improve the quality and affordability of health services, the Seventh Malaysia Plan called for the privatization of several public hospitals,192 including the National Heart Institute.193 However, hospital fees increased in the aftermath of privatization.194 Private and international financing Private expenditures accounted for 46.2% of total national spending on health in 2002.195 The majority (92.8%) of private spending was in the form of out-of-pocket expenses, and the remainder (7.2%) was through pre-paid plans.196 Generally, although individuals with more disposable income tend to receive medical services in private facilities at their own expense, they are also likely to rely on the subsidized public system for higher-cost procedures.197 Malaysia practices a policy of national self-reliance and generally refrains from seeking international funding, although it does receive technical support for health programs from several international development agencies.198 Due to Malaysia’s relatively advanced state of development, assistance from international agencies focuses on a few areas, such as collaborations between the government and the United Nations

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Children’s Fund (UNICEF) and the World Health Organization (WHO) to develop sexuality and HIV/AIDS education and activities for youth.199 Cost Fees for public health services are regulated by the Fees Act 1951.200 Public health services are heavily subsidized by the government, with the patient responsible for about 10% of the actual cost. Certain fees can be waived for eligible low-income and rural individuals.201 Noncitizens202 (such as migrant workers) may also receive services in public facilities, but at a higher rate of fees.203 Providers’ fees in the private sector are guided by the 2002 Fee Schedule issued by the Malaysian Medical Association,204 while hospital charges such as room, board, and medicines are determined by individual hospital boards.205 The Employees’ Provident Fund, established under the Employees Provident Fund Ordinance 1951, is a government health insurance scheme.206 Required monthly contribution is 12% for employers, and 9% for employees, of their monthly salaries, regardless of the age of the employee.207 The scheme covers treatment of critical illnesses for members and their immediate family members,208 and also offers old-age benefits to members upon retirement.209 The Social Security Organization, which pays for work-related illnesses, medical benefits, disability allowances, maternity benefits, and pensions, was established in 1969.210 The Government Pension Scheme for Civil Servants is a “non-contributory social security scheme for government employees.”211 This scheme serves not only as security for old age, but is also designed to provide financial assistance to dependents, should a government employee die in service or retire.212 It is a safety net for widowed spouses and is particularly beneficial in providing for wives, who generally survive longer than husbands.213 However, in terms of coverage, less than 1% of the population is protected by this safety net.214 Voluntary private medical insurance, which is offered by private insurance companies such as ING Insurance and Prudential, is also available to the general public.215 These companies offer plans that cover women’s sexual and reproductive health conditions, such as pregnancy; treatment for reproductive, cervical, and breast cancers; and other specific conditions.216 A national health-financing scheme, which was proposed in the Seventh Malaysia Plan, would contain basic health-care packages, such as secondary-care treatment, out-patient treatment, and preventive care treatment.217 In 2001, the health minister proposed the establishment of the National Health Financing Authority to oversee the national scheme.218 As of mid-2005, both proposals have yet to be finalized.219 The Ministry of Health recently submitted a proposal to

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the Parliament for the establishment of a Medical Assistance Fund (Tabung Bantuan Perubatan), with a starting budget of RM 25 million (USD 6.58 million). The fund is designed to provide coverage for the poor and the disabled for the cost of treatment, drugs, and medical appliances that are not available at government hospitals, and for medical expenses incurred from chronic diseases.220 Two important goals of the OPP3 are to implement a health-care financing scheme for universal coverage and to ensure “appropriate sharing of costs by private and public health-care providers and consumers.”221 The Eighth Malaysia Plan calls for the establishment of a regulatory mechanism to ensure that quality health care is provided at a reasonable cost in both the public and private sectors.222 In the Midterm Review of the Eighth Malaysia Plan, the government committed itself to ensuring that costeffective medical technologies are available in both the public and private sectors.223 Regulation of drugs and medical equipment The registration of all drugs imported by or manufactured in Malaysia is overseen by the National Pharmaceutical Control Bureau in accordance with the Control of Drugs and Cosmetics Regulations 1984.224 Under the regulations, drug manufacturers are required to obtain appropriate licensure to produce drugs, and drug retailers may only sell, supply, or import products that are registered by the bureau.225 Licenses and registrations are issued upon the bureau’s evaluation of the quality, efficacy, and safety of drugs after pharmaceutical, microbiological, and toxicological tests are performed.226 The bureau may also suspend, cancel, or revoke the registration or license of any drugs “at any time and without assigning any reason.”227 Regulation of health-care providers The Malaysian Medical Council, a statutory body constituted under the Medical Act 1971, regulates medical practice in Malaysia by registering and establishing standards of practice of medical practitioners, and investigating and disciplining instances of professional misconduct.228 After five or six years of specialized study, newly graduated medical students must complete a 12-month residency, or “housemanship,” followed by a three-year period of compulsory service in the public health agencies as a medical officer.229 Doctors may become licensed as specialists after an additional two to three years of training through service in the public sector.230 Practicing doctors must also fulfill continuing medical education requirements.231 Obtaining registration by fraud or misrepresentation is deemed a punishable act under the Medical Regulations 1974.232 The council has a Code of Professional Conduct that establishes minimum standards of medical practice for professional health-

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care providers in the government and the private sectors.233 Providers in breach of the code for “infamous conduct in any professional respect”234 may be subject to disciplinary proceedings under the Medical Regulations 1974.235 The professions of nursing,236 midwifery,237 and pharmacy238 are regulated by specific acts and corresponding statutory boards. Nurses are registered under the Nurses Act 1950239 and are governed by the Nursing Board.240 The Midwives Act 1966 regulates the conduct and practice of midwifery.241 The Registration of Pharmacists Act 1951 provides for the registration of pharmacists and the establishment of the Pharmacy Board, which monitors compliance with pharmacology training and examination requirements.242 Pharmacists are bound by the Code of Conduct for Pharmacists and Bodies Corporate, as adopted by the board.243 The Estate Hospital Assistants (Registration) Act 1965 regulates medical assistants working at private estate hospitals and provides for the establishment of the Estate Hospitals Assistants Board.244 Practitioners of traditional medicine are not specifically regulated by the Medical Act 1971, although the act does prohibit such practitioners from representing themselves as modern health-care providers and from using syringes, stethoscopes, and other modern medical equipment for which specialized training is required.245 Since 1992, the National Pharmaceutical Control Bureau of the Ministry of Health has accepted applications for the registration of traditional medicines; regulations were imposed on domestic manufacturers and importers of such medicines in 1998 and 1999, respectively.246 Practitioners of traditional medicine are encouraged to register with various associations, although they are not legally required to do so. The Ministry of Health is now drafting a Traditional and Complementary Medicine Act, which would create a regulatory council similar to that of other medical professions.247 The ministry has also drafted a National Policy on Traditional and Complementary Medicine, which aims to ensure the availability of safe and high-quality traditional and complementary medicine practices and products for the public at large, and to facilitate the integration of such practices and products into the national health-care system.248 The National Committee for Research and Development in Herbal Medicines, whose formation was outlined in the Eighth Malaysia Plan, provides guidance on the practice of traditional and complementary medicine and on related products and training.249 Patients’ rights Malaysia’s legal system operates according to common law principles and allows damages to be recovered for medical malpractice under tort.250 The amount of damages that may be awarded in a personal injury claim is limited by the Civil Law

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Act 1956, which was amended in 1984 to further cap any damages awarded.251 The Medical Act 1971 does not specifically address medical negligence.252 There are no official statistics on medical negligence litigation, although a survey conducted from 1986 through 1990 documented 61 negligence cases against the Ministry of Health, or an average of approximately 12 cases per year.253 Statistics indicate that a great number of doctors do not have malpractice insurance.254 Patients may also bring grievances to the Malaysian Medical Council, which has discretionary jurisdiction to investigate and discipline certain instances of professional misconduct, even if the conduct does not rise to the level of a criminal offense or tort liability. The Malaysian Medical Council’s Code of Medical Ethics outlines the following doctors’ duties toward their patients: ■ to obtain the patient’s consent for medical examination and treatment; ■ to charge reasonable fees, according to the Malaysian Medical Association’s schedule of fees; ■ to maintain patient confidentiality; and ■ to recognize patients’ rights to access their medical records.255 The council may revoke a physician’s license and order reimbursement of legal fees, but may not award damages.256 In 1995, the Federation of Malaysian Consumers Associations, the Malaysian Medical Association, the Malaysian Dental Association, and the Malaysian Pharmaceutical Society signed the Patient’s Charter,257 a nonbinding document intended to educate health-care providers and patients about their respective rights and ethical responsibilities. The charter establishes that patients have the rights to the following: ■ health care and humane treatment, regardless of age, sex, ethnic origin, religion, political affiliation, economic status or social class; ■ choice of care; ■ acceptable safety; ■ adequate information and consent; ■ redress of grievances; ■ participation and representation; ■ health education; and ■ a healthy environment.258 The charter also includes a list of patients’ responsibilities,259 including the responsibility to “accept all the consequences of the patient’s own informed decision.”260 B. REPRODUCTIVE HEALTH LAWS AND POLICIES

Malaysia currently has no government policy or legislation specifically addressing reproductive health.261 However, many of the government’s current policy objectives for wom-

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en’s health and reproductive health are generally described in the Eighth Malaysia Plan.262 One of the plan’s broad strategic goals for women and development is improving women’s health status through the national Family Health Program, which was introduced in 1996 and addresses various areas of women’s overall health and reproductive health.263 The program covers maternal and child health care; immunizations; family planning; early cancer detection; nutrition; the prevention of sexually transmissible infections (STIs), including HIV/AIDS; and the identification of risk factors for noncommunicable diseases, such as cancer, mental illness, and cardiovascular disease.264 The plan also calls for the provision of health education programs for women, which focus on promoting healthy lifestyles and good nutrition.265 In recognition of the “peculiarities of illnesses confronting women, such as … those related to reproductive health,” and in an effort to improve the quality of women’s health care, the plan commits to establishing a special women’s hospital that will serve as a national referral center, and to conducting research on various aspects of women’s health, with an emphasis on biomedical, socio-behavioral, and clinical research.266 Regulation of reproductive health technologies Multiple forms of assisted reproductive technology are available in Malaysia, including artificial insemination and in vitro fertilization.267 More sophisticated procedures are offered in three flagship public hospitals, while simpler fertility assistance procedures are available in most general hospitals of the public system.268 In the private sector, 21 centers offer assisted reproductive technologies.269 The Ministry of Health foresees such technologies as a potential area for medical tourism.270 Family planning General policy framework There is currently no national family planning policy per se.271 However, the government has in the past formulated strategies to guide implementation of family planning and population activities.272 Following the ICPD in 1994, the government formulated a new strategy to enhance population at the macro level and family development at the micro level, which includes the following components: ■ enhancing the quality and standards of contraceptive services in the country through the provision of voluntary family planning services by medical, paramedical, and specially trained personnel, which include supportive and follow-up services such as specialist and specialized counseling services (e.g., genetic counseling and infertility evaluation and therapy); ■ providing family life and population education and services under the social development program to

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facilitate better family life and the complete development of the individual person, and improve the socioeconomic status of women, which will lead to fertility decline and decline in population growth; ■ supporting quality-of-life enhancement programs and activities including those for health, welfare, family development, and improvement of women’s status; ■ integrating family life education and population education into formal and nonformal education curriculums; ■ advising government and nongovernmental agencies on the relationship between population and family planning issues and development; and ■ researching population issues, especially the relationship between medicine, biology, socioeconomic status, and culture on fertility patterns, population growth, and overall socioeconomic development.273 Among the providers of family planning services in Malaysia as of 2000 are 2,826 Ministry of Health clinics, 82 NPFDB clinics, nine army clinics, and 307 clinics run by the Federation of Family Planning Associations of Malaysia.274 Contraception According to the most recent Malaysian Population and Family Survey, which was conducted in 1994, the contraceptive prevalence rate among currently married women aged 15–49 years was 54.5%.275 Of these users, 54.7% used modern methods and 45.3% used traditional methods.276 Among women who did not use contraceptives, the survey found that 58.7% had never practiced contraception, while the remainder had discontinued use for various reasons.277 The most popular contraceptive method used in Malaysia is the pill, as evidenced by the fact that between 1996 and 2000, it was by far the most chosen method of contraception among new family planning acceptors. In 2000 alone, 74.0% of new family planning acceptors chose the pill as their method of contraception. Condom use and tubal ligation are the next most commonly chosen methods (9.0% and 4.7%, respectively).278 There is a continuing belief among some rural Muslim Malays that family planning is completely prohibited in Islam,279 which may explain why Malay women have lower contraceptive prevalence rates than women of other ethnic groups. The 1994 Malaysian Population and Family Survey found that 22% of married Malay women aged 15–49 used a modern method, compared with 47% of Chinese women and 33% of Indian women, respectively.280 Contraception laws and policies There is no statute banning or restricting the use of contraceptives in Malaysia, or legal requirements for spousal con-

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sent or parental authorization. The National Essential Drugs List, issued by the Pharmaceutical Services Division within the Ministry of Health, lists approved drugs for marketing in Malaysia, including contraceptives.281 Despite the absence of laws prohibiting sterilization in Malaysia, the National Council for Islamic Affairs in 1981 issued a fatwa (opinion based on points of law in religious matters) that forbids the sterilization of men and women on the premise that any form of permanent contraception is haram (illegal); this fatwa, however, permits temporary methods of contraception for health and economic reasons.282 Fatwas may become legally binding in states that adopt such opinions through state legislation.283 There are no legal provisions governing the use of emergency contraception. Although emergency contraception is generally not provided in the public health system, an attending medical specialist may prescribe it in cases of sexual violence such as rape or incest.284 Although sterilization is not a commonly used method of contraception overall, tubal ligation is much more prevalent than vasectomy.285 Among new users of family planning methods in 2000, for example, 6.3% chose tubal ligation and virtually none chose vasectomy (0.003%]).286 The eligibility criteria for female and male sterilization in government clinics include the following: ■ having two or more children of each sex; ■ having achieved a desired family size; and ■ having a medical contraindication to other types of contraception.287 In addition, spousal consent is required “to ensure matrimonial harmony between husband and wife.”288 Regulation of information on contraception The Medicines (Advertisement and Sale) Act 1956 prohibits advertisements of contraceptives.289 However, the prohibition does not apply to advertisements issued by the federal government, state governments, local or public authorities, the governing body of a public hospital, or persons authorized by the minister of health to publish such advertisements.290 Government delivery of family planning services Family planning services in the public sector are provided by the Ministry of Health and the NPFDB, with the latter being the primary government body responsible for providing family planning and other sexual and reproductive health services.291 These two bodies provide services and contraceptives through various outlets and clinics, including maternal and child health clinics run by the Ministry of Health, and clinics operated by the NPFDB.292 As of 2000, almost all Ministry of Health clinics (99.7%) had integrated family planning into their provision of services.293 Pursuant to the Eighth Malaysia

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Plan’s Kompleks KASIH Keluarga program, a certain number of specialized clinics are being established nationwide, while other facilities are being upgraded to provide family planning services294 with the long-term goal of developing these clinics into a “one-stop family service centre of excellence.”295 Furthermore, the nationwide Nur Sejahtera: Sihat dan Segak program (Wellness: Healthy and Smart program) is being implemented to increase reproductive health awareness among the middle-aged population.296 As the main provider of family planning services, the NPFDB is responsible for providing sterilization procedures, which are performed in the board’s clinics, whereas Ministry of Health clinics refer such procedures to hospitals.297 Family planning services provided by NGOs and the private sector In addition to the Ministry of Health and the NPFBD, the Federation of Family Planning Associations of Malaysia is the third main implementing agency of family planning services in the country.298 The federation is a nonprofit association that provides family planning services through a network of about 307 clinics to mostly low-income and marginalized women, including those in indigenous communities and urban areas.299 The federation also operates a communitybased project initiated in 1980 called the Community Clinic Extension Family Planning program.300 The program provides family planning services to clients in underserved areas through a network of 423 outlets that are staffed with doctors and community-based agents.301 A wide network of private medical practitioners also plays a main role in the delivery of family planning services in Malaysia.302 The private sector is responsible for about 44.8% of family planning and contraceptive service provision.303 Unmarried individuals generally seek family planning services outside of the government sector, choosing to go to private gynecologists and pharmacies instead.304 Maternal health Malaysia’s maternal mortality ratio has fallen dramatically from 148 maternal deaths per 100,000 live births in 1970, to 30 deaths per 100,000 live births in 2002.305 Improvements in access to health care in rural areas, the development of professional midwifery, the installment of a highly efficient referral system, and the provision of free transportation to medical centers are among the reasons for this significant drop in maternal mortality.306 Seventy percent of pregnant women receive prenatal care, which is provided free of charge in government facilities.307 It is estimated that women make an average of seven prenatal visits per pregnancy.308 Although most deliveries occur in health facilities, more than 95% of all deliveries, even those that take place at home, are assisted

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by skilled attendants.309 The average proportion of deliveries that are considered to be “safe”—i.e., those assisted by trained personnel—is highest in Peninsular Malaysia and Sarawak (about 99% and 98%, respectively), and lowest in Sabah (about 81%).310 Conditions originating in the perinatal period are responsible for about 5% of maternal deaths in government hospitals, and these rank eighth out of ten in the principle causes of maternal mortality in government hospitals.311 Laws and policies The government has demonstrated a high degree of political will in undertaking efforts to reduce maternal mortality and improve the status of maternal health over the past several decades.312 Although there is currently no single comprehensive national law or policy addressing maternal health per se, government activities and services in this area have typically been implemented through the framework of various national programs and initiatives promoting maternal health and safe motherhood.313 Some of the government’s current strategies to reduce maternal mortality and improve maternal health include the following: ■ training traditional birth attendants; ■ utilizing a risk approach strategy, which was implemented in 1986, that identifies women at high risk of pregnancy- or delivery-related complications to give them the necessary level of care and provide referrals;314 ■ increasing access to family planning services and facilities; ■ developing a plan of action for community participation; ■ strengthening resources and capacity at operational levels; ■ using Home-Based Maternal Health Cards, a system introduced in 1994 in which cards are retained by the women, rather than kept on file at health facilities, to improve the exchange of health record information among providers and assure continuity of care;315 ■ establishing “low-risk delivery centers” in urban areas and “alternative birthing centers” in rural areas for low-risk women in order to reduce the number of low-risk deliveries in hospitals and free up more hospital beds, staff, and other scarce resources for highrisk pregnancies requiring specialized care;316 ■ providing “Alternative Birthing Centres (ABC)” which function as half-way centers as an alternative for mothers from very remote areas; and ■ establishing a confidential inquiry system for maternal deaths to identify preventable contributing factors

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and make recommendations for remedial measures at all levels of care.317 In addition to these efforts, the government launched the Safe Motherhood Initiative in 1989, which was inspired by the Safe Motherhood Conference held in Nairobi, Kenya, in 1987.318 The initiative’s strategies include redressing social inequalities facing women, ensuring access to family planning, developing community-based maternity care, and providing back-up and support services at the primary healthcare level.319 Nutrition The National Coordinating Committee on Food and Nutrition formulated the National Plan of Action for Nutrition (NPAN) of Malaysia in 1995 to implement its commitments under the World Declaration and Plan of Action for Nutrition, which was adopted at the International Conference on Nutrition in Rome in 1992.320 The Malaysia plan addresses nine major nutrition areas proposed at the conference, including the following six: ■ promotion of breast-feeding; ■ services for populations that are socially, economically, or nutritionally vulnerable; ■ prevention and treatment of specific micronutrient deficiencies; ■ development of policies and legislation that promote nutritional development; ■ promotion of healthy lifestyles and dietary practices; and ■ fielding of surveys of the national nutrition situation.321 Several outcomes have resulted from the national nutrition plan, including the development of National Dietary Guidelines for Malaysians, the creation of a nutrition tool titled Recommended Nutrient Intake for Malaysia,322 the enactment of the Food and Nutrition Policy, the fielding of the Malaysian Food Consumption Survey, and the inclusion of a nutrition component in the Seventh and Eighth Malaysia Plans.323 In 1997, the government introduced the Nutrition Rehabilitation Program for Pregnant Mothers to improve the health status of pregnant women, specifically low-income women, through the provision of adequate nutrition.324 Other government efforts targeted at improving the nutritional status of mothers and pregnant women include: ■ nutrition education; ■ supplementary feeding programs; ■ iron and vitamin supplements for pregnant women; and ■ efforts to address specific deficiencies, such as iodizing salt to address iodine deficiency.325

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The OPP3 includes endorsing the adoption of better nutritional practices to improve health status as one its key strategies.326 Safe abortion There is a dearth of data regarding the prevalence of abortion in Malaysia.327 An unofficial report issued in the 1980s estimated that one in three live births end in abortion.328 Abortion ratios have reportedly more than doubled since then, with ratios in urban areas being three times higher than those in rural areas.329 Other unofficial sources estimate the rate of illegal abortions to be 0.1% of 500,000 live births per year.330 A confidential government study of maternal deaths in 1991 did not list unsafe abortion as a major cause of maternal death.331 The Ministry of Health’s Information and Documentation System Unit reported 33,759 induced abortions, and nine deaths resulting from abortions, in 2002.332 However, more recently in 2004, the government has publicly recognized the problem of unsafe abortion in Malaysia, and its link to maternal mortality and morbidity.333 Abortion laws and policies The principal source of law on abortion in Malaysia is the penal code. The main code provision dealing with abortion, which was amended in 1989, permits abortion upon the good-faith opinion of a registered medical practitioner who asserts that continuation of the pregnancy would pose a greater risk to the woman’s life or mental or physical health than termination of the pregnancy.334 Prior to the amendment, abortion was permitted only if performed in good faith for the purpose of saving the woman’s life.335 Abortion performed in violation of the penal code with the woman’s consent carries punishment of up to seven years’ imprisonment and a fine for both the provider and the woman if she is “quick with child”;336 the punishment is up to three years’ imprisonment or a fine, or both, if she is not “quick with child.”337 Abortion performed without the woman’s consent, irrespective of whether she is “quick with child,” carries a punishment of up to 20 years’ imprisonment and a fine for the provider.338 If an abortion results in the woman’s death and she has consented to the procedure, the provider is subject to up to ten years’ imprisonment and a fine; if she has not consented, the penalty is up to 20 years’ imprisonment.339 The penalties for illegal abortion under the penal code did not change as a result of the 1989 amendment to the code. The term “abortion” is not actually defined under the laws of Malaysia. Rather, the penal code refers to the procedure as “causing miscarriage,” which is also undefined under the code. However, Malaysia accepts the legal definition of miscarriage from a 1955 Indian court case, In re Malayara Seethu, as the “premature expulsion of the product of conception, an

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ovum or a foetus, from the uterus, at any period before the full term is reached.”340 In 2002, the National Fatwa Committee issued a fatwa setting forth the conditions for permissible abortion. The committee declared that an abortion after 120 days’ gestation is considered murder unless the mother’s life is at stake, or in cases of fetal impairment.341 The parliamentary secretary of the prime minister’s department revealed that the national government had decided not to publicize the fatwa when it was issued for fear that it could be misused.342 A fatwa must be adopted by state governments before it can be legally enforced.343 According to the Malaysia Medical Council’s Code of Medical Ethics, abortions performed for other than therapeutic reasons are considered “infamous conduct” and physicians who perform such acts are subject to disciplinary action in addition to any criminal liability they may incur under the penal code.344 According to senior medical personnel in public hospitals, abortions are performed in accordance with standard operating procedures under a uniform approach to dealing with requests for termination of pregnancy.345 These standardized procedures were compiled at the initiative of a public hospital in the city of Ipoh, which resulted in the publication of the Clinical Practice Guideline: Termination of Pregnancy. According to this publication, which is based on guidelines issued by the Royal College of Obstetricians and Gynaecologists, United Kingdom,346 a request for termination of pregnancy can be accommodated at public facilities for medical or psychiatric conditions.347 The practice guidelines recommend that doctors obtain a second medical opinion before proceeding with the abortion, which should be performed by a doctor who was not involved in the decision-making process.348 The guidelines also instruct doctors to provide counseling to women seeking abortion, with the involvement of a psychiatrist, medical social worker, and other personnel, for the following purposes: ■ to determine the reason for the abortion request and the implications of the termination; ■ to determine the appropriate method of termination (depending on age of gestation) and its possible complications; ■ to provide emotional support; and ■ to discuss future pregnancies and contraceptive use.349 The guidelines also provide for postabortion care.350 Regulation of information on abortion The Medicines (Advertisement and Sale) Act 1956 prohibits individuals from taking part in the publication of adver-

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tisements relating to abortion.351 First-time contravention of the act carries a maximum prison term of one year or a fine of up to RM 3,000 (USD 790), or both;352 the penalty for subsequent offenses is imprisonment of up to two years or a fine of up to RM 5,000 (USD 1,316), or both.353 Individuals charged under the act may avoid punishment in certain situations, such as if the abortion-related advertisement appeared in a technical publication intended for circulation among health-related professionals, including registered medical practitioners, dentists, pharmacists, and individuals in training for such professions.354 Government delivery of abortion services Legal abortions may be performed in public facilities in accordance with standard clinical guidelines. According to senior medical personnel in government facilities, public hospitals will perform abortions as long as two doctors can prove that continuing the pregnancy would result in detriment to the mental or physical health of the woman concerned.355 The private sector provides abortion services at costs that vary from one facility to another. The Federation of Family Planning Associations of Malaysia provides only referrals for abortion.356 HIV/AIDS and other sexually transmissible infections (STIs) Excluding HIV, syphilis is the most common STI in Malaysia, followed by gonorrhea and chancroid. The cumulative number of HIV/AIDS cases reported to the Ministry of Health as of December 2002 was 51,256.357 The majority of HIV infections in Malaysia are transmitted via needle sharing among injecting drug users (76.3%), followed by heterosexual contact (12.1%), other or unknown causes (10.1%), and homosexual or bisexual contact (0.9%).358 By gender, men account for the majority of HIV/AIDS cases, although the rate of HIV infection among women increased from 1.2% of cases (nine) in 1990 to 9% (629 cases) in 2002.359 During 2002 alone, the reported number of HIV infections among women increased by 70% (from 370 to 629 cases).360 Mother-to-child transmission of HIV has also been steadily increasing.361 By occupation, the largest percentage of infected women are housewives (26.3%), with industrial workers (4.1%) and sex workers (2.8%) representing smaller percentages of infected women.362 Laws and policies The Prevention and Control of Infectious Diseases Act 1988 requires a person infected or affected by an infectious disease, or a medical practitioner who becomes aware of the existence of or treats such a disease, to notify the appropriate authorities.363 The act also prohibits infected individuals from behaving in a manner likely to expose others to the

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risk of infection or lead to the spread of the disease.364 The First Schedule of the act lists the applicable infectious diseases, which include chancroid, all forms of gonococcal infections, syphilis, and HIV.365 The penalties for offenses committed under the act include imprisonment of two to five years or a fine, or both.366 The act does not offer legal protections for people living with HIV/AIDS in cases of discrimination.367 In addition, the penal code contains provisions criminalizing negligent368 or malignant369 acts “likely to spread infection of any disease dangerous to life.” It stipulates a punishment of up to six months’ imprisonment or a fine, or both, for negligent acts, and imprisonment extendable to two years or a fine, or both, for malignant acts.370 Furthermore, the Action Plan on the Prevention of HIV/ AIDS in the Workplace was formulated during the implementation of the Eighth Malaysia Plan.371 The highest policy-making body in relation to HIV/AIDS prevention and control is the Ministerial Level Committee on AIDS, which was established in 1992.372 The committee is chaired by the minister of health and is made up of members from various ministries, including education, youth and sports, national unity and social development, culture and tourism, rural development, and the prime minister’s office.373 There are two subcommittees under the main committee—the National Technical Committee on AIDS, which develops and monitors the technical aspects of national HIV/AIDS prevention and control measures; and the National Coordinating Committee on AIDS, which serves as a forum for governmental agencies and NGOs to discuss various social, economic, cultural, religious, legislative, and other issues relating to the prevention and control of HIV/AIDS in Malaysia.374 In addition to comprehensive national plans and programs, several Ministry of Health guidelines address discrete aspects of HIV/AIDS prevention, control, and treatment, including the following: ■ counseling about HIV infection and AIDS; ■ AIDS education; ■ management of HIV infection in Malaysia; ■ management of nursing care for people infected with HIV/AIDS;375 ■ management of infected health-care workers;376 and ■ universal infection control precautions. The Ministry of Human Resources has also developed policy recommendations relating to HIV/AIDS. In 2001, it issued the Code of Practice on the Prevention and Management of HIV/AIDS in the Workplace.377 The code’s main goal is to reduce the spread of HIV/AIDS by providing guidance on prevention and management issues in the workplace, promoting education and awareness on HIV/AIDS, and

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encouraging a nondiscriminatory work environment.378 The Malaysian AIDS Council serves as a liaison between the government and NGOs involved in AIDS-related work. The council itself is an umbrella organization composed of over 30 NGOs and community-based organizations, through which the government channels funds for AIDS-related projects in the nonprofit sector. Among the council’s notable efforts was the publication of the Malaysian AIDS Charter in 1995, a nonbinding policy document that outlines the rights and responsibilities of all sectors of the population in relation to HIV/AIDS.379 The charter asserts that all individuals have the right to be treated with “care, consideration, respect and dignity without discrimination of any kind”; to anonymous testing and informed consent to testing; confidentiality; and to marry, provided that the infected party’s HIV status is disclosed to the partner.380 The government and NGO sectors have made efforts to improve access to antiretroviral treatment and alleviate financial hardship for people living with HIV/AIDS. In November 2002, the Pharmaceutical Services Division obtained cabinet approval to import generic versions of patented antiretrovirals from India under governmental approval to conduct this trade.381 In addition, the Malaysian AIDS Foundation, the fundraising arm of the Malaysian AIDS Council, assists individuals in obtaining antiretroviral therapy through a drug assistance scheme launched in 1998.382 The foundation also sponsors programs that provide monthly financial aid to children with HIV/AIDS, and interest-free loans to people living with HIV/AIDS to assist them in setting up or strengthening small-scale businesses.383 Regulation of information on HIV/AIDS and other STIs The Indecent Advertisements Act 1953 defines advertisements relating to venereal disease and sexual intercourse as matters of an “indecent nature” and restricts their publication.384 Syphilis, gonorrhea, soft chancre, and bubo (lymphogranuloma inguinale) are included within the definition of venereal disease.385 The act prescribes a maximum punishment of imprisonment for one year and a fine of up to RM 500 (USD 130).386 The act does not apply to advertisements relating to venereal disease that are published or authorized by the federal or state governments, or any local or public authority.387 The Malaysian AIDS Charter affords every individual the right to accurate and unambiguous information on HIV/ AIDS; the federal and state governments are charged with responsibility for the public dissemination of such information.388 The charter establishes a national public AIDS resource center that consolidates information from the government, private sector, NGOs, and other related agencies.389

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Adolescent reproductive health Adolescents aged 10–19 years account for 20.4% of Malaysia’s total population.390 Girls in that age-group comprise about 10% of the total population.391 Data on Malaysian adolescents’ health overall, and on their reproductive health in particular, are not readily available,392 and there are few comprehensive studies on the subject; a study conducted in 1994 by the NPFDB with a sample of 2,366 adolescents aged 10–19 still serves as a common source of information on adolescent sexual and reproductive health.393 Of the total number of HIV/AIDS cases as of June 2002, adolescents accounted for 1.6%.394 Laws and policies There is no specific national policy on adolescent reproductive health. In 1995, upon the adoption of the Beijing Declaration and Platform for Action, the government stated the following official position on adolescent reproductive health: …while agreeing that adolescent health is an area requiring attention due to increasing problems of unwanted teenage pregnancies, unsafe abortions, sexually transmitted diseases and HIV/AIDS, we believe that parental guidance should not be abdicated and that sexual permissiveness and unhealthy sexual and reproductive practices by adolescents should not be condoned.395 The government established the Adolescent Health Program under the Family Health Development Division of the Ministry of Health in 1995.396 Three separate divisions were created in the program in response to a 1996 national health survey that found existing health activities to be too general for the needs of adolescents and recommended targeted health promotion and prevention services for adolescents.397 The three divisions focus on policy development, health personnel training, and pilot projects.398 In 2001, the government introduced the National Adolescent Health Policy, which aims to promote the development of adolescents by ensuring that they take responsibility for their health, and by empowering them with the knowledge and skills to practice healthy behaviors.399 The policy focuses on preventing the negative health consequences of risk behaviors and enabling adolescents to make sound choices, develop risk-management skills, and adopt responsible healthy lifestyles.400 Delivery of adolescent reproductive health services by NGOs As of 2001, there were about 170 government health clinics across the country that provided services to adolescents, including medical treatment, screening, and health promotion.401 It is the government’s operational policy not to

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provide certain services, such as family planning methods, to unmarried adolescents.402 However, anecdotal evidence suggests that some private-sector providers offer pregnancy tests and contraceptives to adolescents.403 In addition, the condom is widely available over the counter in convenience stores and pharmacies, with no restrictions on purchasers.404 The government has developed programs addressing specific aspects of adolescent reproductive health, with HIV/ AIDS as a particular area of attention. Through the Program Sihat Tanpa AIDS Untuk Remaja (Staying Healthy Without AIDS program for adolescents, known as PROSTAR), an AIDS education and prevention program, the government has established 458 PROSTAR clubs in 339 schools and 119 districts.405 The clubs involve about 23,780 adolescents who serve as peer group tutors.406 The Eighth Malaysia Plan proposed to train 20,000 additional peer group tutors to reach 2.6 million adolescents in 2001.407 Such programs reflect the government’s recognition of young women’s particular vulnerability to HIV/AIDS, and its emphasis on providing AIDS information and education.408 C. POPULATION

Malaysia’s policies on population have always been closely linked with the economic development of the nation. The First Malaysia Plan (1966–1970) identified the country’s high population growth rate as a problem for national development, and made reduction of the birthrate a key development goal.409 In 1966, Malaysia passed the Population and Family Development Act, which created the National Family Planning Board, an agency responsible for implementing the national family planning program.410 At the time, the board’s objective was to encourage couples to have fewer children in order to reduce the annual growth rate, from 3% to 2%, within 20 years.411 The Midterm Review of the Fourth Malaysia Plan (19811985) in 1984 established a new policy direction on population in which moderate growth was viewed as economically desirable in order to promote a larger consumer base.412 That review identified a specific population size of 70 million as an ideal target toward which to strive over the long term (115 years).413 In 1984, the National Family Planning Board was renamed the National Population and Family Development Board (known by its acronym, NPFDB) to reflect the new policy’s focus on birth spacing and family welfare rather than limiting births.414 Incentives were also developed to encourage childbearing, such as offering tax breaks for each child in a family.415 Subsequent development plans have continued to

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emphasize the link between population growth and economic development.416 Laws and policies There is no separate population policy per se. Population goals are addressed in the country’s development plans and are articulated by the NPFDB. According to the data presented in the Eighth Malaysia Plan, the population—currently over 26 million—is growing at an annual rate of 2.3%.417 This rate is lower than that registered during the Seventh Malaysia Plan period (i.e., 1996– 2000), because fertility rates continue to decline as more women pursue higher education and professional training.418 According to the NPFDB, the thrust of the government’s current policy on population is to strategize to meet the needs of citizens up to the year 2020 in a manner that supports the goals of the National Vision Policy, which stresses resource development and the creation of an economically strong and competitive community.419 This requires an emphasis on the quality of the population, human resource development, and enabling couples to plan their families according to their resources.420 The main aim of the policy is to achieve a population growth rate that is in balance with available resources and sustainable development.421 At the macro level, achieving this aim will require better integration of population factors within development planning processes, and at the micro level, it will mean strengthening the family unit to improve the quality of the population.422 Implementing agencies The NPFDB is charged with overseeing the current population policy and with performing the following functions: ■ formulate policies and methods to increase knowledge and promote practices relating to population and family development in order to promote maternal and child health and the welfare of the family; ■ program, direct, administer, and coordinate population and family development activities nationwide; ■ train personnel providing services in relation to population and family development; ■ conduct research on medical and biological issues related to population and family development; ■ promote research on the interrelations between social, cultural, economic, and population changes, especially concerning the nation’s fertility patterns; and ■ establish an evaluation system to assess the effectiveness of population programs and track the progress toward attaining their objectives.423 (See “Infrastructure of health-care services” for more information.)

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Under the Eighth Malaysia Plan, about RM 8 million (USD 2.13 million) was allocated to the NPFDB for the period covered by the plan (2001–2005).424

III. Legal Status of Women and Girls The health and reproductive rights of women and girls cannot be fully understood without taking into account their legal and social status. Laws relating to their legal status not only reflect societal attitudes that shape the landscape of reproductive rights, they directly impact their ability to exercise these rights. A woman or adolescent girl’s marital status, her ability to own property and earn an independent income, her level of education, and her vulnerability to violence affect her ability to make decisions about her reproductive and sexual health and access to appropriate services. The following section describes the legal status of women and girls in Malaysia. A. RIGHTS TO EQUALITY AND NONDISCRIMINATION

The federal constitution of Malaysia prohibits discrimination against citizens on the grounds of religion, race, descent, place of birth, and gender in any law; in appointments to any public office or employment; in the administration of any law relating to property matters; or in the establishment of or engagement in a trade or employment.425 Gender was included as an additional ground as a result of a 2001 amendment to the constitution; however, it does not extend to provisions regulating personal laws applicable to women.426 The rights of Malaysian women are governed by provisions in the federal constitution, Malaysian legislation, religious and customary laws, and international conventions to which Malaysia is a party. The federal constitution and specific national legislation guarantee women formal rights in a number of different spheres, including political participation, employment, education, health care, marriage, and divorce.427 In addition, over the last ten years and largely due to the efforts of the women’s movement, specific legislation has been enacted or amended to address gender violence and promote gender equality. These include the Domestic Violence Act 1994 (DVA)428 and amendments to the penal code’s rape provisions.429 However, the recent case of Beatrice Fernandez v. Sistem Penerbangan Malaysia & Anor illustrates the limitations of having only formal expressions of the right to equality. In that case, the Court of Appeal held that constitutional rights and guarantees, including the right to equality, were enforceable by private citizens against the state only, and not between private

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citizens themselves.430 This case involves discrimination against a woman by her employer based on pregnancy. There are no constitutional guarantees against discrimination on the ground of sexual orientation. Homosexual acts are punishable offenses under civil, criminal, and Islamic laws. The penal code criminalizes “unnatural offences,” which are interpreted to include homosexuality.431 A relevant provision of the code was invoked for the first time against a former deputy prime minister in a case involving alleged homosexual activity between two consenting adults.432 Transsexuals are often arrested and charged under the Minor Offences Act 1955 433 for “indecent behavior.”434 Under the tenets of Islam, homosexuality is considered morally worse than adultery because it is against nature and the divine objective of creation and reproduction.435 Liwat (sexual relations between male persons) and musahaqah (sexual relations between female persons) are punishable offenses under the Syariah Criminal Offences (Federal Territories) Act 1997.436 The government formulated the National Policy on Women in 1989, which recognizes poverty, lack of education, and, at times, culture and tradition, as obstacles to women’s progress.437 The policy’s primary objectives are the following: ■ ensure that men and women share equitably in the acquisition of resources, information, opportunities, and the benefits of development; and ■ integrate women into all sectors of development in accordance with their capabilities and needs to enhance the quality of life; eradicate poverty, ignorance, and illiteracy; and ensure a peaceful, harmonious, and prosperous nation.438 One visible outcome of the policy was the inclusion of a chapter on Women in Development in the Sixth Malaysia Plan (1991–1995). This was the first time the role of women in Malaysia’s development was formally recognized and highlighted in a national development plan.439 The implementation of that chapter of the plan was originally the responsibility of the Women’s Affairs Secretariat (known as HAWA),440 but is now under the Ministry of Women, Family and Community Development.441 The National Action Plan for the Advancement of Women442 was formulated to implement the women’s development policy, and was approved by the cabinet in 1997. The action plan draws largely from the Beijing Platform for Action and outlines strategies and programs in areas of critical concern for women’s roles in the spheres of health, education and training, the economy, law, power-sharing, the media, religion, culture, sports, and the family. The main objectives of the Malaysian action plan are the following: ■ strengthening the national mechanisms for women’s advancement; ■ increasing awareness and sensitivity of the public and

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the government to women’s issues; and activating NGOs to improve the efficiency and effectiveness of socioeconomic programs.443 The action plan identifies different ministries, agencies, and NGOs that are responsible for instituting affirmative action policies and other incentives to increase women’s opportunities for participation in social and economic life. The recommendations contained in the action plan are in line with the broader policies of national development plans.444 The strategic thrusts of the Eighth Malaysia Plan in the area of women and development are the following: ■ increasing women’s participation in the labor market; ■ providing more education and training for women to meet the demands of a knowledge-based economy and facilitating women’s upward mobility in the labor market; ■ fostering women’s involvement in business; ■ reviewing statutory measures that inhibit the advancement of women; ■ improving women’s health status; ■ reducing the poverty rate among female-headed households; ■ strengthening research activities that seek to increase women’s participation in society and enhance their well-being; and ■ enhancing the national mechanisms and institutional capacity for the advancement of women.445 Formal institutions and policies The government established the Ministry of Women and Family Development in 2001 as the national agency for promoting the advancement of women in the country.446 Among the ministry’s responsibilities are formulating and monitoring policies and programs that address issues relating to women and families; sensitizing policymakers about such issues; and engaging in legal literacy and awareness-raising campaigns for women and the public at large.447 The ministry also oversees implementation of the National Action Plan for the Advancement of Women.448 The ministry was merged with the Ministry of National Unity and Social Development in May 2004 to form the new Ministry of Women, Family and Community Development (The Women’s Ministry).449 Among the bodies within the Women’s Ministry are the Department for Women’s Development, the Community Welfare Department, the NPFDB, the Community Welfare Foundation, and the Social Institute of Malaysia.450 The Women’s Ministry also includes the advisory bodies of the National Advisory Council on Women and the National Council for Women and Family Development.451 ■

Prior to the establishment of the Women’s Ministry, the Women’s Affairs Secretariat, created in 1983, was the lead government agency on women’s issues and was responsible for ensuring the integration of women into the national development process.452 It also served as the secretariat for the National Advisory Council on Integrating Women in Development, the oldest national institutional body for the advancement of women. The advisory council was established in 1976 in response to the World Plan of Action for the Advancement of Women adopted at the First World Conference on Women in 1975,453 which advocated the integration of women into the development process.454 The advisory council is a multisectoral body made up of government and NGO representatives; it serves as a coordinating, consultative, and advisory body to the government, and between the government and NGOs, on matters relating to women in development planning and implementation.455 In addition to setting up mechanisms and policies specifically addressing women’s affairs, the government established the Human Rights Commission of Malaysia in 1999.456 The commission has no enforcement powers, but has, in certain cases, brought to the government’s and the public’s attention what needs to be done to comply with human rights norms.457 B. CITIZENSHIP

The federal constitution grants mothers and fathers the right to confer citizenship to their children born in Malaysia.458 However, in the case of children born outside of the country, the child is considered a citizen at birth only if his or her father is a citizen at the time of the birth.459 The federal constitution discriminates against foreign spouses of Malaysian women who want to acquire citizenship. Whereas it provides that a foreign wife of a Malaysian man may apply for citizenship, there is no similar provision allowing a foreign husband to acquire citizenship as a result of his marriage to a Malaysian woman.460 This dual treatment is premised on the view that upon marriage, a woman should follow her husband and not vice versa.461 Some reprieve has been given to foreign husbands of Malaysian women who are professionals and have applied for work permits.462 Furthermore, the Immigration Department has recently announced that foreign wives who hold social visit passes for at least three years are now allowed to work in Malaysia.463 Unfortunately, this policy has not been extended to foreign husbands. C. MARRIAGE

The laws relating to marriage and family matters in Malaysia are governed by two distinct legal systems—civil law, which is

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applicable to non-Muslims, and Islamic or Syariah law, which applies only to Muslims. The Law Reform (Marriage and Divorce) Act 1976 is the principal piece of legislation governing marriage and divorce for non-Muslims. The act recognizes monogamous marriages464 and prescribes procedures for the solemnization and registration of such marriages. It does not affect the validity of any marriage solemnized under any law, religion, or custom prior to the date the act came into force, on March 1, 1982.465 The minimum age for marriage under the act is 18 years for both males and females.466 However, females who have attained the age of 16 may obtain permission to marry from the chief minister of their state.467 The act also stipulates that individuals under the age of 21 cannot marry without their father’s permission.468 The act outlaws polygamy.469 There is no legal recognition of marriage between two persons of the same sex in Malaysia. Under the Married Women and Children (Maintenance) Act 1950, a married woman is entitled to claim reasonable maintenance from her husband for herself and her children during marriage if the husband neglects to support her, or refuses to provide for the family.470 Upon proof of either of the above situations, a court may order the husband to pay a monthly allowance as maintenance, with consideration for the husband’s means, the family’s financial means, any physical or mental disability of the wife, and the standard of living enjoyed by the family.471 An illegitimate child is also entitled to claim maintenance from his or her father under the act.472 Marriage between Muslims The Islamic Family Law (Federal Territories) Act 1984 applies to matters of marriage among Muslims in the Federal Territories of Kuala Lumpur, Labuan, and Putrajaya.473 Although each Malaysian State has its own set of Islamic laws, the basic principles are the same in all jurisdictions with regard to family law for Muslims, and are enshrined in the various state legislations. The Islamic Family Law (Federal Territories) Act 1984 establishes a minimum age for marriage of 18 for males and 16 for females. However, females under the age of 16 may marry under “certain circumstances” with the written permission of a Syariah court judge;474 the act does not define the “certain circumstances” under which such a marriage would be permitted, however. Generally, a valid Islamic marriage requires the consent of both parties. The states of Kelantan, Kedah, and Melaka, however, legally recognize the marriage of a young woman forced to marry by her father or paternal grandfather, according to the doctrine of ijbat.475 Laws in various states permit Muslim men to marry up to four wives. Women are not allowed to take more than one

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husband. Official sources indicate that only 5% of Muslim marriages in Malaysia are polygamous.476 NGOs estimate the figure to be closer to 20%.477 Generally, the man must obtain his existing wife’s written consent before entering into another marriage, as well as permission from the relevant Syariah court.478 In a number of states, four conditions must be fulfilled before a man may take another wife: ■ the proposed marriage must be “just and necessary”; ■ the husband must have sufficient financial means; ■ the husband must agree to accord equal treatment to the existing wife or co-wives; and ■ the proposed marriage will not cause darar syarie (danger or harm) to the existing wife or cowives.479 The conditions for polygamy vary from state to state. In the state of Perak, for example, the husband need only make a declaration before a Syariah court judge that “he shall be fair to his wives” and obtain a certificate from the judge.480 In the states of Kelantan and Terengganu, permission from the Syariah court is the only requirement.481 Recently, the state of Perlis relaxed its polygamy laws, allowing Muslim men to enter into polygamous marriages without the consent of their existing wives.482 Perlis’s polygamy registration fees have also been made more affordable, and men need not undergo new marital instruction courses before marrying again, a requirement that is customary in other states.483 The state government of Selangor, on the other hand, has recently tightened the procedure for polygamous marriages,484 and requires that courts receiving applications for polygamy hear testimony from the applicant husband, his existing wife, his future wife, and her wali (male guardian) so the judge can determine whether the proposed marriage is “just or necessary.”485 In an attempt to give Muslim Malaysian women additional protection in marriage, the Islamic Family Law (Federal Territories) Act 1984 allows women to include a stipulation (ta’liq) in their marriage contract, such as a “no-polygamy” clause.486 With that stipulation, a woman is entitled to a divorce if her husband takes another wife.487 Native customary or aboriginal law governs marriages between indigenous peoples, unless they elect to marry under the Law Reform (Marriage and Divorce) Act 1976.488 Some customary laws provide indigenous women with stronger legal status than that accorded by civil law. For example, according to adat, the customary law of the Iban indigenous people of Sarawak, marriage is by mutual consent and no dowry is paid.489 Bigamy is also prohibited, and the fine imposed for the offense of bigamy is the same for both men and women.490

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D. DIVORCE

Under the Law Reform (Marriage and Divorce) Act of 1976, married couples may petition for divorce either by mutual consent or by contested petition. The act requires all divorces to be registered.491 In order to obtain a divorce by mutual consent (by way of joint petition),492 the parties generally must have been married for at least two years and domiciled in Malaysia at the time of the petition.493 The marriage must also be registered under the act or a law that provides for monogamous marriage.494 Either party to a marriage may also petition for a divorce on the ground that the marriage has irretrievably broken down.495 The marriage duration, domicile, and registration requirements in these types of divorces are similar to those for divorce by mutual consent.496 In addition, the party must prove at least one of the following as proof of marital breakdown: ■ one party has committed adultery and the other party finds it intolerable to live with his or her spouse; ■ one party has behaved in such a way that the other cannot reasonably be expected to live with him or her; ■ one party has deserted the other party for a continuous period at least two years before the date of his or her petition; or ■ both parties have lived apart from each other for a continuous period of at least two years before the date of the petition.497 A man or woman may also petition for divorce if his or her spouse has converted to Islam, so long as the petition is presented before three months from the date of the conversion.498 However, there is no requirement that the marriage has to have lasted for at least two years.499 In general, the petitioner also needs a certificate from a conciliatory body or marriage tribunal attesting that reconciliation has been attempted and failed.500 Exemptions may apply under certain circumstances specified in the act.501 The Law Reform (Marriage and Divorce) Act 1976 provides for the right of a wife or former wife to receive maintenance from her husband during proceedings for judicial separation or divorce.502 The court may order the husband to pay an amount of maintenance according to the “means and needs of the parties, regardless of the proportion such maintenance bears to the income of the husband.” The court also considers the degree of responsibility of each party for the breakdown of the marriage.503 The right to receive maintenance ceases upon the wife’s remarriage or her commission of adultery.504 Divorce laws governing Muslims Muslim women or men who seek divorce may petition a

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Syariah court under the procedure established by the Islamic Family Law (Federal Territories) Act 1984505 and various state Islamic Family Laws.506 The court summons both parties and inquires into the matter, after which the divorce will be registered and effective upon the court’s consent.507 Syariah family law, as codified in the Islamic Family Law (Federal Territories) Act 1984, allows a marriage to be dissolved by several types of divorce, some initiated by either spouse, and some by only the husband or the wife. These include talaq (repudiation by the husband), khul’ (payment by the wife in return for her release from the marriage contract), ta’liq (delegated repudiation by the wife as stipulated in the marriage contract), or fasakh (judicial dissolution of the marriage).508 Divorce by lian (accusation of adultery), where the husband affirms under oath that his wife committed adultery and she affirms under oath to the contrary, is also provided for under the act.509 The most common procedure for divorce is talaq. A man may divorce his wife with a unilateral pronouncement of talaq with the permission of the court.510 If the wife does not consent to the divorce, or where it appears to the court that there is a reasonable possibility of reconciliation, the court will appoint a conciliatory committee.511 In practice, Syariah law is often disregarded and men regularly pronounce talaq without the court’s permission. Although this constitutes an offense,512 such pronouncements of talaq outside the court may still effectively terminate a marriage and may be recognized by the courts.513 The offense is punishable under the act with a fine of up to RM 1,000 (USD 263) or imprisonment of up to six months, or both,514 although punishment is rarely meted out.515 There are three main ways in which a woman may seek to dissolve her marriage. The first is divorce by khul’, whereby the woman pays her husband tebus talaq, an amount of money to reimburse him for the dowry that was paid to her when they were married.516 This form of divorce is only available where both parties agree to a divorce. A woman cannot herself effectuate a khul’ divorce but must do so through the court. Under a ta’liq divorce, a woman has the right to divorce her husband if he violates one of the conditions listed in the ta’liq agreement (stipulations in the marriage contract) agreed upon at the time of the marriage.517 These conditions may include desertion, failure to pay maintenance, and harm caused to the wife’s person. Upon a woman’s petition, a court will make an inquiry into the validity of the divorce and, if satisfied, confirm and record the divorce.518 Fasakh is the dissolution or rescission of a contract of marriage by judicial decree.519 There are 12 grounds upon which a

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married woman is entitled to obtain a fasakh divorce,520 including when her marital consent was coerced or invalid, cruelty by the husband, the husband’s impotence or refusal to have sexual intercourse after at least four months of marriage or for at least a year, and the husband’s infection with an STI.521 The grounds for fasakh may vary among states.522 Under Islamic Family Law (State of Selangor) Enactment No. 2 of 2003, husbands have been afforded the right to a fasakh divorce, in addition to their traditional right to talaq divorce.523 A controversial recent decision by a Syariah court to allow a Muslim man to pronounce talaq via a mobile telephone text message has been condemned by women’s groups and the head of the Ministry of Women, Family and Community Development.524 The prime minister has indicated that laws may need to be amended to discourage men from divorcing their wives by means of electronic messages.525 Another new development is the decision of Jabatan Kemajuan Islam Malaysia (Department of Islamic Development Malaysia) and the State Religious Departments to introduce a mandatory sentence against husbands who divorce their wives outside the court.526 A divorced Muslim woman is entitled under Syariah law, as codified in the Islamic Family Law (Federal Territories) Act 1984 and state Islamic Family Laws, to reasonable maintenance from her husband.527 This right is afforded only during the period of iddah (the generally three-month period following the dissolution of marriage during which the legal rights and obligations of the spouses are not wholly extinguished and, particularly, where a widow or divorcee is not allowed to remarry528), and terminates earlier if the woman is living in adultery.529 The act’s provisions are similar to those of the Law Reform (Marriage and Divorce) Act 1976—i.e., maintenance is assessed mainly on the means and needs of the parties, regardless of the relationship the maintenance amount bears to the income of the husband.530 A wife is not entitled to maintenance where she is nusyuz, that is, where she unreasonably refuses to obey the lawful wishes of her husband.531 Under Syariah law in Malaysia, the concept of nusyuz is applicable only to women, although the Quran refers to nusyuz by the husband as well.532 In addition to the right to apply for maintenance, the Islamic Family Law (Federal Territories) Act 1984 provides that a woman who has been divorced without just cause may apply to the court for mut’ah (compensation).533 The amount is normally agreed upon by both parties. In the absence of such an agreement, the judge will determine the amount in consideration of the financial position and circumstances of the wife and the family’s financial and social standing.534

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Divorce laws governing indigenous peoples Native customary or aboriginal law governs divorce among indigenous peoples, unless they elected to marry under the Law Reform (Marriage and Divorce) Act 1976.535 Customary laws are often much more liberal in the rights they afford than civil law. Among the Batek peoples, for example, either spouse can initiate divorce simply by leaving.536 Parental rights Under the Law Reform (Marriage and Divorce) Act 1976, courts may, at any time, place a child in the custody of either parent.537 Where there are exceptional circumstances making it undesirable for the child to be placed with either parent, the child may be placed in the custody of a relative, another suitable person, or a child welfare organization.538 In determining the most suitable guardian, the foremost consideration of the court is the welfare of the child.539 The court next considers the wishes of the parents, and then the wishes of the child, if he or she is capable of having an independent opinion.540 Where a child is under the age of seven, the presumption of custody is with the mother, unless she is proven to be unfit.541 Older children’s wishes may be considered if the court finds the children to be mature enough to understand the implications of their decision.542 In awarding custody, a court may impose certain conditions, including conditions of residence, education and religion; temporary guardianship with someone other than the legal guardian; and mandated visits and rights to access the child for the parent or relatives who are not granted custody.543 The granting of custody may also prohibit the legal guardian from taking the child out of Malaysia.544 Amendments to the Guardianship of Infants Act 1961 in 1999 granted equal rights to mothers as the guardians of the infant’s person and property.545 The act applies to non-Muslims, although it is stipulated that it can apply to Muslims in states that adopt this federal act. Parental rights laws governing Muslims The Islamic Family Law (Federal Territories) Act 1984 includes provisions relating to the custody of children in cases of divorce among Muslims.546 Under the act, custody of a child below the age of mummaiyyiz (puberty) goes to the mother, while a child above the age of mummaiyyiz has the right to choose between the mother and father.547 The act enumerates several circumstances where the mother loses her hadanah (custody of a child), including where the mother has remarried and her remarriage would affect the welfare of the child.548 In contrast, men do not lose custody under any circumstances if they remarry. The woman’s right of hadanah is also lost by her gross and open immorality,549 by her changing residence to prevent the father from exercising supervision

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over the child,550 by her abjuration of Islam,551 and by her neglect of or cruelty to the child.552 In the case of illegitimate children, the right of custody lies solely with the mother.553 Fathers are not required under the act to maintain their “illegitimate” children.554 The Islamic Family Law (Federal Territories) Act 1984 also addresses parental rights issues outside of custody matters. For example, it grants fathers the exclusive and unconditional right to make decisions about the person and property of their minor children.555 The mother cannot be the guardian of her child unless she is appointed by the father’s will or a court order.556 In practical terms, this has caused many difficulties for women who have custody of their children upon divorce.557 Because of women’s lack of guardianship rights over their children, formal matters that require the consent and signature of legal guardians, such as registering children for school and applying for identity cards, can become problematic for divorced mothers.558 The states of Johor, Selangor, Negeri Sembilan, and Pahang have announced their decision to adopt the amendment from the Guardianship of Infants Act 1961 that gave women equal guardianship rights into their respective Syariah legislation.559 If enacted, this amendment will grant legal recognition to the parental rights of mothers.560 A cabinet directive issued in 2000 gives Muslim and nonMuslim mothers the right to sign all documents related to their children,561 although it does not confer the same rights of guardianship on Muslim women as does the amended Guardianship of Infants Act 1961. E. ECONOMIC AND SOCIAL RIGHTS

Ownership of property and inheritance The federal constitution prohibits discrimination against citizens “… in any law … or in the administration of any law relating to the acquisition, holding or disposition of property ….”562 Inheritance for non-Muslims is generally governed by the Inheritance (Family Provision) Act 1971 and the Distribution Act 1958.563 The Distribution Act was amended in 1997 so that both husband and wife have equal inheritance rights.564 The 1997 amendments removed the distinction between wives and husbands in the distribution to the surviving spouse of the estate of an intestate.565 Prior to the amendment, a wife who survived her husband was entitled to only one-third of her husband’s estate, whereas a surviving husband was entitled to his wife’s entire estate. In the Islamic system of succession, while the surviving parents, spouse, and offspring of a deceased all inherit, the amounts they inherit differ.566 The general rule is that the share of a man is double that of a woman in the same degree of relationship.567

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A woman’s right to inheritance is also determined by her marital status. Under the Islamic Family Law (Federal Territories) Act 1984, a divorced Muslim woman may claim her share in any property jointly acquired during the marriage upon dissolution of the marriage.568 The general rule is that if the woman has directly contributed to the acquisition of the property, she is entitled to one-half, as illustrated in the 1982 case of Mansjur v. Kamariah (Federal Territory Syariah Board of Appeal).569 However, if she has contributed indirectly, she is entitled to one-third of the property, as shown in the 1985 High Court decision of Boto v. Jaafar570 and the 1989 Special Appeal Committee decision of Rokiah v. Mohd. Idris (Federal Territory Syariah Board of Appeal).571 Syariah courts have the power to divide any assets that were jointly acquired by the couple during their marriage, or to order the sale of the assets and the division of the proceeds between the couple.572 Generally, women in Malaysia have the same rights as men to own, acquire, manage, and dispose of property; these rights do not change upon marriage.573 For both men and women, disposal of property requires the consent of the spouse only if the wife has a share or interest in the property.574 Rights to agricultural land Rural women in Malaysia have the right to own and inherit land.575 Muslim women are eligible to inherit land based on Syariah law.576 Under the Land (Group Settlement Areas) Act 1960, a wife or ex-wife is entitled to co-own land that was developed under the Federal Land Development Agency land reform program,577 which was established in 1956 to alleviate increasing rural poverty by granting agricultural holdings to the rural landless.578 However, the agency grants land titles only to men as household heads.579 Labor and employment According to 2003 data, women constitute approximately 35.9% of the labor force.580 Among women who work, 17.7% hold clerical jobs; 17.4% are service workers in shop and market sales; 12.1% are plant and machine operators and assemblers; 10.4% are skilled agricultural and fishery workers;581 and 6.4% are professionals.582 Experts have noted that women are still disproportionately concentrated in the lower rungs of the workplace hierarchy and perform lower level work.583 Unequal career opportunities for women, gender stereotyping, sexual harassment, lack of child-care facilities, and inflexible working hours have been cited as impediments to women’s full participation in the workforce. Migrant workers constitute a significant proportion of the workforce. The Immigration Department estimates that there are over two million foreign workers in Malaysia, 160,000 of whom are domestic workers.584 Female migrant workers are reportedly the most marginalized and unprotected labor

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group in the country. The federal constitution prohibits discrimination against citizens in any law or appointment to any office or employment under a public authority, or in establishing or engaging in any trade, business, profession, vocation, or employment. There is no specific legislation to protect against genderbased discrimination in the recruitment, placement, remuneration, training, and promotion of women in jobs in the public sector.585 The Employment Act 1955 provides the main legal framework governing matters such as wages, hours of work, benefits, and other work-related matters.586 The act does not make reference to gender, although some provisions apply exclusively to women. For example, the act prohibits the employment of women for night work, unless permitted by the director general of the Labour Department on the basis of an employer’s request.587 It also generally prohibits underground work for women.588 Under the Employment Act 1955, a female employee in the public or private sector is entitled to 60 consecutive days of maternity leave.589 Unless she is receiving her monthly wages during maternity leave, a female employee is entitled to a maternity allowance at a rate of either her ordinary pay or at least RM 6 per day (USD 1.6), whichever is higher.590 However, a woman with five or more children is not entitled to any maternity allowance.591 The act also prohibits employers from dismissing a female employee while she is on maternity leave.592 Despite these provisions for maternity leave,593 however, observers have noted that Malaysian employment laws are inadequate in terms of requiring employers in the public sector to provide nursing breaks and care facilities for nursing mothers, and crèches at workplaces. The government has provided tax relief incentives to the private sector to encourage the provision of on-site child-care facilities.594 However, such facilities are not mandatory.595 The Employment Act was amended in 1988 to provide for flexible working hours and allow benefits for part-time workers similar to those for full-time workers.596 The government has attempted to introduce gender equality at all levels of employment through its policies on labor and the workforce. Government policy calls for increased opportunities for women in training and professional advancement, equal pay for work of equal value, the integration of women into the mainstream of development, and women’s increased participation in the job market.597 Foreign workers who wish to obtain a work permit in Malaysia must undergo a full medical test.598 All foreign workers also need a mandatory annual medical exam to renew their work permit,599 pursuant to the Immigration Act 1959.600

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The Immigration Department approves, renews, or rejects applications for a work permit on the basis of these medical test results. Any worker who tests positive for any of the listed diseases (including HIV/AIDS), pregnancy, or illicit drugs does not obtain a renewal and faces immediate deportation.601 Access to credit The Banking and Financial Institution Act 1989602 and other related banking financial legislation do not formally discriminate on the basis of gender. Loan and credit schemes operated by banks are not gender-biased and are based on the evaluated risk of applicants, both men and women. Nevertheless, according to an unofficial country study, women appear to take out comparatively smaller loans than men; this implies that women have less access to credit facilities,603 presumably due to the requirement of collateral, which can be an obstacle for women seeking loans. Furthermore, women in business in the informal sector604 have little or no access to loan capital from financial institutions due to requirements and procedures that favor the formal sector and are biased against women.605 The Amanah Ikhtiar Malaysia project was initiated in 1987 as Malaysia’s first microcredit scheme. Membership is restricted to low-income individuals606 and the project’s interest-free loans favor women. Small loans of up to RM 10,000 (USD 2,632) are given with no requirements for collateral or a guarantor.607 One specific loan project targets single mothers who are either divorced or widowed to help them support their children through operating their own businesses.608 Other loans for women are made available through the Loan Fund for Hawkers and Petty Traders and the Small Entrepreneur Fund managed by the Credit Guarantee Corporation to provide assistance to small and micro-enterprises.609 Under the Special Assistance Scheme, administered by the Ministry of International Trade and Industry, businesses owned or headed by women receive soft loans and financial assistance for projects in the form of fixed assets and working capital.610 Furthermore, the Micro-Credit Scheme of Bank Simpanan National offers training and guidance for women entrepreneurs.611 Other microcredit programs are operated by bodies such as Yayasan Usaha Maju (The Development Foundation) and the Yayasan Pemnbagunan Terengganu (Terengganu Development Foundation).612 Education According to the 1991 Population and Housing Census, 90% of males were literate, compared with 80% of females.613 Among young people aged 15–24 years, the literacy gap between the sexes is almost nonexistent, with discrepan-

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cies between the sexes increasingly more pronounced in older age groups.614 Official data from 2000 indicate that the proportion of students who are female in government schools increases from 48.6% of total enrollment at the primary-school level to 52.8% at the upper secondary-school level.615 This gender gap continues and even widens in institutions of higher education. As of June 2000, there were 1.4 million females in public primary schools, compared with 1.5 million males;616 984,444 were enrolled in public secondary schools, compared with 958,152 males;617 and 189,000 females were studying in public tertiary institutions, compared with 155,000 males.618 Over 20% of the annual national budget is allocated to education.619 Although access to education in general is not a problem for women, gender segregation arising from stereotyping is still apparent in specific courses. Experts have noted that women are still more likely to enroll in courses traditionally considered more suitable for women, such as service-oriented courses linked to the hotel and catering industry, tourism, and public relations.620 Women are grossly underrepresented in the disciplines of science, technology, and engineering.621 The management and policymaking levels of the education system also remain male dominated, although the gender composition of teachers and lecturers shows that the majority at all levels are female (more than 70%),622 and that many female teachers are increasingly more qualified than male teachers.623 The federal constitution guarantees free basic education for both boys and girls.624 The Ministry of Education provides 11 years of free basic education.625 The Education Act 1996, as amended in 2002, makes primary education compulsory for all children who have attained the age of six years, regardless of their sex.626 Parents who fail to enroll their children in school are subject to a fine of RM 5,000 (USD 1,316) or imprisonment of six months.627 The Eighth Malaysia Plan articulates some of the current policy objectives of the government in the area of education. Education is generally addressed in the context of investing in human capital in order to ensure the growth and strength of the economy.628 The plan’s key policy thrusts relating to education include the following: ■ increasing accessibility to quality education and training to enhance income generation capabilities and quality of life; ■ improving the quality of education and training to ensure that the manpower supply is in line with technological change and market demand; ■ promoting lifelong learning to enhance the employability and productivity of the workforce; and

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intensifying efforts to develop and promote Malaysia as a regional center of educational excellence.629 Proposed strategies and activities to support these goals include the following: ■ expanding and upgrading existing educational and training institutions, and establishing new institutions in the public and private sectors;630 ■ increasing the involvement of the private sector in the provision of education and training;631 ■ undertaking efforts to increase the accessibility of education to students in rural areas;632 ■ reassessing programs at the primary-school level that target low-income students—e.g., programs offering food supplements, loans of textbooks, and financial assistance—to ensure that these students are benefiting from the programs;633 ■ providing women with more opportunities in education and training to facilitate their upward mobility into higher-paying positions;634 and ■ implementing career counseling programs to encourage more women to pursue nontraditional fields of study, such as science, engineering, and vocational and technical education.635 Sex education Adolescent sexual and reproductive health education has been integrated into the school curriculum, and elements of it are taught through existing courses such as physical and health education, science, biology, and moral and Islamic education.636 The Ministry of Education introduced elements of “family health education” to primary-school children in physical and health education classes in 1994.637 The aim of such education is to enable students to obtain knowledge regarding the physical, emotional, and social changes they undergo; the instruction also gives them the skills to cope with these changes and maintain healthy relationships with family members, friends, and other members of the community in which they live.638 Health education strives to provide students with the knowledge, skills, and values to prepare them for the responsibilities and rigors of adult life, marriage, and parenthood, and to deal with social relationships in the context of family and society.639 The three main topic areas in family health education are the human body, personal and family health, and moral and religious values.640 In practice, teachers have shied away from teaching family health education or are not skilled in dealing with what are deemed sensitive issues. Such education is also assigned to teachers who are untrained in this subject area, which often means they neglect to teach it.641 ■

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F. PROTECTIONS AGAINST PHYSICAL AND SEXUAL VIOLENCE

The penal code, the DVA, and the Syariah Criminal Offences (Federal Territories) Act 1997 provide the substantive legal framework for crimes of violence against women and girls. The first two apply to non-Muslims and Muslims alike, while the last applies only to Muslims. Certain forms of physical and sexual violence are addressed through two or more of the above stated laws. The federal constitution is clear in that where the Syariah Court has jurisdiction, the “civil” courts shall have no jurisdiction.642 However, in practice, crimes such as rape and incest tend to be prosecuted in civil courts. Rape The penal code defines and prescribes the punishments for rape, while the Criminal Procedure Code and the Evidence Act 1950 provide the procedural and evidentiary rules for the prosecution of rape. The penal code defines rape as sexual intercourse by a man with a woman under any of the following circumstances: ■ against her will or without her consent; ■ through consent obtained through coercion or fraud, or uninformed consent; or ■ with or without her consent when she is under the age of 16 (except where the irrebuttable presumption of law applies in which a boy under the age of 13 is incapable of committing rape),643 or where the rapist is the victim’s lawful husband.644 Only vaginal penetration by the penis constitutes rape under the definition of the penal code. If objects other than the penis are used, the act is deemed to be “assault with intent to outrage modesty,”645 which carries a lighter punishment than rape.646 The penal code does not recognize marital rape as a criminal offense. The code provides that “sexual intercourse by a man with his wife by a marriage which is valid under any written law for the time being in force, or is recognised in the Federation as valid, is not rape.”647 However, there are three instances in which a man who has nonconsensual sex with his wife can be charged with rape: ■ where the wife is living separately from her husband under a decree of judicial separation; ■ where the wife has obtained an injunction restraining her husband from having sexual intercourse with her; and ■ in the case of a Muslim woman living separately from her husband during the period of iddah, which is approximately three months.648 There are no provisions under the penal code for aggravated rape (e.g., gang rape or the rape of a pregnant woman).

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The legal penalties for rape are mandatory imprisonment of 5–20 years and whipping.649 The evidentiary requirements for rape make it difficult for the prosecution to secure a conviction. It is a well-established rule of practice in Malaysia that evidence presented by a complainant in a sexual offense case must be corroborated,650 although there is no such statutory requirement. The law does, however, require corroboration of evidence given by a young child; uncorroborated evidence by such a witness is not sufficient for conviction.651 Generally, in order to establish the issue of consent, the burden of proof falls on the victim to prove that she put up some form of resistance or struggled with the offender during the rape.652 Where there is no evidence of physical injury, the assumption is that the rape did not occur.653 In 1988, the Evidence Act was amended to disallow the examination of the rape victim’s past sexual history or the introduction of evidence of her past sexual practices.654 However, the act still permits the accused person’s counsel to crossexamine the victim on previous sexual activity between the victim and the accused. In July 2002, a controversial bill on hudud (Islamic criminal law) was passed in the state of Terengganu. Under this bill, which has been given the royal assent by the state’s sultan but has yet to be enforced, the burden of proof for rape is shifted from the perpetrator to the victim, who must produce four credible witnesses (four “good” Muslim males) to prove her innocence. If she is unable to do so, she may be found guilty of “slanderous accusations” and punished with 80 lashes.655 An unmarried woman who is pregnant is assumed to have committed zina (unlawful carnal intercourse or illicit sex), even if she has been raped, and faces a punishment of 100 lashes. A married woman convicted of zina may be stoned to death.656 In order to protect rape victims under the age of 18 from media attention or exploitation, the Subordinate Courts Act 1948657 allows rape cases to be held in camera and prevents the victim’s identity and personal details from being revealed in the press. Incest The penal code and the Syariah Criminal Offences (Federal Territories) Act 1997 both criminalize incest. The penal code was amended in 2001 to include the crime of incest, which is defined as sexual intercourse between two individuals who are within the prohibited degrees of relationship for marriage under the “law, religion, custom, or usage” applicable to them.658 The offense is punishable with imprisonment of 6–20 years and perpetrators “shall also be liable to whipping.”659 The code affords the accused a defense if it

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is proved that he or she was unaware that the person with whom he or she had sexual intercourse was within the prohibited degree of relationship for marriage, or that the act of sexual intercourse was nonconsensual.660 The code deems a female under the age of 16 and a male under age 13 incapable of giving consent.661 Like rape, incest has been given a narrow interpretation to cover acts of sexual intercourse only. In January 2003, the government announced its decision to amend the penal code and increase the punishment for incest to 15–30 years in prison and 10 lashes.662 To improve the reporting of incest, the code is also being further amended to punish individuals who fail to report incest with imprisonment of three years.663 The Registration of Criminals and Undesirable Persons Act 1969 is also being amended to provide for the registration of incestuous rape and incest offenders.664 According to media reports, yet another proposed amendment seeks the death penalty for incest that results in the victim’s death.665 The Syariah Criminal Offences (Federal Territories) Act 1997 punishes incest with a maximum penalty of three years’ imprisonment, a whipping of six lashes, a fine of RM 5,000 (USD 1,316), or any combination thereof.666 Domestic violence The DVA was enacted specifically to provide recourse for persons suffering from domestic violence.667 It offers protection for victims of domestic violence pending investigation or other criminal proceedings in court.668 It is applicable to non-Muslims and Muslims, but its protection does not specifically extend to foreign domestic workers.669 The act does not make domestic violence a separate crime punishable with new penalties. Rather, it enumerates various behaviors that constitute domestic violence, and stipulates that the DVA should be read together with relevant provisions of the penal code to assess the appropriate punishment.670 Under the DVA, a victim of domestic violence can be an immediate, former, or de facto spouse;671 a child; an “incapacitated” adult;672 or any other member of the family. Among the acts that constitute domestic violence are the following: ■ willfully or knowingly placing, or attempting to place, the victim in fear of physical injury; ■ causing physical injury to the victim by such an act that is known, or ought to have been known, to result in physical injury; ■ compelling the victim by force or threat to engage in any conduct or act, sexual or otherwise, from which the victim has a right to abstain; ■ confining or detaining the victim against his or her will; and

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causing mischief, or destruction of or damage to property, with intent to cause or knowing that it is likely to cause distress or annoyance to the victim.673 Victims of dating violence are not protected under the DVA. Given that the act is to be read with the penal code, and that the penal code does not recognize marital rape, married Malaysian women are left with the anomalous position of being protected from domestic violence but not marital rape. Also, mental, psychological, and emotional forms of domestic violence do not fall within the ambit of the DVA.674 Most of the domestic violence cases in Malaysia are classified by the police as Section 323 offenses under the Criminal Procedure Code, or as “non-seizable”675 offenses.676 Consequently, the police may not investigate such cases without specific orders from the deputy public prosecutor, nor can they arrest offenders without a warrant nor obtain an interim protection order.677 An interim protection order and a protection order are two possible forms of protection for victims of domestic violence. The former may be issued against an offender while investigations are pending, while the latter is appropriate when the offender is undergoing criminal proceedings.678 The DVA outlines the circumstances under which either order may be sought.679 A protection order offers the more comprehensive protection of the two, since it protects the victim against violence by the perpetrator and third parties,680 and prohibits all communication and access to the victim’s residence or place of employment, school, or other institution.681 If the court is satisfied that the offender is likely to cause physical injury to the victim, it may attach an arrest warrant to the order.682 Instead of or in addition to issuing a protection order, the court may also order the parties to undergo counseling and attempts at conciliation.683 Under the DVA, a victim may claim compensation for any personal injury, property damage, or financial loss resulting from domestic violence.684 In considering such a claim, the court may take into account the victim’s pain and suffering, the extent of any physical or mental injury suffered, the cost of medical treatment for any injuries, any loss of earnings, the value of any property damage, and the necessary and reasonable expenses incurred by the victim in cases where the victim and the offender must be separated as a result of domestic violence.685 Women’s groups have expressed concern about the effective implementation of the act, and have submitted recommendations for amendments to the government.686 However, the government has yet to take any action to review the act despite promises to do so.687 ■

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Sexual harassment There is no specific legislation addressing sexual harassment. Acts relating to sexual harassment are dealt with under the penal code. The code makes it a crime to intentionally “insult the modesty of any woman” through words, sounds, gestures, or by exhibiting any object. The offense is punishable with imprisonment of up to five years or a fine, or both.688 Another provision of the penal code criminalizes assault or the use of force toward another person with the intent to “outrage the modesty” of that person.689 This crime is punishable with imprisonment of up to ten years, a fine or whipping, or any two of these punishments. The burden of proof for a charge of harassment lies with the prosecution, who must prove the act and the harasser’s intention beyond a reasonable doubt.690 Complainants of sexual harassment may also seek civil legal redress under industrial law or tort law. Neither the Employment Act 1955 nor the Industrial Relations Act 1967 explicitly refers to “sexual harassment.” Complainants must thus pursue redress through an existing cause of action, such as for misconduct. In the landmark 1998 case of Lilian Therera De Costa v. Jennico Associates Sdn. Bhd,691 the Industrial Court692 held, among other things, that in industrial matters, the burden of proof is on the complainant, and allegations of sexual harassment must be corroborated.693 In 1999, the Ministry of Human Resources issued the Code of Practice on the Prevention and Eradication of Sexual Harassment in the Workplace.694 This code defines sexual harassment as “any unwanted conduct of a sexual nature having the effect of verbal, non-verbal, visual, psychological, or physical harassment (i) that might, on reasonable grounds, be perceived by the recipient as placing a condition of a sexual nature on her/his employment; or (ii)…an offence, humiliation, or a threat to her/his well-being, but has no direct link to her/his employment.”695 The code of practice also provides general guidelines on penalties and disciplinary rules for offenses; it requires that offenders be disciplined,696 and that the nature and type of penalty depend upon the severity of the offense.697 Although the code of practice has been effective in broadening awareness about the issue of sexual harassment, it has no legal force and its implementation has not been widespread. Only 1.125% of the 400,000 registered companies in the country have adopted the code.698 The code recommends the establishment of a separate complaint or grievance procedure, which should include a step-by-step procedure for reporting and processing a complaint in a timely fashion, and investigation and appeals procedures.699 In response to the lack of adequate existing laws and pro-

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cedures for sexual harassment victims, the Joint Action Group against Violence against Women,700 a coalition of women’s organizations, launched a campaign for a sexual harassment law. The campaign culminated in the submission of the proposed Sexual Harassment Bill to the Ministry of Human Resources in March 2001.701 The bill requires employers to prevent sexual harassment and provides victims with concrete access to legal redress. Commercial sex work and sex-trafficking The penal code and the Syariah Criminal Offences (Federal Territories) Act 1997 deal with crimes relating to prostitution. Under the penal code, an individual who “solicits or importunes” for the purpose of prostitution or “any immoral purpose” in any place is subject to punishment of one year’s imprisonment or a fine, or both.702 The Syariah Criminal Offences (Federal Territories) Act 1997 specifically outlaws prostitution. It prescribes punishments for women who work as prostitutes,703 as well as other persons who prostitute their wife or a female child under their care, or cause or allow their wife or a female child under their care to prostitute themselves.704 Both offences are punishable with imprisonment of up to three years, a fine of up to RM 5,000 (USD 1,316), a whipping of up to six lashes, or any combination thereof.705 There are no comprehensive anti-trafficking laws in Malaysia, although the federal constitution prohibits slavery706 and all forms of forced labor.707 There are also provisions in the penal code that criminalize trafficking-related acts. For example, the code criminalizes the import, export, removal, buying, selling, disposing of a person as a slave, or habitually trafficking or dealing in slaves;708 the exploitation of any person for the purpose of prostitution;709 the act of knowingly living on the earnings of another person’s prostitution;710 the act of keeping, managing, or assisting in the management of a brothel, as well as knowingly allowing any place to be used as a brothel;711 and forced labor.712 The Immigration Act 1959/1963,713 the Restricted Residence Act 1933 (Revised 1989),714 and the Internal Security Act are among the laws that are used to prosecute traffickers. It has been reported, however, that rather than prosecuting traffickers, police generally arrest or deport individual women who are trafficked for the purpose of prostitution.715 NGOs report that Malaysian authorities often fail to distinguish between trafficking victims and other undocumented migrants, and deport these victims rather than help them.716 These women are treated as illegal immigrants and are subject to harsh penalties under the terms of the Immigration (Amendment) Act 2002.717 Penalties under that act include imprisonment of up to five years, whipping and heavy fines.718 According to NGO reports, many foreign women currently

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serving terms in Malaysia’s prisons for illegal immigration are actually victims of trafficking.719 At the Fifth Asian-African Legal Consultative Committee General Meeting held in Nigeria in July 2002, the Malaysian government disagreed with the position that all persons who are trafficked should be considered victims in need of protection and immune from prosecution.720 During that meeting, Malaysia reported that it was considering a more comprehensive Witness Protection Act for persons who have been classified as “victims of trafficking” according to the Malaysian criteria. Presently, a trafficked person is considered a victim only if he or she makes a police report that he or she has been victimized.721 Customary forms of violence Female genital mutilation is practiced in Malaysia, especially among the Muslim community. However, little research is available in this area,722 and thus the prevalence of the practice is not accurately known. The custom is largely cultural and there is no law or policy regulating it. The prevalent form of female genital mutilation in Malaysia is clitoridectomy, which involves the removal of the clitoral prepuce, as opposed to infibulation practiced by many African communities.723 Sexual offenses against minors The Child Act 2001,724 the penal code, and the Syariah Criminal Offences (Federal Territories) Act 1997 are the key pieces of legislation with provisions addressing sexual offenses against minors. The penal code includes provisions for statutory rape (i.e., of girls under the age of 16) and incest. (See “Rape” for more information.) The Child Act 2001 makes it an offense to engage or hire minors for prostitution and immoral purposes, and imposes penalties for both first time and repeat offenders.725 Depending on the nature of the offense, first-time offenders may be subject to a fine of up to RM 50,000 (USD 13,160) or imprisonment of 3–15 years, or both;726 their punishment may also include whipping of up to six lashes.727 Repeat offenders receive 6–10 lashes.728 The Child Act 2001 also criminalizes the unlawful transfer or the possession, custody, or control of a child, and the unlawful harboring of a child.729 Such offenses are punished with imprisonment of up to five years or a fine of up to RM 10,000 (USD 2,632), or both.730 A possible defense may be that the transfer of a child was pursuant to a bona fide marriage or adoption, and that at least one of the child’s natural parents or guardians had expressly consented to the marriage or adoption.731 The Child Act 2001 does not apply to foreign underage girls who are illegally trafficked into the country.732 The Child Act 2001 provides that an exploited child may,

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under certain circumstances, be deemed in need of “protection and rehabilitation,”733 such as when the child is habitually in the company of or controlled by brothel keepers or persons connected with the business of prostitution.734 In such cases, the child will be sent to a place of refuge735 subject to the Court for Children’s approval.736 The Syariah Criminal Offences (Federal Territories) Act 1997 prescribes punishment for individuals who prostitute a female child under their care, or cause or allow such a child to prostitute herself.737 The offense is punishable with a fine of up to RM 5,000 (USD 1,316), imprisonment of up to three years, whipping of up to six lashes, or any combination thereof.738

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ENDNOTES 1. The island of Borneo is divided among three countries. The East Malaysian states of Sabah and Sarawak occupy most of the northern coast; the Sultanate of Brunei takes up a small section of that coast; and the lower two-thirds of the island belong to Indonesia. See Central Intelligence Agency (CIA), U.S. Government, Malaysia, in The World Factbook (2005), http://www.cia.gov/cia/publications/factbook/geos/ my.html (last modified Apr. 24, 2005); Commonwealth Secretariat, Commonwealth, Country Profiles: Malaysia, http://www.thecommonwealth.org/Templates/ YearbookHomeInternal.asp?NodeID=138656 (last visited May 11, 2005). 2. Bureau of East Asian and Pacific Affairs, U.S. Department of State, Background Note: Malaysia (Jan. 2005), http://www.state.gov/r/pa/ei/bgn/2777. htm. 3. Id. 4. Id. 5. Id. 6. Id. 7. U.S. Department of State, Country Reports on Human Rights Practices: Malaysia 2004 (2005), http://www.state.gov/g/drl/rls/hrrpt/2004/41649.htm. Islam Hadhair or Civilizational Islam is a form of government in accordance with Islamic principles. 8. Bureau Of East Asian And Pacific Affairs, supra note 2. 9. Id. 10. Department of Statistics, Government of Malaysia, Population Clock, http:// www.statistics.gov.my/ (last visited May 13, 2005). 11. World Bank Group, GenderStats: Summary Gender Profile for Malaysia (2002), http://genderstats.worldbank.org/genderRpt.asp?rpt=profile&cty=MYS,Mala ysia&hm=home. 12. Bureau of East Asian and Pacific Affairs, supra note 2. 13. Id.; Central Intelligence Agency (CIA), supra note 1. 14. Malay. Const. art. 3(1). 15. Department of Statistics, Government of Malaysia, Population and Housing Census 2000, § 12, http://www.statistics.gov.my/English/frameset_pressdemo.php; Bureau of East Asian and Pacific Affairs, supra note 2. 16. Central Intelligence Agency (CIA), supra note 1. 17. United Nations (UN), List of Member States, http://www.un.org/Overview/ unmember.html (last visited Mar. 4, 2005). 18. Commonwealth Secretariat, supra note 1; Organization of the Islamic Conference, Members, http://www.oic-oci.org/english/main/member-States. htm (last visited May 11, 2005) (member since 1969, chair of 10th Summit in October 2003); Non-Aligned Movement (NAM), Member States, http://www.nam.gov. za/background/members.htm (last visited May 11, 2005) (Malaysia chaired the 13th Summit in February 2003); Asia-Pacific Economic Cooperation (APEC), Member Economies, http://www.apecsec.org.sg/apec/member_economies.html (last visited May 11, 2005) (member since 1993); World Trade Organization, Malaysia – Member Information, http://www.wto.org/english/thewto_e/countries_e/malaysia_e.htm (last visited May 11, 2005) (member since 1995); Association of Southeast Asian Nations (ASEAN), Member countries, http://www.aseansec.org/74.htm.(last visited May 11, 2005). 19. Consideration of reports submitted by States parties under article 18 of Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Combined initial and second periodic reports of States parties, Malaysia, CEDAW Committee, para. 31, U.N. Doc. CEDAW/C/MYS/1-2 (2004). 20. Malay. Const. art. 3(1). 21. Id. arts. 73(a)–(b), 74(1)–(4). 22. Id. at arts. 32(1), 39, 41. 23. Id. art. 32(2). 24. Id. arts. 32(3), 38(1), (2a), 5th sched., art. 1. 25. Id. art. 33(1), (3). 26. Id. art. 43(2), (2)(a). 27. Id. arts. 43(2)(a)–(b), 44. 28. Id. art. 43(1), (3). 29. Id. art. 55(1)–(2). 30. Id. art. 42(1), (10). 31. Id. art. 32(1). He is liable only to proceedings in the Special Court established in 1993. 32. Id. art. 44. 33. Id. arts. 46, 55(3); Parliament of Malaysia, Gov’t of Malaysia, House of Representatives: General Information, http://www.parlimen.gov.my/eng-dRmaklumatumum.htm (last visited May 9, 2005). 34. See Commonwealth Parliamentary Association, Data on Women in Commonwealth Parliaments and Legislatures 17 (2005), http://www.cpahq.org/ WomenintheCPA_pdf_media_public.aspx (data from 2004 shows 20 of 219 members were female). 35. Malay. Const. art. 45; Parliament of Malaysia, supra note 33. 36. See Commonwealth Parliamentary Association, supra note 34. 37. Malay. Const. art. 45(3), (3A); Parliament of Malaysia, supra note 33. 38. Id. art. 73(a). 39. Id. arts. 66(1), 68(1)–(8). 40. Id. arts. 66(1), 68(1)–(8). 41. Id. art. 66(4A), (4B).

42. Id. art. 66(3), (4A). If the bill is passed in the originating house by a two-thirds vote in the case of a constitutional amendment and a simple majority in other cases, then it is sent to the other house for similar approval. Id. art. 66(4A). The bill then passes into law upon the assent of the king or his inaction for 30 days. Id. art. 66(4A), (4B). 43. Id. 9th sched., list I, arts. 1, 4, 12–16. 44. Id. list III, arts. 1–9A. 45. Bureau of East Asian and Pacific Affairs, supra note 2. 46. Malay. Const. arts. 121(1), (1B), (2), 122AA(1), 182. The Supreme Court was created on Jan. 1, 1985 and was renamed the Federal Court in 1994. The Court of Appeal was established in 1994, and the Special Court was established in 1993; Editorial Comm., Malaysian Courts of Malaysia, Inaugural Report of the Superior and Subordinate Courts in Malaysia 16, 31, 35 (2004), http://www.kehakiman.gov.my/ buku_laporan/buku_laporan.html; Malay. Const. 9th sched., list III, arts. 1–9A. 47. Id. art. 128(2), (3). 48. The Federal Court is empowered by the constitution to make determinations on questions “as to the effect of any provision of [the] Constitution…” arising before any court, or referred to it by the king for its opinion. Id. arts. 128(2), 130. It may also adjudicate whether a federal or state law is invalid on the ground that the legislative body that enacted the law was not constitutionally empowered to do so. Id. art. 128(1)(a). 49. Id. art. 128(1)(b). 50. Id. arts. 121(2)(a)–(c), 128(1)–(3), 130. The Federal Court may adjudicate appeals against decisions of Court of Appeals in criminal cases or important civil cases initially decided by the High Court in exercise of its original jurisdiction. Courts of Judicature Act 1964, No. 7, §§ 87, 96(a)–(b) (1964) (Malay.). 51. Id. pt. IX, art. 122(1). The Chief Justice was known as the Lord President prior to the amendment to the Federal Constitution in 1994. 52. Id. pt. IX, art. 122(1); Editorial Comm., supra note 46, at 16. The king, under the advice of the Chief Justice may appoint additional members to the Federal Court. Malay. Const. pt. IX, art. 122(1A). 53. Malay. Const. art. 125(1). 54. Id. art. 122A(1). The Yang di-Pertuan Agong ordered the number of judges to be increased to fifteen through the 2002 amendment to the constitution. Editorial Comm., supra note 46, at 35. 55. Malay. Const. pt. IX, art. 121(1B)(a); Courts of Judicature Act 1964, No. 7, §§ 50(1)– (2), 87, 96 (1964) (Malay.); Editorial Comm., supra note 46, at 40-43. http://www. kehakiman.gov.my/buku_laporan/buku_laporan.html (Aug. 5, 2004). 56. Malay. Const. pt. IX, arts. 121(1), 122AA(1); Editorial Comm., supra note 46, at 54. 57. Not all decisions of subordinate courts may be tried at the High Courts, exceptions include civil cases not involving a question of law where the amount in dispute is less than RM 10,000. Courts of Judicature Act 1964, No. 7, §§ 26–29 (1964) (Malay.); Editorial Comm., supra note 46, at 64. 58. Editorial Comm., supra note 46, at 55, 59. 59. Malay. Const. pt. IX, art. 122B(1), (2), (4). The Prime Minister consults the Chief Justice and the Chief Judge of the relevant Court before rendering his advice to the king. 60. Id. art. 182. However, actions against the king or state rulers over anything done or not done in his personal capacity may only be initiated with the consent of the Attorney General. Id. arts. 182(3), 183; Editorial Comm., supra note 46, at 31. 61. Malay. Const. art. 182(1). Appointees must be current or past judges of the Federal Court or the High Court. Id. 62. Editorial Comm., supra note 46, at 32. 63. Id. at 91–92, 95, 115, 119. See Subordinate Courts Act 1948, No. 92, §§ 63–65, 85, 90 (1948) (Malay.). 64. The Child Act 2001, No. 611, § 2 (2001) (Malay.); Editorial Comm., supra note 46, at 124. 65. Malay. Const. pt. IX, art. 121(1A). Civil courts have no jurisdiction in respect of any matter within the jurisdiction of the Syariah courts. Id. 66. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 39. 67. Malay. Const. 9th sched., list I, art. 4(a), list II, art. 1. 68. Id. 9th sched., list II, art. 1. Twelve Malaysian states have adopted a version of the Syariah Criminal Offences Act. It is pending approval from the senate in the 13th state, the Federal Territories. Malaysian States Standardize Shariah Laws, Spirithit News, Apr. 15, 2005, http://news.spirithit.com/index/asia_pacific/print/malaysian_states_ standardize_shariah_laws/. 69. Malay. Const. 9th sched., list II, art. 1. States have authority over the “...creation and punishment of offences by persons professing the religion of Islam ... except in regard to matters included in the Federal list.” However, there have been efforts by state governments to expand jurisdiction to these matters, such as the enactment of the Syariah Criminal Offences Act in many States. Communication with Syrin Junisya & Rashidah Abdullah, Asian-Pacific Resource & Research Centre for Women (ARROW), Women of the World: Laws and Policies Affecting Their Reproductive Lives- Malaysia (draft) 25 (Oct. 17, 2003) (on file with the Center for Reproductive Rights). 70. Id. 9th sched., list II, item 1; Zaitoon Dato Othman, Islam in Malaysia Today and It’s Impact:The practice of Shariah Laws in Malaysia, http://www.muslim-lawyers. net/news/datoothman.html. See also CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19. 71. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19.

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72. Anwar, Zainah, Modern and Moderate Islam, AsiaWeek, Sept. 16, 1997, at 19. 73. Id. 74. Id. 75. Poverty Reduction and Social Development Division, Asian Development Bank, Sociolegal Status of Women in Indonesia, Malaysia, Philippines, and Thailand 21 (2002), http://www.adb.org/Documents/Studies/Sociolegal_Status_ Women/. 76. Id. 77. Bureau of East Asian and Pacific Affairs, supra note 2. Kuala Lumpur, Labuan, and Putrajaya were turned into Federal Territories on Feb. 1, 1974, Apr. 16, 1984 and Feb. 2001, respectively. Malay. Const. 9th sched., list I, art. 27, list II, arts. 2–5. 78. Malay. Const. pt. V, art. 71, 8th sched., pt. I, art. 19A(1)–(2). 79. Id. 8th sched., pt. I, arts. 1(1), 2(1), 2(2)(b), (5). 80. Id. arts. 1(2)(a), 2(2)(a)–(b). 81. Id. art. 3. 82. Id. art. 9(2)–(3). 83. Id. at 4(1). 84. See Commonwealth Parliamentary Association, supra note 34. 85. Malay. Const., 9th sched., list II. 86. Id. art. 75. 87. Haji Kaswuir Bin Keman,The Registry of Societies, Message From the Registrar of Societies, http://www.jppmros.gov.my/speech01.htm (last visited May 13, 2005). 88. Id. 89. Section 2 of the Societies Act 1966 defines society as “any club, company, partnership or association of seven or more persons whatever its nature or object, whether temporary or permanent…” Asian Pacific Philanthropy Consortium, Philanthropy and the Third Sector in Asia and the Pacific: Definitions and Forms: Malaysia, http:// www.asianphilanthropy.org/countries/malaysia/definition.html (last modified Jan. 20, 2005). 90. Y.A.B. Dato’ Seri Abdullah bin Haji Ahmad Badawi, Malaysian Prime Minister and Minister of Finance, The 2005 Budget Speech to the Dewan Rakyat (Sept. 10, 2004) (transcript available at http://www.pmo.gov.my/website/webdb.nsf/vALLDOC/ 332D53485BFFB11548256F0C0003EB02. 91. Economic Planning Unit, Government of Malaysia, Mid-term Review of the Eighth Malaysia Plan 2001–2005, § 12.71, at 404 (2003), http://www.epu.jpm.my/ New%20Folder/development%20plan/midterm-RM8.htm. 92. Tay & Partners, Laws of Malaysia, http://www.loc.gov/law/guide/malaysia.html; See also CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 380. 93. Malay. Const. art. 4(1). 94. Id. art. 5(1). 95. Id. art. 6(1)–(2). 96. Id. art. 8(1). 97. Id. art. 11(1), (4). The practice of Islamic beliefs other than Sunni Islam has been restricted significantly by the government. U.S. Dep’t of State, supra note 7, § 2(c). 98. Malay. Const. art. 13(1). 99. Honey Tan Lay Ean,Women’s Centre For Change, Measuring Up to CEDAW: How Far Short are Malaysian Laws and Policies?, in Human Rights Commission of Malaysia (Suhakam), Report Roundtable Discussion: Rights and Obligations Under CEDAW 91–92 (2004), http://www.suhakam.org.my/docs/document_ resource/Report_RTD_CEDAW.pdf (last visited May 12, 2005). The inclusion of gender was specific to art. 8(2), and did not amend art. 12 of the Constitution, which provided for non-discrimination in access to education. Id. 100. Malay. Const. art. 8(2). 101. Id. art. 8(5)(a)–(f), pt. XII (General and Miscellaneous), art. 153. 102. Id. art. 10. 103. Id. 9th sched., list I, art. 4. See Penal Code, No. 574 (1997) (Malay.); Criminal Procedure Code (F.M.S. Cap. 6). 104. With exception to the Federal Territories. Id. art. 74(2), 9th sched., list II, art. 1. 105. Myint Zan, Additional Material: The Three Nixon Cases and Their Parallels in Malaysia, 13 St.Thomas L. Rev. 743, 744 (2001). 106. Administration of Islamic Law (Federal Territory) Act of 1993, No. 505, § 34 (1993) (Malay.). 107. Pusat Pungutan Zakat Wilayah Persekutuan [Zakat Collection Center], Majlis Agama Islam Wilayah Persekutuan [Federal Territories Islamic Religious Council], Zakat Organization in Malaysia, http://www.zakat.com.my/english/news/news-4-0903. shtml (last visited May 13, 2005). 108. Id. 109. See Women’s Aid Organisation (WAO),Women’s Equality in Malaysia: Status Report (March 2001), available at http://www.wao.org.my/news/20010301statusreport.htm (last visited Jun. 19, 2003). 110. Economic Planning Unit, Government of Malaysia,The Third Outline Perspective Plan 2001–2010 (2001). 111. The Third Outline Perspective Plan 2001–2010 (2001), supra note 110, ch. 1, § I, para. 1.01–1.03, at 3; Economic Planning Unit, Government of Malaysia, Eighth Malaysia Plan 2001–2005, ch. 1, § I, para. 1.01, at 3 (2001). 112. Eighth Malaysia Plan 2001–2005, supra note 111, ch. 1, § I, para. 1.01, at 3. 113. Malay. Const. 9th sched., list I, art. 1(a)–(b), (d). 114. Id. 9th sched., list I, art. 1(b); International Comm. of the Red Cross

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Advisory Service on International Humanitarian Law, General Comment: Malaysia, http://www.icrc.org/ihl-nat.nsf/162d151af444ded44125673e00508141/ 96f1b4396a4df1dbc1256aa700413a7b?OpenDocument (last visited May 13, 2005). 115. Honey Tan Lay Ean, supra note 99, at 91. “Treaties to which Malaysia is a party may either require subsequent legislation, in which case they become the law of the land as soon as the necessary laws are enacted or, they may not, in which case they remain within a category of Malaysia’s international law, binding only herself vis-à-vis the other parties to the treaties, but having no effect as such on Malaysian subjects.” Tunku Sofian Jewa, Public International Law: A Malaysian Perspective 35 (1996). 116. Convention on the Elimination of All Forms of Discrimination against Women, adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981) (accession with reservations and declaration by Malaysia Aug. 4, 1995). See also United Nations High Commissioner for Human Rights (UNHCHR), Ratification Status by Country: Convention on the Rights of the Child: Malaysia, http://www.unhchr.ch/tbs/doc.nsf/Statusfrset?OpenFrameSet (last visited May 9, 2005); Declarations and reservations to the CRC: Malaysia, http://www. ohchr.org/english/law/crc-reserve.htm (last visited May 9, 2005). 117. Convention on the Rights of the Child (CRC), adopted Nov. 20, 1989, G.A. Res. 44/25, annex, U.N. GAOR, 44th Sess., Supp. No. 49, at 166, U.N. Doc. A/44/49 (1989), reprinted in 28 I.L.M. 1448 (entered into force Sept. 2, 1990) (accession by Malaysia Mar. 19, 1995). See also UNHCHR, supra note 116. 118. U.N. Division for the Advancement of Women (DAW), Dep’t of Economic and Social Affairs, Declaration, Reservations and Objections to CEDAW, Malaysia, http://www. un.org/womenwatch/daw/cedaw/reservations-country.htm (last visited May 9, 2005). Malaysia initially ratified CEDAW with reservation to articles 2(f), 5(a), 7(b), 9, 11, and 16. In 1998, Malaysia withdrew its reservation with respect of article 2(f), 9(1), 16(1)(b), (d), (e), (h). 119. CEDAW, supra note 116. 120. Id. art. 7(b) 121. Id. art. 9(2) 122. Id. art. 16(1)(a), (c), (f). 123. Vienna Declaration and Programme of Action, World Conference on Human Rights, Vienna, Austria, June 14–25, 1993, U.N. Doc. A/CONF.157/23 (1993); Programme of Action of the International Conference on Population and Development, Cairo, Egypt, Sept. 5–13, 1994, U.N. Doc. A/CONF.171/13/Rev.1 (1995); Beijing Declaration and the Platform for Action, Fourth World Conference on Women, Beijing, China, Sept. 4–15, 1995, U.N. Doc. A/CONF.177/20 (1995); Millennium Declaration, Millennium Assembly, New York, United States, Sept. 6–8, 2000, U.N. GAOR, 55th Sess., U.N. Doc.A/Res/55/2 (2000). 124. Malay. Const. 9th sched., list III, art. 7. Sanitation in the federal capital (Kuala Lumpur) is under the jurisdiction of the federal government exclusively. Id. 9th sched., list I, art. 14. 125. Id. 9th sched., list I, arts. 14(a), (c), 15(b). 126. Fadil Azzim Abbas, U.N. Economic and Social Commission for Western Asia, Social Policies in Malaysia 8 (2003), http://www.escwa.org.lb/information/ publications/sdd/docs/ssd-03-1.pdf. Each five-year plan since the First Malaysia Plan (1966-1970) has included a chapter relating to health policy. Id. at 11. 127. Eighth Malaysia Plan 2001–2005, supra note 111, at 477–498. 128. Id. para. 1.01, at 3. 129. Ministry of Health Malaysia, Government of Malaysia, Health in Malaysia: Achievements and Challenges 12 (Tan Sri Dato’ Dr. Abu Bakar Dato’ Suleiman & Dato’ Dr. M. Jegathesan eds., 2000). 130. The Third Outline Perspective Plan 2001–2010 (2001), supra note 110, paras. 1.22, 3.21, 4.06, 4.14–4.15. 131. Id. para. 7.51–7.52, at 182. 132. Id. paras. 4.06, at 85, 7.54, at 182. 133. Id. para. 6.19, at 156. 134. Eighth Malaysia Plan 2001–2005, supra note 111, paras. 17.01, at 477, 17.27, at 490. 135. Id. para. 17.02, at 477. Primary health-care services are the first point of contact and include maternal child health-care, dental services, school health services and support services such as clinical and imaging facilities, pharmacy and registration. Id. at 484 tbl. 17-2. 136. Id. para. 17.02, at 477. 137. Telemedicine is defined as the practice of medicine using audio, visual and data communications. Telemedicine Act 1997, No. 563, § 2 (1997) (Malay.). 138. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.28, at 477. 139. Id. paras. 17.29–17.36, at 491–493 (2001), http://www.epu.jpm.my/RM8/c17_cont. pdf. 140. Id. paras. 17.29–17.49, at 491–497 (2001), http://www.epu.jpm.my/RM8/c17_cont. pdf. 141. Ministry of Health Malaysia, Government of Malaysia,Vision for Health, § 2, http://www.pharmacy.gov.my/html/nedl.htm. 142. Id. 143. Siti Norazah Zulklifi et al., Gender, Sexuality and Reproductive Health Malaysia, in 1 Gender, Sexuality and Reproductive Health in South East Asia 88 (Pilar RamosJimenez & Celeste Maria V. Condor eds., 2001). 144. Id. 145. Id. 146. Id. 147. Public Health Department, Ministry of Health Malaysia, http://dph.gov.my/ (last visited May 16, 2005); See also Regional Office for the Western Pacific,World

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Health Organization (WHO), Malaysia: Country Health Information Profile 175 (2004), http://www.wpro.who.int//NR/rdonlyres/8AD8E3AE-B205-4587-BA507AAED9C1FFC7/137/maa.pdf. 148. Ministry of Health Malaysia, Government of Malaysia, Annual Report 2000, at 49 (2001). 149. Id. at 49, 51. 150. Regional Office for the Western Pacific,World Health Organization (WHO), Malaysia, supra note 147. 151. Ministry of Health Malaysia, Government of Malaysia, Annual Report 1999, at 236 (2000); National Pharmaceutical Control Bureau, Ministry of Health Malaysia, Annual Report 2002, at 1, 6 (2003), http://www.bpfk.gov. my/pdfworddownload/bpfk2002.pdf. The NPCB operates under the Pharmaceutical Services Division (PSD) of the Ministry of Health Malaysia. PSD, Ministry of Health Malaysia, Annual Report 2002, http://www.pharmacy.gov.my/html/annual_ report2002.htm. 152. Siti Norazah Zulklifi et al., supra note 143. 153. Id. 154. Id. 155. WHO, Malaysia: Country Cooperation Strategy, § 2.3 (2002) available at http://www.who.int/countries/en/cooperation_strategy_mys_en.pdf (last visited May 16, 2005). During the Seventh Malaysia Plan, primary health-care services were expanded, decentralizing hospital outpatient departments to health clinics. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.08, at 480. 156. Eighth Malaysia Plan 2001–2005, supra note 111, paras. 17.13–17.15, at 482–484; Fadil Azzim Abbas, supra note 126, at 19. 157. Fadil Azzim Abbas, supra note 126. 158. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, at 383 tbl.12-1. 159. Mobile units refer to dispensary services, village health teams, flying doctor services and mobile dental services. Id. 160. Total extrapolated from 1,934 rural community clinics and 686 rural health clinics. Id. 161. Id. at 484 tbl.17-2. Basic secondary care services are provided by resident medical officers and visiting specialists in areas of general medicine, surgery, obstetrics and gynecology and pediatrics. Full secondary care services comprise all components of basic secondary care services, with additional services in orthopedics, anesthesiology, psychiatry, dermatology, medical rehabilitation, pathology, imaging, dental, ophthalmology and geriatrics, provide by medical officers and resident specialists. Tertiary care services are highly specialized care in the areas of cardiology, cardiothoracic, pediatric and neurosurgery, geriatrics, neurology, respiratory medicine, urology and nephrology, plastic surgery and burns, maxillofacial, hematology, radiotherapy and oncology, and endocrinology. Id. 162. The Third Outline Perspective Plan 2001–2010 (2001), supra note 110, para. 7.53, at 182. 163. Id. para. 7.54, at 184. WHO, Malaysia: Country Cooperation Strategy, supra note 155, § 2.4. 164. National Population and Family Development Board (NPFDB), Ministry of Women, Family and Community Development, Annual Report 2001, at 8 (2002). NPFDB, Ministry of Women, Family and Community Development, History, at http://www.lppkn.gov.my/History.htm (last visited May 18, 2005). 165. Regional Office for the Western Pacific,World Health Organization (WHO), Malaysia, supra note 147, at 166. 166. Id. 167. WHO, Malaysia: Country Cooperation Strategy, supra note 155, § 2.4, at 7. E.g., the ratio of doctors to population is 1:1465 in Kuala Lumpur, while the ratio is 1:4120 in Sabah. Id. 168. Information and Documentation System Unit, Ministry of Health Malaysia, Health Facts 2003 (prelim), http://www.moh.gov.my/Facts/2003(prelim).htm. 169. YB Dato’ Dr. Chua Soi Lek, Speech at the Dialogue with Malaysian Medical Students ¶ 4 (May 24, 2004) (transcript available at http://www.moh.gov.my/speech/ menteri/240504.htm). 170. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.22, at 487. 171. Id.; Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.17, at 387, § 12.22, at 389. 172. Id. para. 17.23, at 488. Other strategies include increasing the number of students sent abroad, and outsourcing training to the private sector. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.17, at 387. 173. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.17, at 387, § 12.22, at 389. 174. The Third Outline Perspective Plan 2001–2010 (2001), supra note 110, para. 6.19, at 156. 175. Id. para. 7.51, at 182. 176. Eighth Malaysia Plan 2001–2005, supra note 111, para. 1.48, at 17; Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.22, at 389; WHO, Malaysia: Country Cooperation Strategy, supra note 155, § 2.4. 177. Information and Documentation System Unit, supra note 168. 178. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.17, at 486. 179. Information and Documentation System Unit, supra note 168. 180. Estate Hospital Assistants (Registration) Act 1965, No. 435, § 1A (1965) (Malay.) (amended 1990).

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181. National Population and Family Development Board (NPFDB), supra note 164, para. 4.8.2, at 55. 182. Communication with Syrin Junisya & Rashidah Abdullah, supra note 69, at 9. 183. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.17, at 486. 184. Private Healthcare Facilities and Services Act 1998, No. 586, § 74(1) (1998) (Malay.). 185. Dato’ Chua Jui Meng, Health Minister Speaks on Healthcare and Managed Care Organisations, https://www.allianz.com.my/PressCentre/Newsletter/News_HealthCare_CJM1.htm (last visited June 13, 2005). 186. S.M. Mohamed Idris, Make them report death, illness rates, New Straits Times, Sept. 22, 2004, at 13; Enforce act for treatment cost control, government told, Bernama- Malaysian National News Agency, June 7, 2004. 187. Primary Care Doctors’ Organization Malaysia,The Private Healthcare Facilities and Services Act 1998, Healthcare Professional’s Guide § 6.1 (1998), http://www.pcdom.org.my/common/phcfsa98.htm (summarizing the Private Healthcare Facilities and Services Act 1998). 188. Information and Documentation System, supra note 168; WHO, National Expenditure on Health – Malaysia (2005), http://www.who.int/nha/country/MYS. xls. 189. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, at 137 tbl.5-1, 430 tbl.12-5. See Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.50, at 497. 190. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, at 430 tbl.21-5. (total amount set aside for this purpose is RM 7703.5 million). 191. Economic Planning Unit, Government of Malaysia, Seventh Malaysia Plan 1996–2000, para. 17.61, at 551 (1996), http://www.epu.jpm.my/New%20Folder/ development%20plan/RM7.htm. 192. Id. para. 17.25, at 540. 193. Id. paras. 7.34–7.35, at 216, 17.25, at 540, 17.56, at 546. 194. Chan Chee Khoon, The Political Economy of Healthcare Reforms in Malaysia, in Restructuring Health Services: Changing Contexts & Comparative Perspectives 206 (Katuri Sen ed., 2003). 195. National Expenditure on Health – Malaysia (2005), supra note 188. 196. Id. 197. Communication with Syrin Junisya & Rashidah Abdullah, supra note 69. 198. WHO, Malaysia: Country Cooperation Strategy, supra note 155, § 3.1. National self-reliance is part of Malaysia’s Vision 2020 policy. Developmental Aid from Japan, Demark and Germany has ceased since 1998. Meanwhile, Malaysia continues to seek technical advice from international institutions (e.g. The World Bank, Asian Development Bank, WHO) but remains self-sufficient as it is able to pay for advice or develop its own expertise. Id. 199. Id.; Ministry of Health Malaysia, Government of Malaysia, Annual Report 1999, at 89 (2000). 200. Fees Act, No. 209 (1951) (Malay.). 201. Fees (Medical) Order 1982, P.U. (A) 359/82, § 16 (1985) (Malay.). 202. Fees (Medical) (Amendment) Order (No. 2) 1994, P.U. (A) 468/94, § 2 (1994) (Malay.). “Foreign person” means a person who is not a citizen of Malaysia but does not include a non-citizen who holds an identity card issued under paragraph 5(3)(b) or (c) of the National Registration Regulations 1990 and, in the case of a child, one who holds a Malaysian birth certificate and whose father is the holder of any such identity card. Id. § 2. 203. Id. 204. Malaysian Medical Association (MMA), MMA Schedule of Fees (2002), http://www.mma.org.my/current_topic/fee.htm (Sept. 2, 2002). 205. Communication with Syrin Junisya & Rashidah Abdullah, supra note 69. 206. Employees Provident Fund Ordinance 1951, No. 21 (1951) (Malay.), amended by Employees Provident Fund Act 1991, No. 452, § 24(1) (1991), http://www.kwsp.gov. my/index.php?ch=100&pg=162 (last visited May 19, 2005). The Fund covers all employee(s), interpreted by the Act as person(s) “employed under a contract of service or apprenticeship, whether written or oral and whether expressed or implied, to work for an employer.” Id. § 2. 207. Id. § 43, 3rd sched. (1951) (Malay.). As of the end of December 1999, the total number of members was 9.54 million, comprising 4.78 million (50.1 per cent) active members. Ong Fon Sim, Aging in Malaysia: A Review of National Policies and Programmes, Ageing and Long-Term Care: National Policies in the Asia-Pacific, ch. 4 (David R. Phillips & Alfred C.M. Chan eds., 2002), http://web.idrc.ca/es/ev-26511-201-1DO_TOPIC.html. 208. Employees Provident Fund Act 1991, No. 452, § 54(6)(f) (1991) (Malay.), amended by Employees Provident Fund (Amendment) Act 2001, No. 1123 (2001) (Malay.). Portions of a member’s entitlements may be withdrawn for “medical financing.” The total sum of a member’s entitlements under the Fund may be withdrawn if the member has died, reached 55 years old, become physically or mentally disabled, or plans to depart Malaysia permanently. Id. § 54(1)(a)–(e). See also Employees Provident Fund, Members: Withdrawal Scheme, http://www.kwsp.gov.my/index.php?ch=139 (last visited May 19, 2005). 209. Employees Provident Fund Ordinance 1951, No. 21 (1951) (Malay.), amended by Employees Provident Fund Act 1991, No. 452, § 24(1) (1991), http://www.kwsp.gov. my/index.php?ch=100&pg=162 (last visited May 19, 2005). These benefits are available to employees upon compulsory or optional retirement or retirement based on medical reasons, as provided in the employment contract. Id. § 2.

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210. YB Dato’ Dr. Chua Soi Lek, Speech at the Launch of “Allianz Care” at the Mandarin Oriental Hotel, Kuala Lumpur, ¶ 4 (Jan. 11, 2005) (transcript available at http://www. moh.gov.my/speech/menteri2/2005/110105%20Allianz%20Care.htm). In 2000, the SOCSO paid 209,820 workers, and the program expanded to include compensation for workers injured en route to or from workplace. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.12 at 481. 211. Ong Fon Sim, supra note 207. 212. Id. 213. Id. 214. Id. 215. Communication with Syrin Junisya & Rashidah Abdullah, Asian-Pacific Resource & Research Centre for Women (ARROW), Women of the World: Laws and Policies Affecting Their Reproductive Lives- Malaysia (draft) 12 (Dec. 2, 2004) (on file with the Center for Reproductive Rights). 216. Id. 217. Seventh Malaysia Plan 1996–2000, supra note 191, para. 17.34, at 544. 218. Chan Chee Khoon, supra note 194. 219. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 13. 220. YB Dato’ Dr. Chua Soi Lek, Speech at the Launch of “Allianz Care” at the Mandarin Oriental Hotel, supra note 210, ¶¶ 9, 11–12. 221. The Third Outline Perspective Plan 2001–2010 (2001), supra note 110, para. 7.54, at 183 . 222. Eighth Malaysia Plan 2001–2005, supra note 111, para. 1.48, at 17. 223. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.103, at 414. 224. Control of Drugs and Cosmetics Regulations, P.U. (A) 223/84, art. 7 (1984) (Malay.). Unregistered drugs may be imported for the treatment of any person suffering from a life-threatening illness upon NPCB’s approval. Id. art. 15(6). 225. Id. arts. 7(1)(a), (b), (2) (1984) (Malay.). 226. Ministry of Health Malaysia, Annual Report 2002, supra note 151, at 10. 227. Control of Drugs and Cosmetics Regulations, P.U. (A) 223/84, art. 17(1)–(3) (1984) (Malay.). 228. Medical Act 1971, No. 50, § 3 (1971) (Malay.); Malaysian Medical Council (MMC), Overview of the Function and Organization of the MMC, http://www. moh.gov.my/mmc/overview.htm (last visited June 1, 2005). 229. Malaysian Medical Association, Medicine as a Career (2002), http://www. mma.org.my/info/career.htm. 230. Id. 231. Id. 232. Malaysian Medical Council, Code of Medical Ethics, pt. III, § 1.1(c) (2002), http://www.mma.org.my/charters/Ethical_code2.pdf. 233. Malaysian Medical Council,The Code of Professional Conduct, http:// www.moh.gov.my/mmc/codeprolist.htm (Dec. 9, 1986); Overview of the Function and Organization of the Malaysian Medical Council, supra note 228. 234. This is defined as “no more then serious misconduct judged according to the rules, written or unwritten, governing the profession” and acts “which will be reasonably regarded as disgraceful or dishonorable by his professional brethren….” The Code of Professional Conduct, supra note 233, pt. I. Specific acts include “neglect or disregard of professional responsibilities…[, a]buse of professional privileges and skills…[, c]onduct derogatory to the reputation of the medical profession…[, a]dvertising, canvassing and related professional offenses.” Id. pt. II. 235. Laws of Malaysia: Medical Regulations 1974, reg. 27; Medical Act 1971, No. 50, § 29(2) (1971) (Malay.). 236. Nurses Act 1950, No. 14 (1950) (Malay.) (amended 1999) (establishing the Nursing Board). 237. Midwives Act 1966, No. 436 (1966) (Malay.) (establishing the Midwives Board). 238. Registration of Pharmacists Act 1951, No. 371, § 3 (2001) (Malay.) (establishing the Pharmacy Board); Pharmaceutical Services Division, Ministry of Health Malaysia, Pharmacy Board, http://www.pharmacy.gov.my/html/pharmacy_board_ f.htm (last visited May 19, 2005). 239. Nurses Act 1950, supra note 236. 240. Id. § 3. 241. Midwives Act 1966, supra note 237. 242. Registration of Pharmacists Act 1951, No. 371, §§ 3, 5–6 (1951) (Malay.). 243. Id. § 3; Pharmacy Board of Malaysia, Code of Conduct for Pharmacists and Bodies Corporate (1989). 244. Estate Hospital Assistants (Registration) Act, No. 435, §§ 2–3 (1965) (Malay.) (establishing the Estate Hospitals Assistants Board). 245. Medical Act 1971, No. 50, §§ 33–34 (1971) (Malay.). Practitioners of traditional medicine may not, for example, represent themselves as doctor, general practitioner or physician, or represent their practice as a clinic, dispensary or hospital. Id. 246. National Pharmaceutical Control Bureau, Ministry of Health, Registration of Traditional Medicines in Malaysia (1999), http://www.bpfk.gov. my/berita%20-%20berita/April%201999%20registration.htm. 247. Yb Dato’ Chua Jui Meng, Speech at the National Homeopathy Conference ¶ 19 (Aug. 22, 2003), (transcript available at http://www.moh.gov.my/speech/ menteri/220803.htm). 248. Ministry of Health, National Policy on Traditional/Complementary Medicine § 6.1 (2001). 249. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, §

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12.20, at 388. 250. See Communication with Syrin Junisya & Rashidah Abdullah, supra note 182, at 15. 251. Civil Law Act 1956, No. 67, §§ 7–8, 28A (1956) (Malay.). The act was amended in light of concerns that the availability of high damages awards would encourage personal injury lawsuits and turn Malaysia into a “litigious society,” and that society, rather than insurance companies, would have to shoulder the economic burden of large awards. See S. Santhana Dass, Is there a Need for Review After a Decade of the Civil Law (Amendment) Act 1984 on Damages?, 11th Malaysian Law Conference (Nov. 8–10, 2001), http://www.mlj.com.my/free/articles/santhana.htm. 252. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 15. 253. S. Radhakrishnan, Medical Negligence Litigation: Is Defensive Medicine Now The Norm? (1999), http://www.mlj.com.my/free/articles/Radakrishnan.htm. (presented at the 12th Commonwealth Law Conference at Kuala Lumpur in September 1999). 254. Id. 255. Medical Act 1971, No. 50, § 3 (1971) (Malay.). The Code of Professional Conduct, supra note 233; Malaysian Medical Council, Code of Medical Ethics (2002), http://www.mma.org.my/charters/Ethical_code2.pdf. 256. The Code of Professional Conduct, supra note 233, pt. III, § 3. 257. Malaysian Medical Association, Memorandum of Understanding,The Patient’s Charter (2002), http://www.mma.org.my/charters/patient.htm. 258. Malaysian Medical Association, Patient’s Rights (2002), http://www.mma. org.my/charters/patient_right.htm. 259. Malaysian Medical Association,The Patient’s Responsibilities (2002), http:// www.mma.org.my/charters/patient_responsibilities.htm. 260. Id. 261. United Nations Educational, Scientific, and Cultural Organization (UNESCO), Country Profile: Malaysia 75, http://portal.unesco.org/education/en/ file_download.php/05b5675b08404d56f464c0f9caa1a551Malaysia.pdf (last visited May 18, 2005). 262. Eighth Malaysia Plan 2001–2005, supra note 111, ch. 20. 263. Id. paras. 20.18, at 563, 20.28, at 566. 264. Id. paras. 20.18, at 563, 20.28, at 566, 20.35, at 568 . 265. Id. para. 20.35, at 568. 266. Id. para. 20.36, at 569. 267. YB Dato’ Chua Jui Meng, Speech at the Launch of the Malaysian Twins Support Group at the Damansara Fertility Centre ¶ 6 (June 3, 2003) (transcript available at http:// www.moh.gov.my/speech/menteri/030603.htm); NPFDB, Assisted Conception Technology, http://www.lppkn.gov.my/assisted.htm (last visited May 18, 2005). 268. YB Dato’ Chua Jui Meng, Speech at the Launch of the Malaysian Twins Support Group at the Damansara Fertility Centre, supra note 267, ¶ 7. Simpler procedures include assessing hormonal status, laparoscopic evaluation, seminal fluid evaluation, and intrauterine insemination. Id. 269. Id. ¶ 8. 270. See Id. ¶ 23. 271. See Deborah Loh, 46pc rise in AIDS from unprotected sex, New Straits Times, Apr. 16, 2003 (quoting Datuk Seri Shahrizat, Minister for Women and Family Development). 272. See Malaysia National Population and Family Development Programme, Facts and Figures § 4.6 (1982). 273. Letter from Ms. Khoo Swee Kheng, Deputy Director, National Population and Family Development Board, to Syirin Junisya, Programme Officer, ARROW (July 28, 2003) (on file with the Center for Reproductive Rights) (referring to Malaysia National Population and Family Development Programme, Facts and Figures, 1982). 274. NPFDB, Ministry of Women, Family and Community Development, Number of Clinics Providing Family Planning Services by Implementing Agencies and State, Malaysia: 2000, http://www.lppkn.gov.my/popmal/content63.html; See Federation of Family Planning Association, Annual Report 2002, at 12 (2002). 275. National Population and Family Development Board, Population Profile Malaysia 84 fig.5.4. 276. Id. 277. Id. at 89 fig.5.7. Reasons cited for discontinuation were planning for pregnancy (37.9%), side effects (26%), medical advice (7.6%), method failure (4.7%), husband’s objections (2.4%) and others (21.4%). Id. 278. Department of Statistics Malaysia, Social Statistics Bulletin Malaysia 2001, at 187 tbl.4.18 (2002) (figures pertain to methods chosen by new family planning acceptors in 2000, data source NPFDB). 279. International Planned Parenthood Federation (IPPF), Country Profile: Malaysia, http://ippfnet.ippf.org/pub/IPPF_Regions/classic/IPPF_CountryProfile. asp?ISOCode=MY (last visited May 19, 2005). 280. National Population and Family Development Board, Population Profile Malaysia 87 fig.5.5. 281. See Pharmaceutical Services Division, Ministry of Health Malaysia, National Drugs List, http://www.pharmacy.gov.my/html/pharma_care_nedl_f.htm (last visited May 19, 2005). The approved drugs follow the WHO’s definition of “essential drugs” as drugs that meet the health-care needs of the majority of the population, and should thus be easily available in adequate quantities and in suitable dosages. Id. 282. Reasons given by the Council are “1) Sterilisation is haram (forbidden) because it makes the sterilised person forever incapable of continuing the lineage, i.e. the effect of sterilisation is permanent; 2) Contraception to limit the number of offspring is haram (forbidden) unless under harus (permissible) individual circumstances. Contraception that

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is not permanent in nature is permissible when several conditions are met; 3) to space the children for reasons of health, education and family happiness, using other methods than (1) and (2) is harus (permissible).” Nik Noraini & Nik Badli Shah, Islam, Reproductive Health and Women’s Rights in Malaysia, in Islam, Reproductive Health and Women’s Rights 179 (Zainah Anwar & Rashidah Abdullah eds., 2000). 283. Administration of Islamic Law (Federal Territories) Act 1993, No. 505, § 34(1)–(4) (1993). Fatwas are taken to be law after publication in the Gazette. Id. 284. Telephone interview with Dr. Ravindran Jegasothy, Senior Consultant and Head, Department of Obstetrics and Gynaecology, Seremban Hospital (Nov. 10, 2003); Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 20. 285. Nik Noraini & Nik Badli Shah, supra note 282. 286. Department of Statistics Malaysia, supra note 278, at 187 tbl.4. 287. Letter from Ms. Khoo Swee Kheng, supra note 273. 288. Id. 289. Medicines (Advertisement & Sale) Act 1956, No. 290, § 3(b) (1956) (Malay.), amended by Medicine (Advisement & Sale) (Amendment) Act 1980, No. 778 (1983) (Malay.), http://www.pharmacy.gov.my/html/legislations/medicines%20act.doc. Advertisements include any notice, circular, report, commentary, pamphlet, label, wrapper or other document, and any announcement made orally or by any means of producing or transmitting light or sound. Id. § 2. Medicine Advertisement Board (MAB), Ministry of Health Malaysia, Guidelines on Medical Advertisements (For Products), § 4.1, http://www.pharmacy.gov.my/html/MAB/advertisement_board_guidelines.htm# Guidelines%20on%20Medical%20Advertisements (last visited May 19, 2005). 290. Medicines (Advertisement & Sale) Act 1956, supra note 289, § 3. 291. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 22. The National Population and Family Development Board was established through the Population and Family Development Act 1966. Population and Family Development Act 1966, No. 352, § 3(1) (1966) (Malay.). 292. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, at 383 tbl.12-1; National Population and Family Development Board, Ministry of Women, Family and Community Development, Government of Malaysia, Achievements, http://www.lppkn.gov.my/achieve.htm (last visited May 14, 2005). 293. National Population and Family Development Board (NPFDB), supra note 164, para. 2.5.1, at 48; Ministry of Health Malaysia, Annual Report 2000, at 69 (2001). 294. The KASIH clinics also provide services for menopause and andropause, family counseling and parenting training. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.65, at 402–403. Services also include: providing expertise and knowledge of parenthood and family issues to families; education, counseling, management and treatment in the area of human reproduction; research and development on psychosocial and biomedical aspects of the family; and collecting and disseminating information concerning population and the family, at all stages and levels. National Population and Family Development Board (NPFDB), Family Service Complex, http://www.lppkn.gov.my/kasih.htm (last visited May 18, 2005). 295. NPFDB, Strategy, http://www.lppkn.gov.my/strategy.htm (last visited May 18, 2005). 296. The program comprises health screening campaigns and lectures. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.65, at 402–403. 297. Letter from Ms. Khoo Swee Kheng, supra note 273. 298. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 22; International Planned Parenthood Federation (IPPF), supra note 279. 299. See Federation of Family Planning Association, Annual Report 2002, at 12 (2002). 300. Communication with Syrin Junisya & Rashidah Abdullah, supra note 182, at 13. 301. Federation of Family Planning Association, supra note 299. 302. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 23; International Planned Parenthood Federation (IPPF), supra note 279. 303. See National Population and Family Development Board, Population Profile Malaysia 92 fig.5.9. 304. Communication with Syrin Junisya & Rashidah Abdullah, supra note 182, at 28. 305. National Library of Medicine, Mortality rates decline in Malaysia [Abstract], 200 Population Headliners, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Re trieve&db=PubMed&list_uids=12284509&dopt=Abstract (last visited June 13, 2005); Information and Documentation System Unit, supra note 168. (MMR of .03 per 1000 live births in 2002). 306. UNFPA, Maternal Mortality Update 2004: Delivering into good hands 13–14 (2004). 307. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, paras. 270–271. 308. Id. 309. Id. 310. National Population and Family Development Board (NPFDB), supra note 164, at 60 tbl.2.1. 311. Information & Documentation System Unit, Ministry of Health Malaysia, 10 Principle Causes of Death in Government (MOH) Hospitals, Malaysia, 2002, http://www.moh.gov.my/indicators.HTM (last visited May 18, 2005). 312. See ARROW, Combating Maternal Mortality: The Malaysian Experience, 7 ARROWs for Change 4 (2001). 313. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 25. 314. Ministry of Health, National Conference on Safe Motherhood: A Shared Responsibility, In Conjunction with WHO 50th Anniversary § 4.1.1, at 6 (1998);

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ARROW, supra note 312; CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 271. 315. National Conference on Safe Motherhood, supra note 314, § 4.6, at 8; CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 271(h). 316. National Conference on Safe Motherhood, supra note 314, § 4.7, at 8; CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19. 317. National Conference on Safe Motherhood, supra note 314, § 4.5, at 7; CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19. A confidential inquiry was established in 1991. 318. Id. § 4.3, at 6. 319. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 272. 320. The NPAN Malaysia was drafted in 1994 and finalized in 1995. Regional Office for the Western Pacific,World Health Organization (WHO), Report of the Workshop on National Plans of Action for Nutrition: Key Elements for Success, Constraints and Future Plans, § 2.2.1, at 11, (1999), http://www.wpro.who. int/sites/nut/documents/mtg_19992510.htm. 321. Tan Sri Dato’ Dr Abu Baker bin Suleiman & Tee E. Siong, Nutrition and the Malaysian Healthy Lifestyle Programme: Challenges in implementation, 7 Asia Pacific J. Clin Nutri 230–237, 235 (1998); World Declaration and Plan of Action for Nutrition, Rome, Italy, Dec. 1992 (1992); See Nutriweb Malaysia,The National Plan of Action for Nutrition Malaysia (2004), http://nutriweb.org.my/professional/natplanaction.php. 322. Ministry of Health Malaysia, Government of Malaysia, Recommended Nutrient Intake for Malaysia (2005), http://www.moh.gov.my/RNI.htm. 323. Regional Office for the Western Pacific,World Health Organization (WHO), Report of the Workshop on National Plans of Action for Nutrition: Key Elements for Success, Constraints and Future Plans, § 2.2.1, at 11 (1999), http://www.wpro.who.int/sites/nut/documents/mtg_19992510.htm. 324. Eighth Malaysia Plan 2001–2005, supra note 111, para. 20.18, at 563. 325. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 279(a)–(d). 326. The Third Outline Perspective Plan 2001–2010 (2001), supra note 110, para. 4.06. 327. Department of Economic and Social Affairs, United Nations Population Division (UNFPA), Abortion Policies: A Global Review 119–120 (2002), http:// www.un.org/esa/population/publications/abortion/doc/malaysia.doc. 328. Id. 329. Id. 330. Body Wants Review of Abortion Laws, Daily Express, Apr. 18, 2000, http://www. infosabah.com.my/Daily_Express/apr/18-04-2000.htm. 331. Ravindran Jegasothy, Unwanted Pregnancy – Medical and Ethical Dimensions, 58 Malaysian Medical Journal 24 (Supp. A 2003). 332. Regional Office for the Western Pacific,World Health Organization (WHO), Malaysia, supra note 147, at 174. 333. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 252. See also Regional Office for the Western Pacific,World Health Organization (WHO), Malaysia, supra note 147, at 175. 334. Penal Code, No. 574, § 312 (1997) (Malay.), amended by Penal Code (Amendment) Act, No. 727 (1989). 335. Department of Economic and Social Affairs, United Nations Population Division (UNFPA), Abortion Policies: A Global Review 119–120 (2002), http:// www.un.org/esa/population/publications/abortion/doc/malaysia.doc (last visited May 14, 2005). 336. Penal Code, No. 574, § 312 (1997) (Malay.), amended by Penal Code (Amendment) Act, No. 727 (1989) (Malay.). 337. Id; In Roe v. Wade, the opinion referenced “quickening” in common law, American law, and English statutory law in coming up with the viability concept. See Roe v. Wade, 410 U.S. 113, 132–140 (1973). 338. Penal Code, No. 574, § 313 (1997) (Malay.), amended by Penal Code (Amendment) Act, No. 727 (1989) (Malay.). 339. Id. 340. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 33. 341. Deborah Loh & Sheridan Mahavera, Fatwa on when abortions allowed, New Straits Times, Oct. 18, 2002, at 8. 342. Id. 343. Id.; Administration of Islamic Law (Federal Territories) Act 1993, No. 505, § 34 (1993) (Malay.). 344. Malaysia Medical Association, Code of Medical Ethics 2002 §15, at 18 http://www. mma.org.my/charters/Ethical_code2.pdf. 345. Telephone interview with Dr. Ravindran Jegasothy, Senior Consultant and Head, Department of Obstetrics and Gynaecology, Seremban Hospital (Nov. 10, 2003); Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 29. 346. Department of Obstetrics and Gynaecology, Ipoh Hospital, Clinical Practice Guideline:Termination of Pregnancy. 347. Id. § 2. 348. Id. § 2.1(i). 349. Id. § 3. 350. Id. § 7. 351. “[N]o person shall take any part in the publication of any advertisement referring to any article, or articles of any description, in terms which are calculated to lead to

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the use of that article or articles of that description for procuring the miscarriage of women.” Medicines (Advertisement & Sale) Act 1956, supra note 289, § 4; Medicine Advertisement Board (MAB), Ministry of Health Malaysia, Guidelines on Medical Advertisements (For Products), § 4.1.d, http://www.pharmacy.gov.my/ html/MAB/advertisement_board_guidelines.htm#Guidelines%20on%20Medical%20 Advertisements. 352. Medicines (Advertisement & Sale) Act 1956, supra note 289, § 5(1)(a). 353. Id. 354. Id.; MAB, Ministry of Health Malaysia, Guidelines on Public Information (For Services), § 1, http://www.pharmacy.gov.my/html/MAB/advertisement_board_ guidelines.htm#Guidelines%20on%20Public%20Information (last visited May 20, 2005). 355. Ipoh Hospital, supra note 346, § 2.3; Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 29. 356. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 30. 357. Ministry of Health, HIV/AIDS Update: 2002, at 1 (Email from Dr. Abdul Rasid Bin Kasri, Principle Assistant Director, Disease Control Division, Ministry of Health, to Syirin Junisya, Program Officer, Asian-Pacific Resource and Research Center for Women (ARROW) (May 31, 2003, 11:48, on file with Center for Reproductive Rights). 358. Id. 359. Id. at 8. 360. Id. 361. See Id. at 8–10. 362. Id. 8. 363. Prevention and Control of Infectious Diseases Act 1988, No. 342, § 10(1)–(2) (1988) (Malay.). 364. Id. 365. Id. No., 1st sched., § 2, pt. I(1), (7), (15), pt. II. 366. Id. 1st sched., § 24(a)(b)(c) (1988) (Malay.). 367. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 32. 368. Penal Code, No. 574, § 269 (1997) (Malay.), amended by Penal Code (Amendment) Act, No. 727 (1989). 369. Id. 370. Id. 371. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.13, at 386. 372. Disease Control Division, Ministry of Health, Plan of Action for the Prevention and Control of HIV Infection § 7.2.1, at 13 (2004). 373. Id. 374. Id. at 14–15 (2004). 375. Ministry of Health, AIDS Series 4, Guidelines for Nursing Management of People Infected with HIV/AIDS (1995). 376. Id. at 5. 377. Department of Occupation Safety and Health, Ministry of Human Resources, Code of practice on prevention and management of HIV/AIDS at the workplace (2001). 378. Id. at 2, 6 (2001). 379. Malaysian AIDS Council, Malaysian AIDS Charter (1995). 380. Id, pt. II, §§ 4(a), 8(a)–(c). 381. Pharmaceutical Services Division, Malaysian Ministry of Health, Pharmaceutical Service Division Annual Report 2002, http://www.pharmacy.gov.my/html/annual_ report2002.htm. 382. Indra Nadchatram, The MAF People Living with HIV/AIDS Drug Assistance Scheme: Shared Burdens, Shared Responsibilities, 3 Sexual Health Exchange (2003), http://www. kit.nl/frameset.asp?/ils/exchange_content/html/2003-3_the_maf.asp&frnr=1&. 383. Geetha Krishnan, Fund to help HIV/AIDS sufferers, The Star, June 9, 2004, at 30. 384. Indecent Advertisements Act 1953, No. 259, §§ 5–6 (2001) (Malay.). 385. Id. § 6(3) (2001) (Malay.). 386. Id. § 7 (2001) (Malay.). 387. Id. § 5, para. 2 (2001) (Malay.). 388. Malaysian AIDS Council, Malaysian AIDS Charter, pt. I, §§ 1–2, 5 (1995). 389. Id. pt. I, § 3. 390. See Department Of Statistics Malaysia,Yearbook Of Statistics Malaysia 2002, 39 tbl.3.9 (2002) (mid-year estimates of population; data calculated by dividing adolescent population figures by total population). 391. Id. 392. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 263. 393. National Population and Family Development Board (NPFDB) & IPPF, Executive Summary: National Study on Reproductive Health of Adolescents in Malaysia, 1994, at 3 (1998). 394. Resource Centre, Malaysian AIDS Council, AIDS in Malaysia 2 (2002) (source of data from Ministry of Health Malaysia; figures pertain to 13-19 year olds). 395. United Nations, Adoption of the Beijing Declaration and Platform for Action § 20 (1995), http://www.un.org/documents/ga/conf177/plateng/aconf177-20part6en.htm. 396. Ministry Of Health Malaysia, Annual Report 1998, at 66 (1999). 397. Ministry of Health, Second National Health and Morbidity Survey (NHMS 2) 1996: An Overview 18 (1996). 398. Ministry Of Health Malaysia, Annual Report 1998, at 66 (1999). 399. Ministry of Health Malaysia, National Adolescent Health Policy 10 (2001).

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The policy defines adolescents as the population between the ages of 10–19 years. Id. 400. Id. at 10–11. 401. National Population and Family Development Board (NPFDB), supra note 164, at 22 tbl.2.7.3 . 402. Communication with Syrin Junisya & Rashidah Abdullah, Asian-Pacific Resource & Research Centre for Women (ARROW), Women of the World: Laws and Policies Affecting Their Reproductive Lives- Malaysia (draft) 2–3 (June 13, 2004) (on file with the Center for Reproductive Rights). 403. Id. 404. Id. 405. Eighth Malaysia Plan 2001–2005, supra note 111, para. 17.06, at 479. 406. Id. 407. Id. para. 17.30, at 492. 408. Id. para. 20.19, at 563. 409. Economic Planning Unit, Prime Minister’s Department, Government of Malaysia, First Malaysia Plan 1966–1970, at 1, para. 46(vi), 15 (1966); NPFDB, Ministry of Women, Family and Community Development, Population Policy in Malaysia:The Facts ¶ 1, http://www.lppkn.gov.my/popinfo2003.asp (last visited May 20, 2005). 410. Population and Family Development Act 1966, No. 352, § 3(1) (1966) (Malay.). See NPFDB, History, supra note 164. 411. Economic Planning Unit, Prime Minister’s Department, Government of Malaysia, First Malaysia Plan 1966–1970, at 1, para. 46(vi), 15 (1966). NPFDB, History, supra note 164. 412. See NPFDB, Population Policy in Malaysia:The Facts, supra note 409, ¶ 3. 413. See Id. ¶ 7; Siti Norazah Zulklifi et al., supra note 143. 414. NPFDB, History, supra note 164. See Siti Norazah Zulklifi et al., supra note 143. 415. Income Tax Act 1967, No. 53, § 48 (1967) (Malay.) (amended 1971). In 1991, tax breaks were offered for the first five children. This was amended in 1995 to provide tax breaks for each child. 416. Communication with Syrin Junisya & Rashidah Abdullah, supra note 215, at 36. 417. Eighth Malaysia Plan 2001–2005, supra note 111, para. 4.83, at 117. 418. Id. 419. NPFDB, Population Policy in Malaysia:The Facts, supra note 409, ¶ 6; Letter from Ms. Khoo Swee Kheng, supra note 273. 420. Id. 421. Id. ¶ 7. 422. Id. ¶ 7. 423. Population and Family Development Act 1966, No. 352, § 5(a)–(f) (1966) (Malay.). 424 National Population and Family Development Board (NPFDB), supra note 164, at 48. 425. Malay. Const. art. 8(2) (amended 2001). 426. Id.; Women’s Aid Organization, Constituting a Gender Equal Constitution (2003), http://www.wao.org.my/news/20030110talkp_constitution.htm (Oct. 5, 2003). 427. Employment Act 1955, No. 265, §§ 34–40 (1955) (Malay.); Law Reform (Marriage and Divorce) Act 1976, No. 164 (1976) (Malay). 428. Domestic Violence Act 1994, No. 521 (1994) (Malay.). 429. Penal Code, No. 574, §§ 375–376 (1997) (Malay.). 430. [2004] 4CLJ 403. Leave to appeal to the Federal Court (Case No. 08-51-2003) was refused on 11th March 2005. Women’s Aid Organization (WAO), Joint Press Statement, Federal Court to decide whether to hear Employment Discrimination Case, Beatrice Fernandez v. Sistem Penerbangan Malaysia & Anor (2005), http://www.wao.org.my/news/20040103mas.htm (Mar. 9, 2005). 431. See Penal Code, No. 574, §§ 377, 377A–377B, 377D (1997) (Malay.). 432. Alina Rastam, Out Of the Closet and Into the Courtroom? Some Reflections on Sexuality Rights in Malaysia, http://wwlw.multiservers.com/ legal04.htm (last visited June 7, 2005). 433. Minor Offences Act 1955, No. 336, § 21 (1955) (Malay.). 434. Communication with Syrin Junisya & Rashidah Abdullah, Asian-Pacific Resource & Research Centre for Women (ARROW), Women of the World: Laws and Policies Affecting Their Reproductive Lives- Malaysia (draft) 7 (June 18, 2003) (on file with the Center for Reproductive Rights). 435. Nik Noraini & Nik Badli Shah, supra note 282, at 165. 436. Syariah Criminal Offences (Federal Territory) Act 1997, No. 559, §§ 25–26 (1997) (Malay.). There are similar provisions in the Syariah Laws of Johor and Melaka. 437. The Women’s Affairs Division (HAWA), Ministry of National Unity And Social Development,The National Policy on Women § 2.1 (1995). 438. Aminah Ahmad, Country Briefing Paper, Women in Malaysia 35 (1998), http:// www.adb.org/Documents/Books/Country_Briefing_Papers/Women_in_Malaysia/ default.asp (Dec. 1998). 439. “…the Government also recognises that specific strategies must necessarily be formulated to effectively incorporate women in the process of development. Towards this end, concerted efforts will be made to progressively reduce existing constraints and facilitate the assimilation of women into the mainstream social and economic activities.” Economic Planning Unit, Government of Malaysia, Sixth Malaysia Plan 1991– 1995, § 16.01, at 413 (1991). 440. Aminah Ahmad, supra note 438, at 34. 441. International Labor Organization, Ministry of Women, Family and Community Development (KPWK)- Malaysia, http://www.ilo.org/public/english/ employment/gems/eeo/law/malaysia/mnu.htm (last modified Sept. 20, 2004).

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442. Women’s Affairs Department, Ministry of National Unity and Social Development, Plan of Action for the Advancement of Women (1997). 443. Aminah Ahmad, supra note 438, at 34. 444. Id. at 36. 445. Eighth Malaysia Plan 2001–2005, supra note 111, § 20.28, at 566. 446. UNDP, UNDP’s Programmes and Projects in Achieving the MDGs and Reducing Human Poverty, Capacity Building on Gender Mainstreaming for the Ministry of Women, Family and Community Development, http://www.undp.org. my/undp/undp_in_malaysia/undp_in_malaysia_prog/gender03.asp (last visited June 12, 2005). 447. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 67. 448. See International Labor Organization, supra note 441. 449. Malaysian-German Chamber of Commerce and Industry, Cabinet 2004, http://www.mgcc.com.my/mgcc/main.nsf/a1c3e63c92172ee547256b550017c30c/ c31e68dc9de3e23b47256e65001144e8?OpenDocument. 450. Ministry of Women, Family and Community Development, Struktur Organisasi [Organizational Structure], http://www.kpwkm.gov.my/bm/pfl_ kpwkm_organisasi.asp (last visited June 6, 2005). 451. Id.; Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.91, at 410. 452. Aminah Ahmad, supra note 438, at 37. 453. Id. 454. Id. 455. Id. 456. Human Rights Commission of Malaysia (SUHAKAM), About SUHAKAM, http://www.suhakam.org.my/en/about_history.asp (last visited June 12, 2005). 457. For example, on March 17, 2003, SUHAKAM organized the “SUHAKAM Roundtable Discussion: Rights and Obligations under CEDAW.” There were newspaper and television reports, followed by the publication of the “Report: Roundtable Discussion: Rights and Obligations under CEDAW.” See Human Rights Commission of Malaysia (SUHAKAM), Report, Round Table Discussion: Rights and Obligations Under CEDAW § 2.1.3, annex 6 (2004), http://www.suhakam.org.my/ docs/document_resource/Report_RTD_CEDAW.pdf; Human Rights Commission of Malaysia (SUHAKAM), Functions and Powers, http://www.suhakam.org. my/en/about_functions.asp (last visited June 12, 2005). 458. Malay. Const. 2nd sched., pt. II, § 1(a) (pursuant to Article 14(1)(b)). 459. Id. 2nd sched., pt. II, § 1(b)–(c) (pursuant to Article 14(1)(b)). 460. Malay. Const. art. 15(1). 461. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 12. 462. Id. at 12–13. 463. According to ARROW, this happened through an administrative decision by the Immigration Department. Sheridan Mahavera, Foreign Wives Hail Relaxing of Ruling, New Straits Times, May 5, 2003. 464. Law Reform (Marriage and Divorce) Act 1976, No. 164, §§ 5–8 (1976) (Malay.). 465. Id. § 4(a) (1976) (Malay.). In other words, if a woman has been lawfully married under Chinese customary marriage prior to this date, such a marriage is deemed registered under the Act. 466. The age of majority under the Age of Majority Act 1971 is 18. Age of Majority Act 1971, No. 21, § 2 (1971) (Malay.). 467. Law Reform (Marriage and Divorce) Act 1976, No. 164, pt. III, § 10 (1976) (Malay.). 468. Id. pt. III, § 12(a). 469. Id. pt. II, §§ 5–8. 470. Married Women and Children (Maintenance) Act 1950, No. 263, § 3(1) (1950) (Malay.). 471. Law Reform (Marriage and Divorce) Act 1976, No. 164, § 78 (1976) (Malay.). 472. Married Women and Children (Maintenance) Act 1950, No. 263, § 3(2) (1950) (Malay.), amended by Law Reform (Marriage and Divorce) Act 1976, No. 164 (1982) (Malay.). 473. Islamic Family Law (Federal Territory) Act 1984, No. 303 (1984) (Malay.). 474. Id. § 8 (1984) (Malay.). 475. Nik Noraini & Nik Badli Shah, supra note 282, at 188. The doctrine of ijbat, or compulsion, is followed in Kelantan, Kedah and Melaka. See e.g., Islamic Family Law Enactment 1983, Kelantan Enactment No. 1, § 13(2) (1983) (Malay.). 476. [Polygamy] Women Campaign Against Polygamy, Religion News Blog, Mar. 17, 2003, http://www.religionnewsblog.com/archives/00002762.html. 477. Id. 478. Nik Noraini & Nik Badli Shah, supra note 282, at 185; See Islamic Family Law (Federal Territory) Act 1984, No. 303, § 23(1) (1984) (Malay.); Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 23(1) (2003) (Malay.). 479. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 23(4)(a)–(d) (1984) (Malay.); Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 23(5)(a)–(d) (2003) (Malay.). 480. Women’s Aid Organization, Know Your Rights: Polygamy, http://www.wao. org.my/news/20030103knowrghts_polygamy.htm (last visited June 6, 2005). 481. Id. 482. Sean Yoong, Malaysian state promotes itself as polygamist paradise, Human Rights Without Frontiers International, Jan. 3, 2003, http://www.hrwf.net/html/ malaysia_2003.html#Malaysiaatepromoteitselfaspol. 483. Id.

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484. Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 23(1)–(10) (2003) (Malay.). 485. Id. § 23(5). 486. Jacqueline Ann Surin, Muslim wives can make clear about polygamy in marriage contract, The Star, Jan. 17, 2003; Islamic Family Law (Federal Territory) Act 1984, No. 303, § 22(1) (1984) (Malay.); See also Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 26(2) (2003) (Malay.). 487. Malaysian Muslim women told they could include ‘no-polygamy clause,’ The Straits Times, Jan. 19, 2003. 488. Law Reform (Marriage and Divorce) Act 1976, No. 164, § 3(4)(a) (1976) (Malay.). 489. Haw Cheng Sim, Cultural Conceptions of Gender Among the Iban of Sarawak, in Gender, Culture, and Religion: Equal before God, Unequal before Man 76 (Norani Othman & Cecilia Ng eds., 1995). 490. Id. 491. Law Reform (Marriage and Divorce) Act 1976, No. 164, § 107(1)–(4) (1976) (Malay.). 492. Id. § 52. 493. Id. §§ 48(1)(c), 50(1). 494. Id. § 48(1)(a)–(b). 495. Id. § 53. 496. Id. § 50(1). 497. Id. § 54(1)(a)–(d). 498. Id. § 51(1). 499. Id. § 51(3). 500. Id. § 106(1)–(5). 501. Exceptions include cases where the petitioner alleges that he/she has been deserted by the other spouse and does not know his/her whereabouts; the petitioner’s spouse is imprisoned for a term of five years or more; the petitioner alleges that his/her spouse is suffering from an incurable mental illness; or the Court is satisfied that there are exceptional circumstances which make reference to a conciliatory body impracticable. Id. § 106(1)(i)–(vi). 502. Id. § 77(1). 503. Id. § 78. 504. Id. § 82(1)–(2). 505. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 47(1)–(16) (1984) (Malay.). 506. See e.g. Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 47(1)–(17) (2003) (Malay.). 507. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 47(1)–(16) (1984) (Malay.). 508. Id. §§ 47(3)–(4), 49–50, 52. 509. Id. § 50A. 510. Id. § 47(3). “If the other party consents to the divorce and the Court is satisfied after due inquiry and investigation that the marriage has irretrievably broken down, the Court shall advise the husband to pronounce one talaq before the Court.” See also Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 57(1)–(3) (2003) (Malay.). 511. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 47(5) (1984) (Malay.). 512. Id. § 124. 513. Id. § 55A. Talaq pronounced outside the Court is valid if the husband reported to the Court within 7 days, or ascertained as valid according to Islamic law by the Court. Id. § 55A(1)–(3). 514. Id. § 124. 515. Sisters in Islam, Violation of Muslim Women’s Human Rights: Further Discrimination Against Muslim Women Under the Selangor Islamic Family Law Bill 2003 Through Selective Gender Neutral Provisions (2003), http://www.muslimtents.com/sistersinislam/memorandums/29052003.htm. 516. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 49(1)–(4) (1984) (Malay.). The amount of tebus talaq is either agreed upon by both parties or where the parties cannot agree, determined by the Court. Id. § 49(1), (3). Similar provisions are provided for under the Kelantan Islamic Family Law Enactment No. 1 of 1983 in section 36(1)–(3) and the Islamic Family Law (State of Selangor) Enactment 2003 in section 49(1)–(4). 517. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 50(1) (1984) (Malay.). There are similar provisions in state Islamic Family Laws. E.g., Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 50(1) (2003) (Malay.); Islamic Family Law Enactment 1983, Kelantan Enactment No. 1, § 37 (1983) (Malay.). 518. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 50(2) (1984) (Malay.). 519. Ahmad Ibrahim, Family Law in Malaysia and Singapore 219 (1978). 520. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 52(1) (1984) (Malay.). 521. Id. § 52(1)(d)–(i). 522. See Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 53(1) (2003) (Malay.); Islamic Family Law Enactment 1983, Kelantan Enactment No. 1, § 38 (1983) (Malay.). 523. Islamic Family Law (State of Selangor) Enactment 2003, Selangor Enactment No. 2, § 53(1)–(5) (2003) (Malay.); Sisters in Islam,Violation of Muslim Women’s Human Rights: Further Discrimination Against Muslim Women Under the Selangor Islamic Family Law Bill 2003 Through Selective Gender Neutral Provisions (2003), http://www.muslimtents.com/sistersinislam/memorandums/29052003.htm (May 29, 2003). 524. Jonathan Kent, Malaysia Reviews Texting Divorce, BBC News, July 31, 2003, http:// news.bbc.co.uk/2/hi/asia-pacific/3112151.stm.

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525. Kazi Mahmood, SMS Divorce Raises Controversy in Malaysia, Islam Online, Aug. 3, 2003, http://www.islamonline.org/English/News/2003-08/03/article04.shtml. 526. Sisters in Islam, Mandatory Jail Sentence for Divorce Outside the Court, http://www.muslimtents.com/sistersinislam/PressStatements/09082003.htm (Aug. 9, 2003). 527. Section 59(1) of the Islamic Family Law (Federal Territory) Act 1984 empowers the court to order a man to pay maintenance to his wife or former wife. 528. Nik Noraini & Nik Badli Shah, supra note 282, at 266. 529. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 65(1) (1984) (Malay.). See section 65(2) for information about the right to receive a pemberian (present). 530. Id. § 61. 531. Id. § 59(2). Instances of nusyuz as given in the sub-section are: (a) when she withholds her association with her husband; (b) when she leaves her husband’s home against his will; or (c) when she refuses to move with him to another home or place; without any valid reason according to Hukum Syara. 532. Nik Noriani Nik Badli Shah, Marriage and Divorce Under Islamic Law 49 (2001). 533. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 56 (1984) (Malay.). 534. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 17. 535. Law Reform (Marriage and Divorce) Act 1976, No. 164, § 3(4)(a) (1976) (Malay.). 536. Vincent Lyon-Callo, Malaysia and the Orang Asli, http://vms.cc.wmich. edu/~lyoncallov/MALAYSIA.html (last visited June 8, 2005). The Bateks were driven out of the rainforest by massive logging and development in the 1970s and 1980s. Id. 537. Law Reform (Marriage and Divorce) Act 1976, No. 164, § 88(1) (1976) (Malay.). 538. Id. 539. Id § 88(2). 540. Id. § 88(2)(a)–(b). 541. Id. § 88(3). 542. Id. § 88(2)(b). 543. Id. § 89(1)–(2)(a)–(d). 544. Id. § 89(2)(e). 545. Guardianship of Infants Act 1961, No. 351, § 5(1)–(2) (1961) (Malay.), amended by Guardianship of Infants (Amendment) Act 1999, No. A1066 (1999) (Malay.). 546. Islamic Family Law (Federal Territory) Act 1984, No. 303, §§ 88–91 (1984) (Malay.). 547. Islamic Family Law (Federal Territory) Act 1984, §§ 82, 83, 84. 548. Id. § 83(a). 549. Id. § 83(b). 550. Id. § 83(c). A divorced wife may take her own child to her birth-place. 551. Id. § 83(d). 552. Id. § 83(e). 553. Id. § 85. 554. This requirement under the former § 80(2) was abolished from the IFLA in 1994. See Id. § 80(2). 555. Id. § 88(1). A person shall be deemed to be a minor unless he or she has completed the age of 18 for the purposes of guardianship of person and property. Islamic Family Law (Federal Territory) Act 1984, § 88(4). 556. Id. § 91. Section 91 of the Islamic Family Law (Federal Territory) Act 1984 states, “A mother, whether a Muslim or a Kitabiyah, may be validly appointed executrix of the father, and in that case she may exercise her powers as a testamentary guardian or, in the absence of a legal guardian, she may be appointed legal guardian by the Court, but in the absence of such appointment she shall not deal with the minor’s property.” 557. Sisters in Islam, Guardianship Law and Muslim Women 22 (2002). 558. Id. 559. Women’s Aid Organisation, Know Your Rights: Guardianship Act, http://www.wao.org.my/news/20020701knowrghts_guardianship.htm (last visited June 9, 2005). 560. Guardianship of Infants Act 1961, No. 351, § 5(1)–(2) (1961) (Malay.), amended by Guardianship of Infants (Amendment) Act 1999, No. A1066 (1999) (Malay.). 561. Women’s Aid Organisation, Know Your Rights: Guardianship Act, http://www.wao.org.my/news/20020701knowrghts_guardianship.htm (last visited June 9, 2005). 562. Malay. Const. art. 8(2). 563. See CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 437. 564. Id. 565. Distribution Act 1958, No. 300, § 6(1) (1958) (Malay.), amended by Distribution (Amendment) Act 1997, No. A1004, § 3 (1997) (Malay.). 566. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 438. 567. Id. 568. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 58 (1984) (Malay.). See also id. § 2. 569. Mansjur v. Kamariah (1982) 4 JH 73; Communication with Syrin Junisya & Rashidah Abdullah, supra note 434 at 20. 570. Boto v Jaafar (1985) 2 MLJ 98; Communication with Syrin Junisya & Rashidah Abdullah, supra note 434 at 20. 571. Rokiah v Mohd. Idris. (1989) 3 MLJ ix; Communication with Syrin Junisya & Rashidah Abdullah, supra note 434 at 20. 572. Islamic Family Law (Federal Territory) Act 1984, No. 303, § 58(1) (1984) (Malay.). 573. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra

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note 19, para. 440. 574. Id. 575. Id. para. 344. 576. Id. 577. Id. 578. Merete Lie & Ragnhild Lund, Globalisation, Place and Gender 10 n.iii (1999), http://www.skk.uit.no/WW99/papers/Lie_Merete.pdf. 579. United Nations Global Strategy For Shelter To The Year 2000 (GSS), http://www. unhabitat.org/programmes/housingpolicy/gss_monitoring.asp 580. Ministry of Women, Family and Community Development, Malaysia, Statistics on Women, Family and Social Welfare 2004 at 13 (2004). 581. Id. at 10. 582. Id. at 14. 583. Ganambal Mosses & Irene Xavier,Women Workers in Malaysia: A Country Report (1997), http://www.members.tripod.com/~cawhk/9810/9810art02.htm (Nov. 1997). 584. Women’s Aid Organisation, U.N. Conference on Racism, Discrimination, Xenophobia, and Related Intolerance (WCAR),WAO’s Participation at the Asia/Middle East NGO Forum,Teheran, Iran 17–18 February (2001), http://www. wao.org.my/news/20010301wcar.htm (Mar. 1, 2001). Domestic servants are not defined as employees and therefore do not benefit from the Employees Provident Fund Act 1991, and the Employees’ Social Security Act 1969; Honey Tan Lay Ean, supra note 99, § 2.1.3, reprinted in Human Rights Commission of Malaysia (SUHAKAM), Report, Round Table Discussion: Rights and Obligations Under CEDAW annex 6 (2004), http:// www.suhakam.org.my/docs/document_resource/Report_RTD_CEDAW.pdf. 585. Aneeta Kulasegaran,Women’s and Children’s Rights–And the Protection Offered by Domestic Law (1999), http://www.mlj.com.my/articles/Aneeta.htm. 586. CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 206. 587. Employment Act 1955, No. 265, § 34(1) (1995) (Malay). 588. Id. § 35. 589. Id. § 37(1)(a). 590. Id. § 37(2); Ministry of Human Resources, Employment of Women §3, http:// www.mohr.gov.my/mygoveg/makluman/women.htm (last visited June 9, 2005). 591. Employment Act 1955, No. 265, § 37(1)(c) (1995) (Malay). 592. Id. § 40(3). 593. As a result of Beatrice’s case, it would appear that parties may contract out of the Employment Act, e.g. by providing in a Collective Agreement that a female employee may not have children, thereby bypassing the requirement for maternity leave and benefits. Women’s Aid Organization (WAO), Joint Press Statement, Federal Court to decide whether to hear Employment Discrimination Case, Beatrice Fernandez v. Sistem Penerbangan Malaysia & Anor (2005), http://www.wao.org. my/news/20050103mas.htm (June 12, 2005). 594. Eighth Malaysia Plan 2001–2005, supra note 111, § 20.09, at 560. 595. Human Rights Commission of Malaysia (SUHAKAM), Report, Round Table Discussion: Rights and Obligations Under CEDAW § 2.1.3 annex 6 (2004), http:// www.suhakam.org.my/docs/document_resource/Report_RTD_CEDAW.pdf. 596. Employment Act 1955; CEDAW, Combined initial and second periodic reports of States parties: Malaysia, supra note 19, para. 212. 597. YB Dato’ Chua Jui Meng, Speech at the Official Opening of National Seminar on Gender Equality at Work (Aug. 26, 2002) (transcript available at http://www.mohr.gov. my/mygoveg/makluman/spm260.htm). 598. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434 at 33. 599. Id. 600. Immigration Act 1959/63, No. 155, § 8(3)(a)–(o) (1963) (Malay.). The Act bars the right of entry of “prohibited immigrants”; among this category are people with “a contagious or infectious diseases which makes his presence in Malaysia dangerous to the community.” Id. § 8(3)(b). 601. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434 at 33. 602. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 24. 603. Economic and Social Commission for Asia and the Pacific, Report of the Expert Group Meeting on Alleviating the Feminization of Poverty, Bangkok, Apr. 14–16, 1997, at 7 (1997). 604. Identifying characteristics as developed by the International Research and Training Institute for the Advancement of Women (INSTRAW) include (i) simple technology; (ii) very little capital; (iii) no fixed place of business; (iv) quasi-legality or lack of registration; and (v) little record keeping. Lee Lee Loh Ludher, The Greatness Which Might Be Theirs: Women in the Informal Sector in Malaysia, in The Greatness Which Might Be Theirs, ch. 4 (1995), http://www.bic-un.bahai.org/95-0826.4.htm. 605. Lee Lee Loh Ludher, Bahá’í Topics: An Information Resource, Women in the Informal Sector in Malaysia, http://www.bahai.org/article-1-7-6-12.html (last visited June 6, 2005). 606. Gwyn Wansbrough,The Grameen Bank: An Interesting Alternative for Developing Countries, http://ssmu.mcgill.ca/journals/latitudes/2grameen.htm (last visited June 10, 2005). 607. United Nations Educational, Scientific and Cultural Organization & Asia and Pacific Regional Bureau for Education, Final Report of the Regional Workshop on Continuing Education Programmes Focusing on Small-scale Enterprise for Neo-literature through Community Learning Centres 2002, at 52–53 (2002); Amanah Ikhtiar Malaysia, http://aim.gov.my.

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608. Mid-term Review of the Eighth Malaysia Plan 2001–2005, supra note 91, § 12.87, at 409; Grameen Dialogue, AIMing at Single Mothers, Fishermen, Bulletin Board, http://asp.grameen.com/dialogue/dialogue35/Bbd2.html (last visited June 10, 2005). 609. Ministry of Housing and Local Government, Istanbul+5 Special Session of the United Nations General Assembly, New York, 6–8 June 2001, Country Report of Malaysia 35 (2001). 610. Eighth Malaysia Plan 2001–2005, supra note 111, § 12.86, at 409. 611. Id. § 12.87, at 409. 612. Ministry of Women and Family Development, Final Draft, Report of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) § 14.6(i) (2003). 613. Final Draft, Report of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), supra note 612, at 217 § 10.4 614. Final Draft, Report of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), supra note 612, at 218 tbl.10.5. 615. Department of Statistics, Government of Malaysia, Social Statistics Bulletin Malaysia 2001, at 126, 134 (2002). 616. Id. at 126. 617. Id. at 130, 134. 618. Id. at 155 (2002). 619. Eighth Malaysia Plan 2001–2005, supra note 111, § 4.127, at 127. 620. Aminah Ahmad, supra note 438, at 42. 621. Rosnah Mohd.Yusuff & Mohd. Amin Mohd. Soom,Women in Engineering Education and Training: A Cause for Concern?, http://www.eng.upm.edu. my/~feiic/buletin/womenee.html (last visited June 10, 2005). 622. Ganambal Mosses & Irene Xavier,Women Workers in Malaysia: A Country Report (1997), http://www.members.tripod.com/~cawhk/9810/9810art02.htm (Nov. 1997). 623. Final Draft, Report of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), supra note 612, at 222 tbl.10.21; Communication with Syrin Junisya & Rashidah Abdullah, supra note 434 at 38. 624. Malay. Const. art. 12(1). 625. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 5. 626. Education Act 1996, No. 550, § 29A(1) (1996) (Malay.), amended by Education Amendment Act 2002, No. A1152, § 7 (2002) (Malay.); Southeast Asian Ministers of Education Organization (SEAMEO), Malaysia- Education Data, http://www. seameo-innotech.org/resources/seameo_country/educ_data/malaysia.asp (last visited June 10, 2005). 627. Education Act 1996, No. 550, § 29A(4) (1996) (Malay.). 628. Eighth Malaysia Plan 2001–2005, supra note 111, at 87–129. 629. Id. § 4.65, at 111–112. 630. Id. § 4.66, at 112. 631. Id. § 4.68, at 112–113. 632. Id. § 4.69, at 113. 633. Id. § 4.101, at 122 . 634. Id. § 20.30, at 567. 635. Id. § 20.30, at 567. 636. Sharifah Maimunah bt Syed Zin, Seminar Paper: Sexual and Reproductive Health of Young People: Moving From Policies to Programmes, Family Health Education in Malaysian Schools 3 (2002) (presented at the National Youth Seminar on Youth-Friendly Sexual and Reproductive Health Programme – The National Youth Agenda with International Perspectives). 637. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 6. 638. See Mary Huang Soo Lee, Communication and Advocacy Strategies: Adolescent Reproductive and Sexual Health, Case Study: Malaysia 6 (1999). 639. Id. 640. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 6. 641. Id. 642. Id. 643. Evidence Act 1950, No. 56, § 113 (1950) (Malay.). 644. Penal Code, No. 574, § 375(a)–(f) (1997) (Malay.). 645. Id. § 374. This offence carries a maximum sentence of ten years’ imprisonment, fines, or whipping or any combination of two such punishments. Id. 646. Id. The narrow definition of rape under the Penal Code does not encompass other forms of acts of violation such as forced cunnilingus, fellatio and anal penetration. In such cases, the unnatural offences under Sections 377, 377A, 377B, 377C, and 377D of the Penal Code will be applicable. 647. Id. § 375, Exception. 648. Id. § 375, Exceptions 1–2. 649. Id. § 376. 650. Women’s Crisis Centre, Penang, Shame, Secrecy and Silence: Study of Rape in Penang 104 (Rohana Ariffin ed., 1997). 651. Evidence Act 1950, No. 56, § 133A (1950) (Malay.). 652. Women’s Crisis Centre, Penang, supra note 650, at 177. 653. All Women’s Action Society (AWAM),Working Together Towards Better Services For Rape Survivors, Draft Report 12 (1999). 654. Evidence Act 1950, No. 56, § 146A (1950) (Malay.). 655. Press Statement, Women’s Centre for Change (WCC), Penang, Hudud in Terengganu (May 9, 2002), http://www.wccpenang.org/newsrelease2.htm. 656. Women’s Aid Organisation,WAO Statement,Terengganu Hudud Laws (2002),

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http://www.wao.org.my/news/20020601waohudud.htm (June 7, 2002). 657. Subordinate Courts Act 1948, No. 92, § 101 (1948) (Malay.). 658. Penal Code, No. 574, § 376A (1997) (Malay.). 659. Id. § 376B(1). 660. Pe Id. § 376B(2). 661. Id. § 376B, Exception. 662. Sujatani Poosparajah, Cabinet Agrees to Gallows, Long Sentences for Child Rapists, News Straits Times, Jan. 9, 2003, http://www.corpun.com/myj00301.htm. 663. Id. 664. Id. 665. Laws Should Protect As Well As Punish, The Star, Jan. 12, 2003, http://www.corpun. com/myj00301.htm; Tough laws for incest, Smart News Network International, Jan. 9, 2003, http://www.snni.org/cgi-bin/snni2/list_item.cgi?archives/2003_01_10/malaysia/ st1001_1.txt. These amendments will be found in Section 376C of the Penal Code. 666. Syariah Criminal Offences (Federal Territory) Act 1997, No. 559, § 20 (1997) (Malay.). 667. Domestic Violence Act 1994, No. 521 (1994) (Malay.). 668. The court may issue a protection order prohibiting the accused from using domestic violence against the victim. Domestic Violence Act 1994, No. 521, §§ 4(1), 5(1)(a)–(c), 12–13 (1994) (Malay.). 669. An analysis of media coverage of foreign domestic worker abuse has revealed that abuse of foreign domestic workers is a recurring phenomenon in Malaysian society. Women’s Aid Organisation,WAO Research and Advocacy, Foreign Domestic Worker Abuse: The Growing Problem of Foreign Domestic Worker Abuse in Malaysia, http://www.wao.org.my/research/fdw.htm (last visited June 10, 2005). 670. Domestic Violence Act 1994, No. 521 § 3 (1994) (Malay.); Laura Hebert, Monitoring the Domestic Violence Act 1994 Malaysia § 2 (1997). 671. De facto spouse is interpreted as “a person who has gone through a form of ceremony which is recognized as a marriage ceremony according to the religion or custom of the parties concerned, notwithstanding that such ceremony is not registered…” Domestic Violence Act 1994, No. 521 § 2 (1994) (Malay.). 672. An incapacitated adult means a “person who is wholly or partially incapacitated or infirm, by reason of physical or mental disability or ill-health or old age…” Id. 673. Id. 674. For a comprehensive exposition on the limitations of the Domestic Violence Act, see Memorandum prepared by the Women’s Centre For Change, Penang at http://www. wccpenang.org/s_legal_00.htm (last visited June 10, 2005). 675. Criminal Procedure Code (F.M.S. Cap. 6), § 2 (Year) (Malay.). 676. Id. 1st Sched. 677. Domestic Violence Act 1994, No. 521 § 4 (1994) (Malay.). 678. Id. §§ 4(1), 5(1), 12–13. 679. Id. §§ 12–13. 680. The court may include a provision in a protection order prohibiting the person against whom the order is made from inciting “any other person to commit violence against the protected person or persons.” Id. § 5(2). 681. Id. § 6(1)(a)–(f). 682. Id. § 7(1). 683. Id. § 11. 684. Id. § 10(1). 685. Id. § 10(2)(a)–(e). 686. Email from Zarizana Abdul Aziz, Chairperson, Legal Reform Sub-Committee of Women’s Crisis Centre Penang, to Asian-Pacific Resource & Research Centre for Women (general address) (Mar. 8, 1999, 5:44 PM) (on file with the Center for Reproductive Rights). 687. Online Women In Politics,Women’s Human Rights Situation in Malaysia 2, http://www.onlinewomeninpolitics.org/womensit/mly.pdf (last visited June 10, 2005). 688. Penal Code, No. 574, § 509 (1997) (Malay.). 689. Id. § 354. 690. See Forensic Medicine for Medical Students, Burden of Proof, http://www. forensicmed.co.uk/burden_of_proof.htm (last visited June 14, 2005). The meaning of beyond reasonable doubt was discussed in Miller v. Minister of Pensions (1947) 2 All ER 372. Id. 691. High Court Decision 3 CLJ 583 [1998] Malaysian High Court; Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 35. 692. Industrial Court Award No. 606 of 1996 and High Court Decision 3 CLJ 583. In that case, the Complainant made 2 allegations of sexual harassment of her by the Managing Director. The Judge found, inter alia, that not informing her husband of one of the allegations of sexual harassment was an unusual act. Further, the fact that the Complainant took some time before telling someone about the allegations of sexual harassment also worked against her; Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 35. 693. The case is currently pending in the Court of Appeal on an appeal by the claimant. Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 35 n.147. 694. Ministry of Human Resources, Code of Practice on the Prevention and Eradication of Sexual Harassment in the Workplace (1999). 695. Id. art. 4. 696. Id. art. 18. 697. Id. art. 19. 698. Zarizana Abdul Aziz & Cecelia Ng, Combating Sexual Harassment: The Way Forward (2001) (presented at 11th Malaysian Law Conference, Nov. 8–10, 2001, Kuala Lumpur), http://www.wccpenang.org/r_sex_h_05a.htm.

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699. Code of Practice on the Prevention and Eradication of Sexual Harassment in the Workplace, supra note 694, arts. 15, 18. 700. The Joint Action Group Against Violence Against Women (JAG-VAW) is a fluid group of women’s organisations working in coalition nationally on certain issues. On the issue of sexual harassment, the JAG-VAW group consists of Women’s Centre for Change (WCC) (the Chair), Women’s Development Collective (WDC), All Women’s Action Society (AWAM), Women’s Aid Organisation (WAO), Sisters in Islam (SIS), Malaysian Trades Union Congress (Women’s Wing) (MTUC), Persatuan Sahabat Wanita (PSWS) and Women’s Candidacy Initiative (WCI). See Joint Action Group Against Violence Against Women (J.A.G.), A Memorandum on Proposed Sexual Harassment Bill (2001), http://www.wccpenang.org/ir_sex_har_memo_02.htm (March 30, 2001) (presented to Yang Berhormat Dr. Haji Abdul Latiff Ahmad, Deputy Minister of Human Resources). 701. Joint Action Group Against Violence Against Women (J.A.G), supra note 700. 702. Penal Code, No. 574, § 372B (1997) (Malay.). 703. Syariah Criminal Offences (Federal Territory) Act 1997, No. 559, § 21(1) (1997) (Malay.). 704. Id. 705. Id. § 21(1)–(2). 706. Malay. Const. art. 6(1). 707. Id. art. 6(2). Except compulsory service for national purposes prescribed by federal law which is never invoked. 708. Penal Code, No. 574, §§ 370–371 (1997) (Malay.). 709. Id. § 372. 710. Id. § 372A. 711. Id. § 373. 712. Id. § 374. 713. Immigration Act 1959/63, No. 155. (1963) (Malay.). 714. Restricted Residence Act 1933, No. 377, § 2 (1933) (Malay.). If the Minister, on the basis of written information and an inquiry, is satisfied that reasonable grounds exist for it, the Minister can issue an order directing a person to reside within a specified area for a fixed term. Under § 2A, the person may also be subjected to police supervision for up to five years. 715. U.S. Department of State, Country Reports on Human Rights Practices 2002: Malaysia (2003), http://www.state.gov/g/drl/rls/hrrpt/2002/18252.htm (Mar. 31, 2003). 716. Human Rights Watch, Human Rights News, Malaysia: Mass Expulsion Puts Migrants at Risk (2004), http://hrw.org/english/docs/2004/11/19/malays9704.htm (Nov. 23, 2004). 717. Immigration (Amendment) Act 2002, No. 1154 (2002) (Malay.). 718. Id. at 6(3). 719. Human Rights News, Malaysia: Mass Expulsion Puts Migrants at Risk, supra note 716. 720. Asian-African Legal Consultative Organization (AALCO), Summary Records of the Fifth General Meeting, Held on Thursday, 18 July 2002, at 3:00 p.m., http://www.aalco.org/summary_records_of_the_fifth_general%20meeting.htm. 721. Id. 722. Roziah Omar,The Malay Woman in the Body: Between Biology and Culture 23 (1994). 723. Id. 724. For a critique of the Child Act 2001, see “A Memorandum on Child Bill 2000.” Women’s Crisis Centre, A Memorandum on Child Bill 2000 (2000), http://www. wccpenang.org/ir_child_bill_memo.htm (Oct. 6, 2000). A few of the recommendations have been incorporated, but not all. 725. Child Act 2001, No. 611, § 43(1)(a)–(j), (2) (2001) (Malay.). 726. Id. § 43(1)(aa) (for offences under subsections (a) to (h) and (k)). 727. Id. § 43(1)(bb) (for offences under subsections (i) and (j)). 728. Id. § 43(2)(b) (for offences under subsections (1)(i) and (j)). 729. Id. § 48(1)–(3). 730. Id. § 48(1)–(2). 731. Id. § 48(4)(a)–(b). 732. Laws of Malaysia: Child Act 2001 (Act 611), § 2(1); Communication with Syrin Junisya & Rashidah Abdullah, supra note 434, at 7. 733. Child Act 2001, No. 611, § 38(a)–(c) (2001) (Malay.). 734. Id. § 38(c). Other circumstances exist if the child is “being induced to perform any sexual act, or is in any physical or social environment which may lead to the performance of such act” and if the child “lives in or frequents any brothel or place of assignation.” Id. § 38(a)–(b). 735. Id. § 39 (1). 736. Id. § 39(4). “If the Court For Children is not satisfied that a child brought before it is in need of protection and rehabilitation, the Court For Children shall order the child to be returned to the care and custody of his parent or guardian.” Id. § 39(5). 737. Id. § 21(2). 738. Id. § 21(1)–(2).

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WOMEN OF THE WORLD:

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

3. Philippines Statistics GENERAL

Population ■

Total population (millions): 83.1.1

■

Population by sex (thousands): 40,418.2 (female) and 40,990.0 (male).2

■

Percentage of population aged 0–14: 36.5.3

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Percentage of population aged 15–24: 20.3.4

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Percentage of population in rural areas: 39.5

Economy ■

Annual percentage growth of gross domestic product (GDP): 3.5.6

■

Gross national income per capita: USD 1,080.7

■

Government expenditure on health: 1.5% of GDP.8

■ ■

Government expenditure on education: 2.9% of GDP.9 Percentage of population below the poverty line: 37.10

WOMEN’S STATUS ■ ■ ■ ■ ■ ■ ■ ■ ■

Life expectancy: 73.1 (female) and 68.8 (male).11 Average age at marriage: 23.8 (female) and 26.3 (male).12 Labor force participation: 54.8 (female) and 84.3 (male).13 Percentage of employed women in agricultural labor force: Information unavailable. Percentage of women among administrative and managerial workers: 58.14 Literacy rate among population aged 15 and older: 96% (female) and 96% (male).15 Percentage of female-headed households: 11.16 Percentage of seats held by women in national government: 18.17 Percentage of parliamentary seats occupied by women: 15.18

CONTRACEPTION ■ ■ ■ ■

Total fertility rate: 3.03.19 Contraceptive prevalence rate among married women aged 15–49: 49% (any method) and 33% (modern method).20 Prevalence of sterilization among couples: 10.4% (total); 10.3% (female); 0.1% (male).21 Sterilization as a percentage of overall contraceptive prevalence: 22.4.22

MATERNAL HEALTH ■ ■ ■ ■

Lifetime risk of maternal death: 1 in 90 women.23 Maternal mortality ratio per 100,000 live births: 200.24 Percentage of pregnant women with anemia: 50.25 Percentage of births monitored by trained attendants: 60.26

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WOMEN OF THE WORLD:

ABORTION ■ ■ ■ ■

■

Total number of abortions per year: Information unavailable. Annual number of hospitalizations for abortion-related complications: Information unavailable. Rate of abortion per 1,000 women aged 15–44: Information unavailable. Breakdown by age of women obtaining abortions: 2.0% (under 20); 24.2% (age 20–24); 27.3% (age 25–29); 30.3% (age 30–34); 16.2% (age 35 and older).27 Percentage of abortions that are obtained by married women: 91.0.28

SEXUALLY TRANSMISSIBLE INFECTIONS (STIS) AND HIV/AIDS ■ ■ ■ ■

Number of people living with sexually transmissible infections: Information unavailable. Number of people living with HIV/AIDS: 9,000.29 Percentage of people aged 15–49 living with HIV/AIDS: <0.1 (female) and <0.1(male).30 Estimated number of deaths due to AIDS: <500.31

CHILDREN AND ADOLESCENTS ■ ■ ■ ■ ■ ■

■ ■

Infant mortality rate per 1,000 live births: 26.32 Under five mortality rate per 1,000 live births: 30 (female) and 40 (male).33 Gross primary school enrollment ratio: 112% (female) and 113% (male).34 Primary school completion rate: 80 (female) and 72 (male).35 Number of births per 1,000 women aged 15–19: 38.36 Contraceptive prevalence rates among married female adolescents: 11.4% (modern methods); 10.4% (traditional methods); 21.8% (any method).37 Percentage of abortions that are obtained by women younger than age 20: 2.0.38 Number of children under the age of 15 living with HIV/AIDS: Information unavailable.

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ENDNOTES 1. See United Nations Population Fund (UNFPA),The State of World Population 2005, at 112 (estimate for 2005). 2. See United Nations Population Fund (UNFPA), Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003 (2003), http://www.unfpa.org/profile/default.cfm. [hereinafter UNFPA, Country Profiles]. 3. See The World Bank,World Development Indicators 2004, at 39 (2004), http:// www.worldbank.org/data/ (estimate for 2002). [hereinafter The World Bank]. 4. See UNFPA, Country Profiles, supra note 2. 5. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimate for 2003). 6. See The World Bank, supra note 3, at 183. (estimate for 1990-2002). 7. See The World Bank,World Development Indicators 2004: Data Query (2004), http://devdata.worldbank.org/data-query/ (statistical figure obtained through the Atlas method) (estimate for 2003). 8. See UNFPA,The State of World Population 2005, supra note 1, at 112. 9. See United Nations CyberSchoolBus, InfoNation: Government Education Expenditure (2004), http://www.un.org/Pubs/CyberSchoolBus/infonation/e_ infonation.htm (estimate for 1997). 10. See The World Bank, Country At A Glance Tables For Philippines 2004, at 1 (2004), http://www.worldbank.org/data/countrydata/countrydata.html. 11. See UNFPA,The State of World Population 2005, supra note 1, at 108. 12. See UNFPA, Country Profiles, supra note 2. 13. See Id. 14. See Social and Demographic Statistics Branch, United Nations Statistics Division,The World’s Women 2000:Trends and Statistics (2000) (estimate for 2001). 15. See UNFPA, Country Profiles, supra note 2. 16. See Social and Demographic Statistics Branch, supra note 14, at 48.(estimate for 1991-1997). 17. See Save the Children, State of World’s Mothers 2004, at 37 (2004), http:// www.savethechildren.org/mothers/report_2004/images/pdf/SOWM_2004_final.pdf (estimate for 2004). 18. See United Nations Statistics Division, Millennium Indicators Database (2005), http://unstats.un.org/unsd/mi/mi_series_results.asp?rowId=557 (last updated Mar. 16, 2005) (estimate for 2005). 19. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimate for 2000-2005). 20. See Id. at 108. 21. See Engenderhealth, Contraceptive Sterilization: Global Issues and Trends, tbl. 2.2, at 47 (2002) (estimates for 1998). 22. See Id. at tbl. Supp. 2.5, at 56 (estimate for 1998). 23. See World Health Organization et al., Maternal Mortality in 1995: Estimates Developed by WHO, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) 45 (2000) (estimate for 1995). 24. See UNFPA,The State of World Population 2005, supra note 1, at 108. 25. See Save the Children, supra note 17, at 37 (estimate for 1989-2000). 26. See UNFPA,The State of World Population 2005, supra note 1, at 112. 27. See Akinrinola Bankole et al., Characteristics of Women who Obtain Induced Abortion: A Worldwide Review, 25 Int’l Fam. Planning Persp. 68–77 (1999), http://www. guttmacher.org/pubs/journals/2506899.html (statistical figures obtained through ad hoc surveys and hospital records) (estimates for 1993). 28. See Id. 29. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., UNAIDS/World Health Organization (WHO) Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 Update: Philippines 3 (2004), http://www.who.int/GlobalAtlas/PDFFactory/HIV/EFS_PDFs/EFS2004_ PH.pdf (estimates for 2003). 30. See UNFPA,The State of World Population 2005, supra note 1, at 108. 31. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., supra note 29. 32. See UNFPA,The State of World Population 2005, supra note 1, at 108. 33. See UNFPA, Country Profiles, supra note 2. 34. See UNFPA,The State of World Population 2005, supra note 1, at 108. The ratio may be more than 100 because the figures remain uncorrected for individuals who are older than the level-appropriate age due to late starts, interrupted schooling or grade repetition. 35. See Id. 36. See Id. 37. See Saroj Pachauri & K.G. Santhya, Reproductive Choices for Asian Adolescents: A Focus on Contraceptive Behavior, 28 Int’l Fam. Planning Persp. 186–195 (2002), http://www. agi-usa.org/pubs/journals/2818602.html (estimates are for 1998). 38. See Bankole et al., supra note 27.

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T

he Republic of the Philippines is an archipelago between the Philippine Sea and the South China Sea, east of Vietnam.1 The Philippines was colonized by the Spanish in 1521, and their rule lasted for almost four hundred years;2 during that time, there was a significant conversion to Roman Catholicism.3 On May 1, 1898, the Americans defeated the Spanish in Manila Bay during the Spanish-American War,4 and Filipinos, led by Emilio Aguinaldo, declared independence from Spain shortly after the defeat.5 On December 10, 1898, Spain ceded the Philippines to the United States, which began to occupy the country under the Treaty of Paris.6 The U.S. occupation continued until May 1942, when the Japanese seized control of the island from U.S. forces. The Japanese occupation lasted until September 1945, when Japanese forces finally surrendered to the United States.7 Less than a year later, on July 4, 1946, the Philippines gained its independence from the United States.8 After independence, the Philippines received assistance from the United States for postwar reconstruction.9 Successive Philippine government administrations focused on strengthening ties to neighboring Asian countries and diversifying the economy.10 In 1965, President Ferdinand E. Marcos came to power, and by 1972 he had declared martial law, citing communist insurrection as his justification.11 Marcos suppressed democratic institutions and restricted civil liberties, primarily ruling by decree and popular referenda.12 The corruption in the Marcos regime plunged the country into poverty, transforming it from one of Asia’s wealthiest countries into one of its poorest.13 The assassination of opposition leader Benigno (Ninoy) Aquino in 1983 led to a chain of events that resulted in a presidential election in February 1986, with Aquino’s widow, Corazon Aquino, running as the opposition candidate.14 Marcos’s 21-year rule ended that year when the EDSA15 Revolution (also known as “People Power”) forced him into exile;16 Corazon Aquino was installed as president on February 25, 1986.17 Aquino ruled for six years until 1992, when Fidel Ramos was elected president.18 Ramos declared “national reconciliation” to be his highest priority.19 He legalized the communist party and granted amnesty for all rebel groups.20 In 1998, Joseph Ejercito Estrada was elected president21 with overwhelming popular support for his promise to alleviate poverty and crack down on crime.22 However, allegations of corruption led to impeachment proceedings and a rebellion in the form of the EDSA Revolution II (or “People Power II”).23 In January 2001, the country’s Supreme Court declared Estrada unable to rule in light of mass resignations from the government, and administered the oath of office to Vice President Gloria Macapagal-Arroyo as the constitutional

WOMEN OF THE WORLD:

successor.24 Gloria Macapagal-Arroyo was elected to a second term in 2004. Some of the major challenges confronting the Philippine government today include internal security threats from various groups within the country, such as Muslim and communist insurgency groups.25 In 2004, the total population was estimated to be 81.4 million,26 approximately 49.6% of whom are female.27 The national language of the Philippines is the Tagalog dialect of Pilipino; Tagalog and English are the country’s two official languages.28 Eight major dialects of Pilipino (out of 87 native languages and dialects) are the first languages of more than 85% of the population.29 The ethnic composition of the Philippines consists of Christian Malay (91.5%), Muslim Malay (4%), Chinese (1.5%), and other (3%).30 Indigenous cultural communities and peoples, which constitute about 16% of the population, live throughout the country but primarily in the regions of Cordillera and Mindanao.31 The majority of the Philippine population is Roman Catholic (83%), while the rest is Protestant (9%), Muslim (5%), and Buddhist and other (3%).32 The Philippines has been a member of the United Nations since 1945.33 It is also a member of the Association of Southeast Asian Nations,34 Asia-Pacific Economic Cooperation,35 and the Non-Aligned Movement.36

I. Setting the Stage: The Legal and Political Framework of the Philippines Fundamental rights are rooted in a nation’s legal and political framework, as established by its constitution. The principles and goals enshrined in a constitution, along with the processes it prescribes for advancing them, determine the extent to which these basic rights are enjoyed and protected. A constitution that upholds equality, liberty, and social justice can provide a sound basis for the realization of women’s human rights, including their reproductive rights. Likewise, a political system committed to democracy and the rule of law is critical to establishing an environment for advancing these rights. The following section outlines important aspects of the Philippines’s legal and political framework. A. THE STRUCTURE OF NATIONAL GOVERNMENT

The Constitution of the Republic of the Philippines was ratified by a national plebiscite on February 2, 1987, and entered into force on February 11, 1987.37 It establishes a democratic and republican state with a sovereign people from whom all

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government authority emanates, including the power of the executive, legislative, and judicial branches of government.38 The constitution provides for a presidential system of national government with a bicameral legislature and an independent judiciary.39 Executive branch The executive branch of the national government is headed by the president, who is chief of state, head of government,40 and commander in chief of the armed forces.41 The president nominates and, with the approval of the Commission on Appointments,42 selects the heads of the various executive departments.43 He or she has control over all executive departments, bureaus, and offices.44 The president is elected by direct vote of the people for a six-year term without the possibility of reelection.45 The constitution also provides for a vice president and a cabinet appointed by the president with the approval of the Commission on Appointments.46 The vice president is elected by popular vote for a six-year term for no more than two successive terms.47 He or she may be appointed as a member of the cabinet without needing confirmation by the Commission on Appointments.48 In case of the president’s death, permanent disability, removal from office, or resignation, the vice president shall become president and serve the remaining term.49 The president and the vice president may be impeached from office on grounds that include treason, bribery, corruption, or betrayal of the public trust.50 A two-thirds vote of all the members of the Senate is necessary for impeachment.51 Legislative branch Legislative power in the national government rests with a bicameral Congress consisting of the Senate and the House of Representatives,52 and with the people by initiatives and referenda.53 The Senate consists of 24 elected members who serve six-year terms.54 One-half of the membership is elected every three years.55 The House of Representatives is composed of not more than 250 members, most of whom are elected from the legislative districts in the provinces, cities, and the metropolitan Manila area that are established in proportion to the size of their respective populations.56 Twenty percent of the members are elected through a party-list system of registered national, regional, and sectoral parties and organizations.57 All representatives serve three-year terms.58 Most bills may originate in either house.59 Exceptions apply to appropriation bills and revenue or tariff bills; bills authorizing an increase in the public debt; bills of local application; and private bills, which must originate in the House of Representatives.60 A bill may be passed into law by either the House of Representatives or the Senate after it has passed

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three readings on separate days, and has been approved by the president.61 If the president takes no action on the bill for 30 days, it is automatically approved and becomes law.62 If the president vetoes the bill, it returns to the house that originally passed it and is reconsidered.63 A two-thirds vote to pass the bill by both houses is then required for the bill to become law.64 The people can enact laws, or approve or reject laws passed by Congress or local legislative bodies, with a petition signed by at least 10% of all registered voters (of whom at least 3% are represented in every legislative district).65 The constitution may be amended or revised upon proposal by a three-fourths vote of all the members of Congress66 or by a constitutional convention,67 and then ratified by a majority of the votes cast in a plebiscite.68 The constitution may also be amended through the initiative of a petition of at least 12% of all registered voters (of whom at least 3% are represented in every legislative district),69 and then ratified by a majority of the votes cast in a plebiscite.70 Judicial branch The judiciary has common law powers of equity and tends to recognize judicial precedent.71 The 1981 Judicial Reorganization Act sets out four main levels of courts and provides for special courts.72 At the top is the Supreme Court, below which is the Court of Appeals, then 13 regional trial courts,73 and finally, at the local level, metropolitan trial courts, municipal trial courts, and municipal circuit trial courts.74 Special courts include the Court of Tax Appeals and the Sandiganbayan (a high-ranking court that hears cases of government officials charged with graft and corruption).75 The Supreme Court, which is headed by a chief justice and consists of 14 associate justices,76 is the highest court of appeal in all civil and criminal matters. It has original and appellate jurisdiction in all cases involving questions about the constitutionality of any treaty, law, presidential decree, proclamation, order, or regulation; it also has appellate jurisdiction in cases involving a sentence of life imprisonment.77 Members of the Supreme Court and judges of the lower courts are appointed by the president upon recommendation by the Judicial and Bar Council78 and serve until 70 years of age.79 The Supreme Court has the power to discipline judges of lower courts or order their dismissal.80 The Court of Appeals consists of a presiding justice and 50 associate justices who are appointed by the president.81 It hears appeals from the regional trial courts and quasi-judicial agencies, instrumentalities, boards, and commissions (e.g., the Civil Service Commission and the National Labor Relations Commission).82 The regional trial courts83 hear appeals from the met-

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ropolitan trial courts, municipal trial courts, and municipal circuit trial courts,84 and have exclusive original jurisdiction over all actions involving marriage, marital relations,85 children and family cases under the 1997 Family Courts Act, and other serious offenses.86 Metropolitan trial courts, municipal trial courts, and municipal circuit trial courts87 have exclusive original jurisdiction over criminal and civil cases of a less serious nature.88 Every municipality in the Philippines has its own municipal trial court.89 In cases reaching the courts from barangays (villages), a prior attempt to amicably settle the dispute is a precondition for formally filing a complaint with a court or government office, with some exceptions.90 Failure to comply with this prerequisite may result in the dismissal of the case.91 The Court of Tax Appeals is a special court with exclusive appellate jurisdiction over appeals from the Commissioner of Internal Revenue and the Commissioner of Customs on certain specific issues.92 The Sandiganbayan is another special court with jurisdiction over criminal and civil cases involving graft and corruption by public officers and employees in the performance of their duties.93 In addition to these special courts, the Code of Muslim Personal Laws of the Philippines provides for Sharia district courts and Sharia circuit courts, which exist in the Autonomous Region of Muslim Mindanao (where the Code of Muslim Personal Laws is enforced) and are applicable only to Muslims.94 Sharia circuit courts are equivalent in rank to municipal circuit trial courts.95 Appeals from the Sharia circuit courts are heard by Sharia district courts, which are equivalent in rank to regional trial courts.96 Sharia courts have jurisdiction over the subject matter within the Code of Muslim Personal Laws, which includes matters relating to marriage, divorce, family, and property.97 The Autonomous Region in Muslim Mindanao also has a Sharia appellate court, which was created under Republic Act No. 6734 of 1989, entitled Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao.98 The Sharia appellate court has jurisdiction over cases involving personal, family, and property relations, and exercises appellate jurisdiction over all cases tried in Sharia district courts.99 It is equivalent to the Court of Appeals, and cases tried in the Sharia appellate court may be appealed to the Supreme Court.100 Republic Acts Nos. 6734 and 6766 also create systems of tribal courts for the indigenous cultural communities in the Autonomous Region in Muslim Mindanao and the Cordillera Autonomous Region, respectively.101 These courts have jurisdiction over personal, family, and property rights in accordance with the tribal codes of the indigenous cultural

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communities within the autonomous region.102 The provisions of the Muslim Code of Personal Laws and the tribal codes apply only to Muslims and indigenous communities, respectively.103 In cases of conflict between the Muslim or tribal codes and national law, the latter prevails.104 Alternative forms of dispute resolution Presidential Decree No. 1508 of 1978, otherwise known as the Katarungagn Pambarangay Law, institutionalized a system of amicable, informal dispute settlement at the barangay level without judicial intervention.105 Lawyers are excluded from the entire process.106 The vast majority of disputes are subject to proceedings for amicable settlement, with some exceptions.107 This is the only system that is formally accepted and practiced in all barangays in the Philippines.108 The Punong Barangay (village chief or barangay chairman) is an elected official who heads the system.109 He or she is assisted by the Lupong Tagapamayapa (Peace Seeking Committee), which is composed of ten to twenty persons who are appointed by the Punong Barangay.110 The Punong Barangay serves as the chairperson of the committee.111 The parties to the dispute choose, by agreement, a Pangkat Ng Tagapagsunod (conciliators panel) composed of three members from among the Lupong membership.112 If the parties cannot agree on the makeup of the panel, the Punong Barangay selects the conciliators panel by lottery.113 In addition to this system of dispute settlement, other dispute resolution mechanisms such as mediation are also available.114 In 2004, the government enacted the Alternative Dispute Resolution Act, which aims to “actively promote party autonomy in the resolution of disputes” and “the freedom of the party to make their own arrangements to resolve their disputes.”115 The act establishes procedures for mediation and other alternative dispute mechanisms, including international commercial arbitration. Indigenous cultural communities and indigenous peoples who are not included in the jurisdictions of the Autonomous Region in Muslim Mindanao and the Cordillera Administrative Region have the right to use their own commonly accepted justice and conflict resolution institutions that are compatible with the national legal system and internationally recognized human rights.116 B. THE STRUCTURE OF LOCAL GOVERNMENTS

The Philippines is divided into 17 regions,117 79 provinces, 117 chartered cities, approximately 1,500 municipalities, and 42,000 barangays.118 With the exception of the Muslim parts of Mindanao, which officially became an autonomous region in 1990, regions are administrative subdivisions, which are composed of provinces119 that are generally grouped on the

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basis of similar cultural and ethnological characteristics.120 Provinces are the primary political subdivisions.121 Local governing bodies are established from the provincial level down.122 Chartered cities are independent of provinces;123 they do not pay provincial taxes, but have the power to levy taxes.124 Municipalities are subordinate to provinces,125 and barangays and rural villages are at the lowest level. Provinces have a governor and a vice-governor.126 The governor is the chief executive of the province.127 Chartered cities are headed by a mayor, who is aided by a vice-mayor.128 Municipalities are headed by a municipal mayor, who is aided by a municipal vice-mayor.129 Barangays are headed by a chairperson, who is aided by seven members, a secretary, and a treasurer.130 Provinces, cities, municipalities, and barangays have their own legislative bodies.131 The provincial, city, and municipal legislative bodies consist of their respective vice-governors, vice-mayors, regular members, president of the leagues, president of the federation of youth chairpersons, and sectoral representatives.132 The law provides that the membership of these bodies should also include three other sectoral representatives, including one female representative.133 The barangay is the primary unit for planning and implementing government policies, programs, plans, and projects within the community.134 It also acts as a forum where people can express their collective views, and where disputes can be amicably settled.135 There is a Sangguniang Kabataan (youth legislative body) in every barangay,136 which is headed by the Sangguniang Kabataan Chairperson (Youth Legislative Chairperson) who serves as an ex officio member of the Sangguniang Barangay (the barangay legislative body).137 Barangay officials and members of the Sangguniang Kabataan serve five-year terms and no more than three consecutive terms in the same position.138 As at the national level, there are mechanisms of recall, voter initiatives, and referenda for each of the governmental bodies described above.139 Each local government unit (LGU) has the power to create its own sources of revenues and to levy taxes, fees, and charges.140 The constitution mandates the autonomy of local governments,141 but also states that the president exercises general supervision over local governments.142 In the Autonomous Region in Muslim Mindanao, regional government powers are exercised through the regional governor, the Regional Assembly, and special courts.143 Executive power is vested in a regional governor, who is elected by direct vote by the people in the autonomous region144 and serves a three-year term for a maximum of two consecutive terms.145 Subject to confirmation by the Regional Assem-

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bly, the regional governor appoints members to a nine-person cabinet, at least four of whom should come from indigenous cultural communities.146 The regional governor also appoints the cabinet members’ deputies, and the heads and members of regional government commissions and bureaus.147 The regional governor is assisted by a vice-governor, who may be appointed as a member of the regional cabinet without confirmation by the Regional Assembly.148 The regional governor has control over all regional executive commissions, boards, bureaus, and offices, subject to certain exceptions.149 He or she also exercises general supervision over the LGUs within the autonomous region.150 Legislative power is vested in the Regional Assembly, except to the extent reserved for the people by provisions on initiatives and referenda, as provided by law.151 The Regional Assembly is composed of members elected by popular vote, with three members elected from each of the region’s congressional districts.152 The members of the Regional Assembly serve threeyear terms for a maximum of three consecutive terms.153 Directly or through the regional governor, the Philippine president exercises general supervision over the regional government, including the LGUs therein, to ensure that national and regional laws are faithfully executed.154 The preservation of peace and order is the responsibility of the local police agencies, while defense and security are the responsibility of the national government.155 There are indigenous cultural communities and peoples not included in the jurisdictions of the Autonomous Region of Muslim Mindanao and the Cordillera Administrative Region;156 these encompass many tribal groups that have indigenous political structures such as, inter alia, the Council of Elders, the Council of Timuays, Bodong Holder,157 and tribal barangays.158 C. THE ROLE OF CIVIL SOCIETY AND NONGOVERNMENTAL ORGANIZATIONS (NGOS)

Since 1986, NGOs in the Philippines have flourished.159 According to some reports, there are as many as 500,000 registered NGOs in the country.160 The constitution’s Declaration of Principles and State Policies provides that the state “shall encourage non-governmental, community-based, or sectoral organizations that promote the welfare of the nation.”161 The 1992 Local Government Code requires the inclusion of NGOs in decision-making processes at the local level.162 The Philippine Council for NGO Certification provides accreditation to NGOs applying for donee institution status if they meet the minimum standards for certification.163 NGOs certified by the council may then receive donee institution status by the Bureau of Internal Revenue.164

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D. SOURCES OF LAW AND POLICY

Domestic sources The Philippine legal system is based on Spanish and AngloAmerican law, and is a mix of the civil and common law tradition.165 Domestic sources of Philippine law are the constitution, enactments by Congress, presidential decrees, and executive orders. Other forms of legislation, such as circulars, rules, and regulations under legislative or constitutional authority, are also an important source of domestic law. The 1987 Constitution of the Republic of the Philippines, specifically its Bill of Rights article, draws heavily from the U.S. model.166 The Bill of Rights guarantees 22 fundamental rights, including equal protection of the laws; freedom of religion; and free access to the judiciary and adequate legal assistance for those in need.167 The constitution also contains an article on Social Justice and Human Rights, which mandates Congress “[to] give highest priority to the enactment of measures that protect and enhance the right of all people to human dignity, reduce social, economic and political inequalities, and remove cultural inequities by equitably diffusing wealth and political power for the common good.”168 The article includes specific rights and state mandates in the areas of labor; agrarian and natural resources reform; urban land reform and housing; health; women; the role and rights of people’s organizations; and human rights.169 The constitution also includes an article on the family, which affords several rights within the family sphere, and an article titled Declaration of Principles and State Policies, which contains 28 principles and policies that provide guidance to the government in performing its functions.170 The inviolability of the separation of church and state is established as an important principle.171 The constitution also provides that “[the state] shall equally protect the life of the mother and the life of the unborn from conception.”172 As state policy, the constitution provides that the state recognizes and promotes the rights of indigenous cultural communities within the framework of national unity and development.173 The domestic legal framework is also established by several codifications of law, including the 1930 Revised Penal Code, the 1949 Civil Code, the 1974 Labor Code, the 1974 Child and Youth Welfare Code, and the 1987 Family Code.174 Customary laws are followed by some indigenous groups and by Muslims.175 While many of these laws remain unwritten, Muslim personal laws were codified into the Code of Muslim Personal Laws by Presidential Decree No. 1083 in 1977. This code contains provisions on, inter alia, family relations, the legal capacity of persons to act and restrictions on such capacity,176 the creation of Sharia courts as part of the judicial system,177 and penal provisions.178 In addition, the

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rights of indigenous peoples and indigenous cultural communities are enshrined in the 1997 Indigenous Peoples Rights Act, which recognizes, protects, and promotes such individuals’ rights to social justice, self-determination, empowerment, cultural identity, and ancestral domain.179 Government policies are formulated within the broad framework of the constitution and its Declaration of Principles and State Policies, which include full respect for human rights,180 adequate social services, an improved quality of life for all,181 and the promotion of social justice.182 Successive medium-term development plans provide comprehensive national policy frameworks for the country’s socioeconomic and development goals. The Medium-Term Philippine Development Plan 2004–2010 is currently operative.183 The plan contains detailed targets and strategies within five broad topic areas: economic growth and job creation; energy; social justice and basic needs; education and youth opportunity; and anticorruption and good governance.184 International sources The constitution authorizes the president to sign treaties and international agreements. Such agreements become effective when ratified by at least two-thirds of all the members of the Senate.185 The constitution’s Declaration of Principles and State Policies notes that the Philippines “adopts the generally accepted principles of international law as part of the law of the land and adheres to the policy of peace, equality, justice, freedom, cooperation, and amity with all nations.”186 The Philippines has ratified the following international treaties: the Convention on the Elimination of All Forms of Discrimination against Women and its Optional Protocol;187 the Convention on the Rights of the Child188 and the Optional Protocols on the involvement of children in armed conflict,189 and on the sale of children, child prostitution, and child pornography;190 the International Convention on the Elimination of All Forms of Racial Discrimination;191 the International Covenant on Civil and Political Rights192 and its Optional Protocol;193 the International Covenant on Economic, Social and Cultural Rights;194 the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment;195 and the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families.196 International consensus documents that the government has adopted include the 1993 Vienna Declaration and Programme of Action; the 1994 International Conference on Population and Development (ICPD) Programme of Action; the 1995 Beijing Declaration and Platform for Action; and the 2000 United Nations Millennium Declaration.197

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II. Examining Reproductive Health and Rights In general, reproductive health matters are addressed through a variety of complementary, and sometimes contradictory, laws and policies. The scope and nature of such laws and policies reflect a government’s commitment to advancing the reproductive health status and rights of its citizens. The following sections highlight key legal and policy provisions that together determine the reproductive rights and choices of women and girls in the Philippines. A. GENERAL HEALTH LAWS AND POLICIES

The Philippine Constitution declares as state policy that “[t]he State shall protect and promote the right to health of the people and instill health consciousness among them.”198 It also mandates the state to “provide adequate social services”199 and “adopt an integrated and comprehensive approach to health development which shall … make essential goods, health and other social services available to all the people at affordable cost.”200 The government’s current objectives and strategies for promoting and improving health are articulated in the Medium-Term Philippine Development Plan 2004–2010; the National Objectives for Health 1999–2004; and the Health Sector Reform Agenda, which was launched in 1999.201 Objectives The Medium-Term Philippine Development Plan 2004–2010 contains the broad policy goal of improving the “accessibility and affordability of essential services,” including health-related services.202 Its specific health objectives include the following: ■ improve the accessibility, affordability, and quality of health care; ■ reduce costs of medicine by 50%; and ■ achieve a health insurance coverage rate of 85% by 2010.203 The National Objectives for Health 1999–2004 is a specific health-sector policy formulated by the Department of Health in light of the major challenges to health posed by the poor economic status204 of almost half the population,205 limited access to health-care services due to a weak hospital system, insufficient mechanisms for providing public health programs, uneven distribution of health and human resources, and inequitable health-care financing.206 These objectives fall under the two broad categories of disease prevention and control, and health promotion and

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protection. The objectives include, among others, the following: ■ reducing morbidity, mortality, disability, and complications from tuberculosis, pneumonias, diarrheas, dengue, sexually transmissible infections (STIs), including HIV/AIDS, and reproductive tract infections (RTIs);207 ■ lowering morbidity and mortality associated with cardiovascular diseases,208 cancer,209 diabetes,210 kidney diseases,211 asthma,212 osteoporosis,213 mental disorders,214 and diet and nutritional disorders;215 ■ providing an “Essential Health Care Package” throughout the life cycle to ensure the well-being of the family;216 ■ addressing the health issues of “special groups,” including children in need of protection, women in difficult circumstances, migrant workers, persons with disabilities, the rural and urban poor, and indigenous persons;217 ■ determining the health risks of unsanitary conditions and practices in homes, schools, workplaces, and the environment;218 and ■ promoting healthy attitudes and practices by individuals, families, communities, and business and industry.219 (See subsections within “Reproductive Health Laws and Policies” for information on more specific reproductive health-related objectives. Also see “Rape” and “Domestic violence” for objectives related to reducing violence against women.) The policy’s primary strategies for carrying out these objectives include the following: ■ increasing financial investments for primary health care; 220 ■ developing national standards for planning and implementing local health programs;221 ■ assuring the quality of health care; 222 ■ developing functional, local health systems to carry out public health programs and deliver personal health-care services;223 and ■ supporting health workers by harnessing multisectoral support for a frontline health worker development program in primary health care.224 (See “Infrastructure of health-care services” for more detailed information on strategies relating to local health systems development.) The Department of Health also formulated the Health Sector Reform Agenda in 1999, which calls for reforms in the following four areas:

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health service delivery—by integrating public health care into the hospital system, upgrading infrastructure, expanding hospital networks, improving patient referral systems, and transforming health facilities into fiscally autonomous units by instituting fee-for-service systems; ■ health operations—by decentralizing and devolving responsibility to local governments, and promoting the development of local health systems; ■ health regulatory structure—by assuring quality of services, and strengthening the capacities of health regulatory agencies; and ■ health financing—by expanding coverage of the National Health Insurance Program (PhilHealth), decreasing out-of-pocket expenditures, and securing funding for vital public health programs.225 Infrastructure of health-care services Government facilities The Department of Health is the principal government agency that formulates national health policies and programs, and guides the development of local health systems, programs, and services.226 Since the adoption in 1991 of a policy of devolving health-care responsibilities to LGUs (i.e., governments from the provincial level down) the Department of Health is no longer the sole provider of public health services and is required to “provide assistance” to other national government agencies, LGUs, civil society (e.g., NGOs and people’s organizations), and the private-sector entities that implement health programs, projects, and services.227 Although the Department of Health’s role has been somewhat curtailed, it still directly operates a few large-scale health programs, such as those relating to HIV/AIDS and tuberculosis;228 maintains national health facilities; and administrates a limited number of subnational medical facilities that issue referrals to local health agencies.229 There is a regional Department of Health office in each of the 17 administrative regions of the Philippines.230 The public health system is made up of approximately 640 hospitals,231 2,405 rural health units, and 14,416 barangay health stations.232 Municipal governments maintain rural health units and barangay health stations, which are primary health-care facilities; provincial governments maintain the provincial and district hospitals.233 About 40% of all hospitals are public; these contribute 42,070 beds, or 52% of all bed capacity in the country.234 There is approximately one doctor per 9,727 people, one nurse per 7,361, and one midwife per 4,503.235 Pursuant to the devolution framework of 1991, the delivery and management of basic health services was delegated to ■

LGUs.236 These units provide public health services in their local jurisdiction in the areas of basic health care, family planning services, maternal and child health care, nutrition, and communicable and noncommunicable disease prevention and control.237 The devolution of health services to LGUs is one of the most significant developments in the Philippine public health system in the past 20 years.238 The purpose of the policy was to transform LGUs into “self-reliant communities and active partners in nation-building by giving them more powers, authority and resources and corresponding responsibilities and obligations,” and to empower citizens through participating in “policy and decision-making relative to the quality of health care in their community.”239 The Department of Health has implemented projects with the support of foreign donor agencies to help offset the impact of decentralization on the quality of services. The Local Government Unit Performance Program (LPP) was a nine-year nationwide project (1994–2003) with the goal of expanding local service delivery coverage and improving the quality of care provided to women and children.240 Two key components of the LPP were the Department of Health’s Matching Grant Program, which required local governments to provide counterpart contributions, and the Sentrong Sigla (Center of Wellness) Program, formerly known as the Quality Assurance Program, which awarded quality certifications to ensure the quality of health services in LGUs.241 The program reportedly enhanced the management and performance capacity of LGUs, particularly with respect to programs devoted to family planning, safe motherhood, and child survival.242 The Sentrong Sigla Strategic Plans for 2003–2007, the second phase of the program, are continuing with modifications.243 Another key project was the Integrated Community Health Services Project, a six-year project (1997–2003) aimed at “upgrading basic health facilities, developing and implementing key health subsystems, providing quality essential drugs, training of health personnel, and mobilizing community participation and support for health.”244 Privately run facilities The private sector plays a significant role in the delivery of health care, especially within the devolution framework. There are approximately 1,068 private hospitals,245 accounting for about 60% of all hospital facilities in the country and providing almost half of the country’s hospital beds.246 The number of private clinics is estimated to be even larger. There are also close to 200 Well-Family Midwife Clinics nationwide that operate through private-sector investment, donations, and loans.247

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Financing and cost of health-care services Government financing The national government expenditure on health in 2002 was 16.7 billion Philippine pesos (USD 299 million), and the local government expenditure on health that year was 17.8 billion pesos (USD 319 million); these outlays make up a total government expenditure of almost 34.5 billion pesos (approximately USD 620 million), which represents a decrease of 18.2% from 2001.248 Government health expenditure was 2.7% of the country’s GNP in 2002, a proportion that has fallen steadily from 3.5% in 1997.249 Private and international financing Given the limited government resources allocated to health care, the private sector and the international community play an important role in the financing of health services. According to figures from the Philippine National Health Accounts from 2002, private expenditures on health (out-of-pocket expenses, private insurance costs, Health Maintenance Organization costs, employer-based plans, private school plans, etc.) totaled 68.6 billion pesos (USD 1.2 billion), an increase of 8% from the previous year.250 Private sources constitute the largest share of the Philippines’s total health expenditure, comprising 59.5% in 2002.251 Funding for a number of Department of Health projects (including the national population program) is provided through foreign assistance.252 In 2001, there were 35 projects financed through funds from international organizations such as the Asian Development Bank (ADB), World Bank, Australian Agency for International Development (AusAID), German Technical Cooperation, United States Agency for International Development (USAID), European Union, and United Nations agencies; in addition, funds were provided by the governments of Japan, Belgium, and Finland.253 Foreign-assisted projects are implemented by the Department of Health through the Bureau of International Health Cooperation and project management offices, in partnership with LGUs and NGOs.254 Health spending from foreign loans increased by 69.1% from 2001 to 2002, mainly due to the financial support from the Hospital Development Program of Austria; the Rural Water Supply, Sewerage and Sanitation of the ADB; the Early Childhood Development of the ADB, and Social Expenditure Management Project II of the World Bank.255 Cost A large number of primary health-care facilities and hospitals provide basic health services below cost to patients. Public hospitals have charity wards for indigent patients where services are virtually free.256 Yet, the financial burden of health care falls heavily on individual Filipino families.257 In 2002,

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54.8% of health spending was paid out of pocket.258 The National Health Insurance Program or PhilHealth, an expansion of the former Medicare program, was instituted through the enactment of the National Health Insurance Act of 1995.259 The program, which is administered by the Philippine Health Insurance Corporation (PHIC),260 mandates compulsory medical coverage for all citizens of the Philippines.261 In the 2003 Philippines National Demographic and Health Survey (NDHS), 30% of households reported having at least one member with PhilHealth membership.262 Employees in the private sector constitute the largest proportion of all PhilHealth members (43%), followed by government employees (27%), individual payers (15%), indigent persons (11%), overseas Filipino workers (2%), and retirees or pension holders (2%).263 There is a dearth of official data on the differential costs of health services in the public and private sectors. According to one unofficial study, the average private hospital bill is about 4.5 times the average public hospital bill.264 The study also found that public and private hospitals charge charity patients, uninsured patients, and insured patients differently, with insured patients being charged the most.265 A study conducted among a sample of midwife-owned clinics266 revealed a wide range of prices for various family planning and maternal health services. For example, costs for the following services were: 100 to 350 pesos (USD 1.8 to 6.3) for an IUD insertion; 50 to 300 pesos (USD 0.9 to 5.4) for a pap smear; 30 to 275 pesos (USD 0.5 to 4.9) for a pregnancy test; 10 to 150 pesos (USD 0.2 to 2.7) for a prenatal visit; and 450 to 3,800 pesos (USD 8.1 to 68.1) for a delivery.267 Regulation of drugs and medical equipment Drugs and medical devices and equipment are regulated by the Department of Health through the Bureau of Food and Drugs.268 Before any drug or device is manufactured, imported, exported, sold, or distributed, it must first be registered with the bureau.269 The requirements for licensure include, inter alia, proof of safety, efficacy, and good quality based on clinical studies conducted in the Philippines, and a full statement of the composition of the drug or device.270 Banning, recalling, or withdrawing drugs or devices from the market may be ordered if products are proven to be unregistered, unsafe, ineffective, or of doubtful therapeutic value.271 The Bureau of Health Devices and Technology under the Department of Health is responsible for regulating health technologies and medical and health-related devices, and for monitoring compliance with regulations.272 Regulation of health-care providers The Philippine Constitution mandates the government to “establish and maintain an effective food and drug regulatory

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system and undertake appropriate health manpower development and research, responsive to the country’s health needs and problems.”273 The Professional Regulation Commission is tasked with administering, implementing, and enforcing the regulatory policies of the government with respect to professionals.274 Individual regulatory boards under this commission cover different medical and allied professions, including the following: medicine; midwifery; nursing; nutrition and dietetics; optometry; pharmacy; and physical and occupational therapy. These boards, among other things, formulate licensure exams275 and each board also has its own Code of Ethics;276 violations of such codes may result in the suspension or revocation of the registration certificate that allows an individual to practice his or her profession. The Board of Medicine considers “gross negligence, ignorance or incompetence … resulting in an injury or death of the patient” to be sufficient grounds for reprimand, suspension, or revocation of the certificate of registration.277 Once admitted as health services providers, health workers are subject to the provisions of the Code of Conduct and Ethical Standards for Public Officials and Employees, which sets out the standards of conduct for public employees, including health employees.278 Health personnel are also subject to the Rules and Regulations of the Magna Carta of Public Health Workers, which governs the employment conditions and conduct of public-sector health workers.279 The Magna Carta of Public Health Workers requires health workers to discharge their duties humanely, with conscience and dignity; perform their duties with utmost respect for life; and exercise their duties without consideration of a client’s race, gender, religion, nationality, party politics, social standing, or ability to pay.280 Traditional practitioners are governed by the Traditional and Alternative Medicine Act of 1997, which led to the establishment of the Philippine Institute of Traditional and Alternative Health Care.281 Regulation and licensure of hospitals and health facilities are the responsibility of the Department of Health’s Bureau of Health Facilities and Services and PhilHealth.282 All private and public hospitals and health facilities must obtain a license from the bureau before they are allowed to operate. Before a hospital is given a license, it must comply with set standards on service capability, personnel, equipment and instruments, and physical facility environment.283 The operating license is renewed annually.284 The grounds for revocation or suspension of an operating license include refusing to admit patients who cannot pay or issuing a death certificate as punishment for nonpayment of hospital bills.285 Health-care providers

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and facilities must be accredited by the PHIC in order to participate in PhilHealth and provide services to members.286 To receive accreditation, the provider must comply with the qualities, standards, and procedures set forth by PhilHealth regarding qualifications and capacity.287 According to the Senate bill known as the Anti-Medical Malpractice Act of 2004, any medical practitioner who performs any act constituting medical malpractice or the illegal practice of surgery is penalized with imprisonment, revocation of his or her license to practice, and a fine.288 The act defines malpractice as “any personal injury, including death, caused by the negligent or wrongful act or omission of any medical practitioner,” and it defines illegal surgery as a “surgery performed to remove healthy human organ/s without the consent of the patient, with intent to gain on the part of the person or persons responsible for such surgery.”289 The bill is encountering stiff opposition from medical professionals who contend that the existing criminal code provisions adequately respond to the excesses that might be committed by members of the medical profession.290 Neither the Revised Penal Code nor the Civil Code makes specific reference to medical malpractice, however.291 Patients’ rights There is no specific law or policy establishing the rights of patients. However, criminal and civil liability for medical negligence can be enforced through relevant provisions of the Revised Penal Code and the Civil Code.292 In addition, the Magna Carta of Public Health Workers guarantees the right to nondiscrimination on the grounds of race, gender, religion, nationality, party politics, social standing, or ability to pay in receiving health care from public health workers.293 (See “Regulation of health-care providers” for more information on the Magna Carta of Public Health Workers.) The right to informed consent is recognized by the Code of Ethics of the Medical Profession (1960) formulated by the Philippine Medical Association.294 The code states that “[t]he physician has the duty to obtain consent from his patient for any treatment or procedure he intends to undertake and to inform him adequately about these matters so that the agreement may be characterized as informed.”295 Proposed legislation on medical malpractice and patients’ rights is pending before the House of Representatives and the Senate.296 The document, known as the Magna Carta of Patients Rights and Obligations, was introduced in the House and the Senate in 2004.297 It proposes 15 patients’ rights, including the rights to the following: ■ medical care and humane treatment; ■ informed consent; ■ privacy and confidentiality;

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disclosure of and access to information; refusal of diagnostic and medical treatment; ■ religious belief; and ■ refusal to participate in medical research.298 Violation of these rights may result in fines and administrative sanctions such as the revocation of the license to practice. Republic Act No. 8344 of 1996 penalizes personnel of hospitals and medical clinics who refuse to provide appropriate medical support in emergencies or serious cases with imprisonment of 6–28 months, a fine of 20,000–100,000 pesos (USD 359–1,793), or both. If the medical professional was acting in accordance with an established policy or instructions from a superior, the director of the facility is subject to imprisonment of 4–6 years, a fine of 100,000–500,000 pesos (USD 1,793–8,964), or both.299 ■ ■

B. REPRODUCTIVE HEALTH LAWS AND POLICIES

There is no separate national law or policy addressing reproductive health in the Philippines. However, the constitution provides that the state shall defend “[t]he right of spouses to found a family in accordance with their religious convictions and the demands of responsible parenthood.”300 Reproductive health is also peripherally addressed in the Medium-Term Philippine Development Plan 2004–2010. Among various goals relating to “social justice and basic needs,” the plan calls for an “emphas[is] [on] maternal health, women’s health, nutrition, and responsible parenthood.”301 Although there is no specific policy on reproductive health, the government created the Philippine Reproductive Health Program in 1998 in an effort to implement the ICPD Programme of Action.302 The national program identifies the following ten priority reproductive health services: ■ family planning; ■ maternal and child health care and nutrition; ■ prevention and management of abortion complications; ■ prevention and treatment of STIs, including RTIs and HIV/AIDS; ■ an Information, Education, and Communication (IEC) component in counseling on sexuality and sexual health; ■ diagnosis and treatment of breast and reproductive tract cancers and other gynecologic conditions; ■ men’s reproductive health; ■ adolescent reproductive health; ■ prevention and management of violence against women; and ■ prevention and treatment of infertility.303 There are efforts in the present Congress to introduce legis-

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lation that would strengthen the reproductive health program through the adoption of a comprehensive and formal legal approach to reproductive health. For example, a bill entitled Reproductive Health Care Act of 2002 was introduced in the House of Representatives.304 The proposed bill is based on the principle that all persons must be allowed “to choose and make decisions for themselves in accordance with their religious convictions, culture and the demands of responsible parenthood.”305 The draft bill proposed the establishment of a Reproductive Health Management Council within the Department of Health.306 It also proposed punishments including imprisonment, a fine, or both for the following infractions:307 ■ restrictions on the dissemination of family planning information; ■ third-party consent requirements for voluntary sterilization and other voluntary sexual and reproductive health procedures; ■ prohibitions by government agents or agencies on reproductive health care and services; ■ refusals to provide quality health services and information based on marital status, gender, sexual orientation, age, religion, and nature of work, although conscientious objection is recognized on the condition that an appropriate referral be immediately provided; and ■ provision of limited, incorrect, or inadequate information on reproductive health and sexuality.308 The draft bill also proposed an initial allocation of 50 million pesos (approximately USD 896,000) to support its proposed policies and objectives, as well as unspecified subsequent appropriations by Congress in the Department of Health’s annual budget.309 This bill was consolidated with three other bills into the single Responsible Parenthood and Population Management Act of 2005, which establishes a demographic rationale for a two-child norm policy and repeatedly stresses the illegality of abortion and has not yet been adopted.310 As of November 2004, about 17 bills on population and reproductive health were pending in Congress.311 Regulation of reproductive health technologies There is currently no law that regulates assisted reproductive technologies in the Philippines although, as noted above, the prevention and treatment of infertility is one of the ten priority reproductive health services of the Philippine Reproductive Health Program. However, a draft of the 2003 Act Prohibiting the Cloning of Humans and Providing Penalties for Violations Thereof was filed in the House of Representatives and is pending review by the Congress and Senate.312

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Family planning General policy framework The official position of the present government administration is to pursue a policy of natural family planning. The administration has issued an order to mainstream natural family planning on the ground that “NFP [natural family planning] is the only method acceptable to the Catholic Church.”313 The National Family Planning Policy of 2001 and the Philippine Population Management Program (PPMP) Directional Plan (2001–2004) also comprise the national policy framework on family planning. The policy and plan aim to help couples and individuals “achieve their desired family size within the context of responsible parenthood and improve their reproductive health towards the attainment of sustainable development.”314 Specific objectives include the following: ■ attaining a national total fertility rate (TFR) of 2.1– 2.7 lifetime births per woman; ■ increasing the contraceptive prevalence rate to 60%; ■ increasing the proportion of family planning use that corresponds to modern methods to 32.5%; ■ increasing the private-sector share of reproductive health and family planning service delivery to 40%; and ■ reducing direct government funding for family planning services to 30% of their total funding.315 To operationalize the current family planning policy, the Department of Health utilizes the following strategies and activities: ■ strengthening organizational support (e.g., improving policies and legislation) for service delivery; ■ improving the accessibility of family planning services and intensifying IEC efforts; ■ instituting capacity building and training for family planning service providers; ■ decentralizing logistics and financial management to local governments and the private sector; ■ improving information technology and statistics management and developing a reproductive health database; and ■ strengthening partnerships with NGOs.316 Contraception Contraceptive prevalence rates have increased substantially over the past decades, going from 15.4% of currently married women of reproductive age in the late 1960s, to 17.4% in the early 1970s,317 to 48.9% as of 2003, according to the most recent NDHS.318 About 33.4% of currently married 15–49year-old women, and 21.6% of all women in that age-group, use a modern method of contraception.319 The method most

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commonly used among married women is the pill (13.2%), followed by female sterilization (10.5%), withdrawal (8.2%), rhythm (6.7%), the IUD (4.1%), injectables (3.1%) and the lactational amenorrhea method (LAM, 0.3%). Just 1.9% of women in union rely on the male condom320 and only 0.1% on vasectomy.321 By age-group, overall contraceptive prevalence is highest among married women aged 35–39 (56.6%) and lowest among those aged 15–19 (25.6%).322 Regional disparities in contraceptive use are widespread, and among the 17 administrative regions of the Philippines, the Autonomous Region in Muslim Mindanao has the lowest contraceptive prevalence, at 16.2%; the Cordillera Administrative Region, which has a significant indigenous population, has a rate of 48.5%.323 About 20% of births nationwide are unwanted,324 and this percentage increases with the mother’s age (reaching 80% among those aged 45–49).325 Almost half (45%) of births to Filipino women are reportedly unplanned.326 Contraception laws and policies Presidential Decree No. 79 for Revising the Population Act of 1971, enacted in 1972, mandated the Commission on Population (POPCOM) to “make available all acceptable methods of contraception, except abortion, to all Filipino citizens desirious of spacing, limiting or preventing pregnancies.”327 The act called upon physicians, nurses, and midwives, as well as personnel of clinics and other commercial channels and designated agencies to dispense and administer contraceptives.328 This legal provision coexists with stricter laws regulating the licensing, sale, and distribution of contraceptives. For example, Republic Act No. 4729 of 1966 mandates that contraceptive drugs and devices must be sold, dispensed, and distributed through a duly licensed drugstore or pharmaceutical company and with the prescription of a qualified medical practitioner.329 Moreover, according to Republic Act No. 5921 of 1969, drugs, chemical products, and devices that might induce abortion or prevent conception need a proper prescription by a duly licensed physician, and must be made available only in drugstores or hospital pharmacies.330 In 2001, upon the petition of an antiabortion coalition,331 the Bureau of Food and Drugs of the Department of Health delisted Postinor—the brand name for the emergency contraceptive regimen of 750 mcg levonorgestrel tablets—from its registry of drug products. This decision immediately prohibited the importation, use, sale, and distribution of Postinor, and all existing inventories of the drug were recalled.332 This move also reversed the 1999 approval of Postinor for use in government-run Women and Child Protection Units for rape survivors to protect them from unwanted pregnancy resulting from rape.

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In 1976, Presidential Decree No. 1013 amended the Philippine Medical Care Act of 1969 to recognize sterilization as an acceptable procedure of fertility control.333 Sterilization is covered under PhilHealth334 and the National Family Planning Policy; the method is promoted as the first option for couples who have attained their desired family size.335 Accredited health facilities may claim reimbursement from the PHIC for voluntary sterilization procedures performed on PhilHealth cardholders.336 Voluntary surgical sterilization clients are required to give written consent in the presence of a witness after receiving counseling that the method is permanent.337 Officially, spousal consent is not required for the procedure, but there is anecdotal evidence that some providers ask for the husband’s consent.338 Regulation of information on contraception Republic Act No. 4729 classifies contraceptive drugs and devices as prescription products.339 As such, contraceptives are covered by a 1987 Bureau of Food and Drugs regulation stating that no prescription products may be advertised or promoted in any form of mass media.340 (Such products may, however, be advertised in medical journals and other publications or literature intended for the medical and allied professions.341) Consequently, since the condom is sold without a prescription, it is the only method of contraception that can be promoted or advertised in the mass media. Nonetheless, some elected officials and government agencies have taken arbitrary actions to restrict condom promotion.342 Recent reports indicate, for example, that the Advertising Board of the Philippines, or AdBoard, which is the umbrella organization of the advertising industry in the Philippines, has used obscenity laws to restrict television public service announcements that promote condoms.343 The guidelines of the Family Planning Organization of the Philippines344 stipulate that all individuals of reproductive age (specified as ages 15–44) have the right to information, counseling, physical examinations, and contraceptive supplies, specifically condoms or contraceptive pills.345 Government delivery of family planning services The Philippine government is the major source of family planning services, with seven out of ten users of family planning (70.1%) relying on government facilities.346 The Department of Health is mainly responsible for delivering family planning services to the public. It assumed this role from POPCOM in 1998347 in a transfer of responsibility that represents a policy shift in the rationale for providing family planning from reducing fertility (with women as the primary targets) to improving the general and reproductive health status of all.348 The following methods constitute the official method mix and are available in government health facilities: pills,

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condoms, hormonal injectables, IUDs, natural family planning (NFP), LAM, tubal ligation, and vasectomy.349 Some methods and services are provided free of charge.350 Hospital-based voluntary sterilization services are covered under PhilHealth.351 The Department of Health has instructed all hospitals under its direct administration to create mobile voluntary surgical sterilization teams to bring such services directly to the communities.352 The Department of Health has also ordered all regional hospitals and medical centers to include in their annual budget funds for mobile voluntary surgical sterilization teams to ensure their operation.353 The Department of Health has attempted to improve the distribution and storage of contraceptives through the establishment of a Contraceptive Distribution and Logistics Management Information System that aims to facilitate the direct delivery and equitable distribution of contraceptive supplies to governmental and nongovernmental family planning facilities based upon need.354 Since the 1960s and until very recently, up to 80% of all family planning methods that were distributed free by government facilities—such as condoms, pills, and injectables— had been donated by USAID.355 However, the agency began to phase out its contraceptive support to the family planning program in 2003,356 and plans to completely stop donating contraceptives to the Philippines as of 2007. The policy to decentralize health services has had a significant impact on family planning and reproductive health service delivery ever since the funding, staffing, and administration of these programs were devolved to LGUs.357 The law authorizing devolution mandated that LGUs provide basic services, including family planning services;358 furthermore, a 1996 executive order made the LGUs responsible for ensuring the availability of family planning information and services,359 which has empowered local officials to an unprecedented degree. Local officials, including governors and mayors, have been known to issue administrative orders that prohibit the delivery of modern family planning methods and essentially allow only NFP services.360 For example, policies banning all artificial birth control methods, including condoms, in health clinics operating in Manila City, Laguna, and Puerto Princesa on the island of Palawan were introduced in 2000, 1995, and 2001, respectively. 361 Although the policies in both Laguna and Puerto Princesa were subsequently overturned by new local government administrations, the Manila City policy still exists.362 Family planning services provided by NGOs and the private sector The Health Sector Reform Agenda and the Philippine Reproductive Health Program emphasize the importance of partnerships with NGOs and the private sector in the delivery

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of health services.363 Contraceptive supplies such as pills and condoms are available from pharmacies and some supermarket check-out counters (in the case of condoms).364 Almost 200 Well-Family Midwife Clinics have been established nationwide with financial support from the private sector, USAID, and individual midwives; these clinics provide family planning and maternal and child health-care services, and also undertake commercial contraceptive and marketing activities.365 The Philippine NGO Council on Population, Health and Welfare, Inc., is an umbrella organization that coordinates international and local NGOs engaged in family planning services.366 Together with international and local NGOs, the council sponsors IEC activities to disseminate family planning information and it provides grants and resource management training to ensure the financial viability of family planning operations.367 Despite the availability of services in the private sector, most people reportedly use public-sector services because of factors such as the high market price of contraceptives, the limited range of choices, and a lack of awareness about methods’ availability, given the legal restrictions on the advertising of prescription drugs and other contraceptives, except condoms. Maternal health According to government studies, two-thirds of the estimated nine million Filipino women of reproductive age who are married or have partners are considered to be at high risk for unsafe pregnancy because they are under 18 years of age; are over 35 years of age; have had four or more pregnancies; have too closely spaced pregnancies; or are concurrently ill.368 Data from national household surveys conducted in 1998 estimated the maternal mortality ratio at 172 maternal deaths per 100,000 live births.369 Based on this ratio, the Department of Health estimates that 3,614 maternal deaths occur annually.370 However, according to the National Statistics Office, there were only 1,579 registered maternal deaths in 1998,371 which suggests that many deaths go unreported. The statistics office further notes that three out of ten of these deaths were not medically attended.372 According to the 2003 NDHS, although a high percentage of pregnant women receive prenatal care (88%),373 the majority of births in the five years preceding the survey still occurred at home (61%),374 with 59.8% of those women receiving delivery assistance from a qualified health professional (doctor, nurse, or midwife),375 and 65.7% receiving postnatal care (defined as within 41 days of delivery).376 Of the 2.4 million women who become pregnant in the Philippines each year, about 360,000 suffer a major obstetric complication.377 Laws and policies In 2000, the government introduced its Safe Motherhood Policy, which is operational at the national level and aims to

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reach all women of reproductive age and identifies indigenous women, women belonging to marginalized groups (i.e., fisher folks, farmers, and the urban poor) and adolescents in particular as needing safe motherhood initiatives.378 The specific objectives of the policy are to reduce maternal and child health indicators to the following levels: ■ a maternal mortality ratio of 86 maternal deaths per 100,000 live births, from 172 in 1998; ■ a low-birth-weight proportion of 12.0% of all live births, from 16.6% in 1998; and ■ a neonatal mortality rate of 3.8 newborn deaths per 1,000 live births, from 7.8 in 1998.379 The guidelines for safe motherhood programming as stated in the Safe Motherhood Policy are anchored in ensuring that quality maternal and newborn health services meet the following conditions: ■ that they be as accessible as possible and located near where women live; ■ that they be acceptable to women and responsive to preferences for privacy, confidentiality, and being cared for by female health workers; ■ that essential supplies and equipment be on hand; ■ that continuity of care and follow-up be provided; ■ that they be staffed by technically competent health workers who provide respectful and nonjudgmental care; and ■ that patients be involved in decision-making.380 The policy also stipulates that pregnant women should make at least four prenatal visits that include advice on nutrition and health care, a physical examination, tetanus toxoid immunization, micronutrient supplementation, information on early detection and management of complications, and treatment for STIs, anemia, toxemia, and other risk conditions.381 With regard to delivery assistance, the policy mandates that all deliveries be attended by a skilled attendant (defined as a doctor, nurse, midwife, or traditional birth attendant with training and education or Department of Health accreditation to provide safe deliveries). Deliveries should also occur in a location that is within two hours of a well-equipped hospital that can handle emergency obstetric cases.382 After giving birth, women should make at least two postpartum visits, one month apart, to allow immediate and safe referral of cases needing higher-level care, and to receive follow-up immunizations, family planning services, micronutrient supplementation, and counseling on personal hygiene and infant care.383 Delivery services and other maternal health services are provided, in part, through a chain of midwife-owned clinics with almost 200 branches throughout the country.384 These

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clinics cater to low- and middle-income families and offer services for a fee. (See “Cost” under “Financing and cost of health-care services” for more information on the clinics.) Furthermore, the specific objectives of the National Family Planning Policy of 2001 and the PPMP Directional Plan (2001–2004) include reducing the maternal mortality ratio to under 100 maternal deaths per 100,000 live births, and lowering infant and perinatal mortality rates to 32 deaths per 1,000 live births and 18 per 1,000, respectively.385 (For more information, refer to “Family planning.”) Access to maternal health services at the local level has also been addressed through legislation at the local level. The 1990 Barangay-Level Total Development and Protection of Children Act provides for the establishment of a referral and support system for pregnant women for prenatal and neonatal care and delivery assistance.386 Nutrition Protein energy malnutrition and micronutrient deficiencies are leading nutritional problems in the Philippines. The proportion of pregnant women exhibiting vitamin A deficiency has been increasing over the years; 50% of pregnant women and more than 40% of lactating women are affected by iron deficiency anemia. According to one study in 1998, over 10% of mothers were suffering from night blindness.387 Moreover, the prevalence of night blindness was higher among lactating women than among pregnant women. 388 There is no law or policy that specifically addresses nutritional deficiencies among pregnant and lactating women. However, in 2000, the government introduced the Philippine Food Fortification Act of 2000,389 which mandates food fortification of food staples by manufacturers, producers, and importers390 based on Department of Health standards.391 Fortification involves the addition of micronutrients deficient in the Filipino diet to foods that are widely consumed, especially by vulnerable groups.392 Fines are imposed for noncompliance with food fortification requirements.393 In addition, while the Philippine Plan of Action for Nutrition does not specifically address maternal nutrition, it does lay out objectives to prevent and eliminate malnutrition and establish food security in general.394 Safe abortion About 400,000 unsafe abortions occur in the Philippines every year, and complications from induced abortions are the fourth leading cause of maternal deaths.395 Abortion laws and policies The Philippines has a highly restrictive abortion law. The constitution provides that “[the state] shall equally protect the life of the mother and the life of the unborn from conception.”396 Although there is no explicit constitutional provi-

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sion allowing abortion if the life or health of the mother is endangered, an annotation based on the deliberations of the Constitutional Commission that drafted the Philippine Constitution elaborates that “[w]hen necessary to save the life of the mother, the life of the unborn may be sacrificed; but not when the purpose is only to spare the mother from emotional suffering, for which other remedies should be sought, or to spare the child a life of poverty, which can be answered by welfare institutions.”397 Authorization of an abortion to save the life of the woman requires consultation with a panel of professionals.398 The Revised Penal Code from 1930 imposes a range of penalties for women undergoing abortion and for providers of abortion services. Penalties include the following: ■ imprisonment of 30 months to 6 years for any woman who causes or consents to her own abortion;399 and ■ imprisonment of two to six years for any person who intentionally causes an abortion with the consent of the woman.400 Health professionals (e.g., doctors, midwives, or pharmacists) who are caught providing abortion services or dispensing abortive drugs also run the risk of having their license to practice suspended or revoked.401 The emergency contraceptive Postinor was delisted in 2001 by the government on the alleged ground that it is an abortifacient; subsequently, an executive body established to review complaints that were filed in opposition to the decision to delist Postinor has determined that it is both legal and safe.402 (Refer to “Contraception” for more information.) The Philippine Reproductive Health Program of 1998 identifies the prevention and management of abortion complications as one of ten priority areas of reproductive health services.403 (See “Reproductive Health Laws and Policies” for more information on the Philippine Reproductive Health Program.) In an attempt to address the high level of need for postabortion care, the Department of Health issued a policy in 2000 on the prevention and management of abortion and its complications.404 This policy aims to strengthen the capacity of the country’s health-care system in this area, and to improve the accessibility of quality postabortion care services to all women of reproductive age.405 The policy provides for the following measures:406 ■ prevention and treatment of abortion complications by prompt referral and transfer of the patient if needed; stabilization of emergency conditions; treatment of complications before, during, and after the procedure; and health education;407 ■ providing counseling on postabortion care, family planning, STI prevention, and other reproductive health issues; and408

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linking services for the prevention and management of abortion and its complications to other reproductive health services, which involves, inter alia, identifying services that the patient may need, such as treatment for RTIs and STIs, cervical cancer screening, and infertility management.409 The policy calls for the establishment of different types of services for the prevention and management of abortion and its complications at each level of the health-care system. Community and rural health units, barangay health stations, and private clinics are required to perform physical examinations and diagnose, manage and make any necessary referrals for complications caused by abortion.410 At municipal and district hospitals, available services should include uterine evacuation in cases of incomplete abortion; diagnosis and referral for severe complications; laparotomy and other indicated surgery if needed; and supplying blood transfusions (with attendant blood cross-typing) if needed.411 At provincial and regional hospitals or medical centers, treatment for severe complications and bleeding and clotting disorders should be made available.412 In addition, information and education should be offered at each level, as well as follow-up care, including counseling and the provision of appropriate family planning services.413 Regulation of information on abortion Government policy allows public health facilities to provide information and counseling, including referrals, on the prevention and management of abortion complications.414 Government delivery of abortion services As noted above, government policy relating to the prevention and management of abortion and its complications calls for services to be available at each level of the public health-care system. (See “Abortion laws and policies” for more information.) However, some hospitals have been known to refuse to provide services for women experiencing abortion complications.415 Abortion services provided by NGOs and the private sector Some international NGOs, such as EngenderHealth, have been involved in implementing programs and services for the prevention and management of abortion complications and postabortion care in collaboration with the government.416 HIV/AIDS and other sexually transmissible infections (STIs) From January 1984 to February 2005, 2,231 HIV/AIDS cases were reported to the Philippine HIV/AIDS Registry, and 84% of these infections were contracted through heterosexual, homosexual, and bisexual sexual contact.417 Of these cases, 815 (36.5%) were female.418 Official national-level ■

information on the prevalence of STIs could not be found. Laws and policies The Philippine AIDS Prevention and Control Act of 1998419 is a comprehensive law that aims to respond to HIV/ AIDS concerns. Through this law, the government declared its policy to undertake the following steps: ■ promote public awareness about the causes, modes of transmission, consequences, and means of prevention and control of HIV/AIDS through a nationwide educational and information campaign;420 ■ extend to every person with or suspected of having HIV/AIDS full protection of his or her human rights and liberties by prohibiting compulsory HIV testing and discrimination in any form and by guaranteeing their right to privacy and access to basic health and social services;421 ■ promote safety precautions in practices and procedures that carry the risk of HIV transmission;422 ■ positively address and seek to eradicate conditions that aggravate the spread of HIV infection, such as poverty, gender inequality, prostitution, marginalization, drug abuse, and ignorance;423 and ■ recognize the potential role of affected individuals in propagating vital information and educational messages about HIV/AIDS, and utilize their experiences to warn the public about the disease.424 The act penalizes any person who knowingly or negligently causes the infection of another person through unsafe and unsanitary practices or procedures in the course of practicing his or her profession with 6–12 years’ imprisonment and administrative sanctions, such as fines and the suspension or revocation of the license to practice.425 The act also reconstitutes and strengthens the Philippine National AIDS Council, a body created in 1992 by executive order.426 The AIDS Prevention and Control Act mandated the council to act as the central advisory, planning, and policy-making body for HIV prevention and control.427 Among the council’s functions under the AIDS Prevention and Control Act are the following: ■ monitoring the implementation of the act and issuing orders or recommendations to the implementing agencies;428 ■ developing a comprehensive, long-term national HIV/AIDS prevention and control program and monitoring its implementation;429 and ■ evaluating the adequacy of, and advising on the utilization of national resources for HIV prevention and control.430 The council’s 26 members include the heads of selected

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government agencies, the heads of the leagues of mayors and governors, the chairpersons of the committee on health of the Senate and the House of Representatives, NGO representatives, and others.431 The Rules and Regulations Implementing the Philippine AIDS Prevention and Control Act of 1998 recognize certain rights of people living with HIV/AIDS and prohibit discrimination again them. The regulations require written informed consent before HIV testing,432 and mandate the provision of free pretest and posttest counseling for persons who undergo HIV testing.433 The rules prohibit compulsory HIV testing as a precondition for employment; admission to an educational institution; housing; entry or continued stay in the country; provision of medical services or any kind of service; and the enjoyment of human rights and civil liberties, including the rights to travel, enter into marriage, and conduct a normal family life.434 The prohibition on compulsory HIV testing may be lifted with a court order when a person is charged with certain crimes under the Revised Penal Code (e.g., the crime of rape); when the determination of HIV status is necessary to resolve relevant issues under the Family Code of the Philippines (e.g., in a claim for annulment on the ground that at the time of marriage, one party was afflicted with a serious and incurable STI); and in cases of organ and blood donation.435 With limited exceptions, the rules guarantee patient confidentiality and protect the right to privacy of an individual who undergoes HIV testing or is diagnosed with HIV.436 However, in the case of minors, HIV test results may be released to the parents of the minor.437 Moreover, HIVinfected persons are obligated to disclose their HIV status and health condition to their spouse or sexual partner at the earliest opportune time.438 Discrimination based on HIV/AIDS status by employers (in hiring, promotions, job assignments, benefits, job opportunities, and other employment issues) or by educational institutions (in admissions, discipline, participation, benefits, and services) is strictly forbidden.439 Regardless of individuals’ actual, suspected, or perceived HIV status, their rights to housing, travel, entry into or exit from the Philippines,440 and participation in public office may not be abridged.441 Persons and relatives of people who have HIV/AIDS (or who are suspected or perceived to have it) cannot be denied access to credit and insurance services, medical care, and burial services.442 Discriminatory acts and polices may be punishable by six months to four years of imprisonment, and a fine of up to 10,000 pesos (USD 179).443 Schools, hospitals, and other institutions in violation of these provisions may also be stripped of their licenses or permits.444

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The intentional transmission of an STI, including HIV/ AIDS, through rape is deemed a punishable act by the 1997 Anti-Rape Law. The law considers a rapist’s knowledge of his infection with HIV/AIDS or another STI as an aggravating circumstance when such infection is transmitted to the victim, and is punishable with death.445 The Philippine Reproductive Health Program identifies the prevention and treatment of HIV/AIDS, other STIs, and RTIs as one of the elements of a Reproductive Health Care Package.446 The 2000–2004 Medium-Term Plan for Accelerating the Philippine Response to HIV/AIDS, titled Seizing the Opportunity, aimed to achieve certain important targets by 2004; these targets include the following: ■ establishing an active coordinating mechanism for HIV/AIDS prevention in at least 60% of local government jurisdictions;447 ■ initiating HIV/AIDS education in public and private tertiary and secondary formal education programs,448 in programs sponsored by the main organized churches and religions in the country,449 and in the mass media; 450 ■ developing at least five cost-effective interventions to reduce infection through unprotected sex among high-risk groups and through transfusions with contaminated blood products;451 and ■ introducing universal access to HIV and STI prevention and treatment in at least five high-infection risk zones.452 Strategies adopted to pursue the aforementioned goals are currently being continued. Several specific Department of Health policies deal with STIs. The Guidelines for the Management of Asymptomatic Women with Reproductive Tract Infections and STIs, formulated in 1997, aim to provide early detection and treatment of RTIs and STIs in asymptomatic women; prevent related complications; and establish standards for risk assessment, training, and referrals for managing asymptomatic women with RTIs or STIs.453 The guidelines provide for routine testing for RTIs and STIs in family planning and maternal health clinics; risk assessment of all women who use the health-care system; routine testing of pregnant women for syphilis; training for health workers on RTI and STI detection; effective and appropriate services for managing RTIs and STIs; assurance of clients’ privacy and confidentiality of information; and development of an appropriate referral system.454 Regulation of information on HIV/AIDS and other STIs The Philippine AIDS Prevention and Control Act of 1998 guarantees access to complete HIV/AIDS information at tourist points of entry and in local communities in schools,

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health facilities, workplaces, and during seminars for Filipino overseas workers before they leave the country.455 However, the act also specifies that HIV/AIDS education in schools should not be used “as an excuse to propagate birth control or the sale or distribution of birth control devices” and should not utilize “sexually explicit materials.”456 The act requires all commercially available or donated condoms to include literature on “[their] efficacy against HIV and STD infection, as well as the importance of sexual abstinence and marital fidelity.”457 Surveillance The Philippines uses passive and active surveillance systems to monitor the epidemiology of HIV/AIDS and STIs in the country. The HIV/AIDS Registry, established in 1987, is the passive surveillance system and receives its data from confirmed cases of HIV reported by hospitals, laboratories, blood banks, and clinics.458 The National HIV Sentinel Surveillance System, which was established in 1993, consists of two active surveillance systems and aims to provide an early warning of any increase in HIV-seroprevalence.459 The first of these two systems, known as HIV Serologic Surveillance, monitors seroprevalence among high-risk groups, including registered female sex workers, freelance female sex workers, men who have sex with men, and intravenous drug users.460 The second active system is the Behavioral Sentinel Surveillance, established in 1997, which monitors the level of risk behaviors among high-risk groups.461 In 2003, a third system, the Sentinel STI Etiologic Surveillance System, became operational. This system tracks STI trends to determine their implications for HIV transmission.462 Medical research The National Guidelines for Biomedical/Behavioral Research, issued by the Philippine Council for Health Research and Development, specify directives for HIV/AIDS research.463 They provide that in the course of biomedical research involving persons living with HIV/AIDS or testing for HIV/AIDS, a physician or investigator must strictly conform with requirements of medical confidentiality, informed consent, and respect for the dignity of the individual, particularly during pre- and posttesting, counseling, and follow-up.464 Researchers must submit HIV/AIDS statistics (all detected or attended cases of HIV) to the Department of Health for public health purposes and to facilitate data collection for situation analyses, planning, and policy formulation.465 The physician or investigator should strictly observe the principles of confidentiality and informed consent in these efforts.466 Adolescent reproductive health According to the 2002 Philippine Statistical Yearbook, 21.6% of the total population, or 17.1 million individuals,

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are adolescents between the ages of 10 and 19.467 The 1998 NDHS showed that an estimated 10.8% of rural girls and 4.7% of urban girls aged 15–19 had already begun childbearing.468 In 1998, 6.3% of reported maternal deaths were the deaths of girls aged 15–19.469 According to the 2002 Young Adult Fertility and Sexuality Study, a periodic survey of young people’s sexuality and fertility behavior, 31% of young adult males and 15% of young adult females report having engaged in premarital sex.470 Approximately 70% of young adult males and 68% of young adult females reported not using any method of protection against pregnancy or STIs the last time they had sex.471 Misconceptions also abound: for example, 28% of young adults believe that HIV/AIDS is curable, and 73% think that they are immune to HIV.472 There are no official data on the incidence of STIs among adolescents. However, among registered HIV/AIDS cases as of February 2005, 1.5 % of those infected were below age 10, 1.9% were aged 10–19, and 30% were aged 20–29.473 Of those aged 29 and below, 53.9% were female.474 Indigenous youth face even greater barriers than others in access to basic social services, including health care, since they generally live in remote areas that have poor infrastructure and often lack facilities. In the southern regions of the Philippines, this limited access to health care, which is aggravated by armed conflict between the government and rebel groups, often leads to a high overall prevalence of communicable diseases, high mortality rates, widespread malnutrition, and poor sanitation.475 The inadequacy of data on indigenous youth has been identified by the government as a problem.476 Laws and policies The constitution provides that “[t]he State recognizes the vital role of the youth in nation-building and shall promote and protect their physical, moral, spiritual, intellectual and social well-being.”477 It also defends “the right of children to assistance, including proper care and nutrition, and special protection from all forms of neglect, abuse, cruelty, exploitation and other conditions prejudicial to their development.”478 The Special Protection of Children against Abuse, Exploitation and Discrimination Act of 1992 also declares as state policy the provision of “special protection to children from all forms of abuse, neglect, cruelty, exploitation and discrimination, and other conditions, prejudicial to their development.”479 With respect to indigenous youth, the act entitles children of indigenous cultural communities access to health and nutrition services,480 and protection from any form of discrimination.481 A person found guilty of discriminating against children of indigenous cultural communities is penalized with six months’ imprisonment and a fine.482 In 2000, the Department of Health issued the Adolescent

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and Youth Health Policy in recognition of the health needs of young people in the Philippines.483 The policy provides for the creation of the AYH Sub-Program under the Program for Children’s Health, Cluster for Family Health, with the objective of instituting “a comprehensive program for the health of adolescents and youth.”484 The program aims to reduce morbidity and mortality among adolescents and youth; eliminate unwanted pregnancies, abortions, and STIs; eliminate disabilities and accidents caused by drug abuse and destructive behaviors; promote health and development; and provide quality adolescent and youth-friendly health programs and services,485 including reproductive health, nutrition, immunization, psychosocial health, oral health, sexual health, and environmental safety.486 The guidelines under this policy stipulate that health-care services (including contraception) for young people should be “accessible and available at all times”;487 the privacy and confidentiality of adolescents should be preserved;488 services should be directed toward gender-specific concerns;489 and special services, including medical, legal, rehabilitative, and support services, shall be available to youths with disabilities and those who are victims of sexual violence and abuse.490 In support of the policy’s goals, the Department of Health developed the Adolescent and Youth Health and Development Program (AYHDP). This program specified the following steps for achieving the aforementioned goals by 2004:491 ■ reduce the proportion of teenage girls (aged 15–19) who begin childbearing to 3.5%;492 ■ increase the proportion of adolescents who seek health care to 50%; ■ raise the proportion of adolescents with basic knowledge of fertility, sexuality, and sexual health to 80%; ■ increase the percentage of facilities providing basic health services for adolescents and youth to 70%; ■ establish specialized services in 50% of government hospitals for adolescents who suffer from occupational illnesses and substance abuse, and who are victims of rape and violence; ■ integrate gender-sensitivity training and reproductive health education in the secondary school curriculum; and ■ establish resource centers or one-stop-shops for adolescents and youth in each province.493 Likewise, the PPMP Directional Plan (2001–2004) set forth several specific goals and targets for improving and promoting the reproductive health of young people, and for reducing the incidence of early marriage, teenage pregnancy, and other reproductive health problems.494 The plan also called for the establishment of youth centers; programs of capacity building

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for parents, service providers, and adolescents; advocacy and IEC programs; partnerships with NGOs; and an adolescent reproductive health database system.495 In 1997, POPCOM, with the assistance of the national and local governments and NGOs, launched “Hearts and Minds,” a nationwide IEC campaign that teaches young Filipinos about sexual health, responsible adulthood, and parenthood.496 Since the early 1970s, the Department of Education (previously known as the Department of Education, Culture and Sports), has implemented reproductive health and family planning IEC projects for adolescents through the Population Education Program (PopEd) and the Population Awareness and Sex Education Program (PASE).497 Introduced in 1972, PopEd covers topics in reproductive health, gender equality, HIV/AIDS, family life, and responsible parenthood.498 The Revitalized Home Guidance Program, which was established in secondary schools, has been successful in improving adolescents’ relationships with the opposite sex; in increasing young people’s knowledge about STIs, HIV/AIDS, courtship, friendship, dating, and adolescent development; and in establishing Teen Health Centers.499 The School-Based Women’s Health Project promotes reproductive and adolescent health.500 The Department of Education also launched the Feminine Hygiene Education Program in 1994, which provides elementary and secondary school students with lectures on physiological and biological changes during puberty, and information on reproductive health.501 A program sponsored by the European Commission aims to reduce adolescents’ risk of STIs, including HIV/AIDS, and other reproductive health problems through peer counseling, community-based education, and the provision of medical services.502 Delivery of adolescent reproductive health services by NGOs Adolescent reproductive health programs offered by NGOs are restricted primarily to IEC components and referrals to government clinics for contraceptive services because of opposition from religious groups.503 The Family Planning Organization of the Philippines recognizes the right of adolescents to receive reproductive health services—including information and education, counseling, physical examinations, and contraceptive supplies (i.e., condoms or pills)—and thus implemented its Development and Family Life Education for Youth program in 1983.504 The program focuses mainly on empowering Filipino youth in addressing their sexual and reproductive health concerns, and it has established Teen Centers that provide a comprehensive package of IEC activities, peer counseling, and reproductive health services.505 The Foundation for Adolescent Development offers campus-based educational programs, including SEXTERS, an out-of-classroom program that nurtures the social, emo-

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tional, and sexual development of adolescents.506 The foundation also provides adolescent reproductive health services through youth-friendly facilities known as Teen HealthQuarters; capacity building for adolescents on health, sexuality, and development in colleges and universities; information and peer counseling on STIs, including HIV/AIDS; and support programs for Filipino youths.507 The Philippine NGO Council on Population, Health and Welfare, Inc., produces and implements reproductive health, family planning, population, and adolescent reproductive health learning modules for the Department of Education’s nonformal education accreditation and equivalency program.508 The Philippine Medical Women’s Association provides nationwide IEC and family planning programs for adolescents and youths.509 Other NGO projects are the Women’s Media Circle’s BODYTALK TV series and its multimedia advocacy campaign for young women known as XYZ, and the Remedios AIDS Foundation’s Youth Zone.510 C. POPULATION

The country’s annual population growth rate has declined from 3.0% in the 1960s511 to an average annual rate of 2.32% in the 1990s. The rate of growth over the past decade, which the government still considers to be high,512 is attributed to the slow pace of decline in the country’s TFR, from 4.1 lifetime births per woman in 1993 to 3.5 in 2003.513 In the early 1970s, the Philippine Population Program (which was at that time called the National Population Program) adopted a clinic-based approach to providing family planning services, but the rural population had poor access to such services because clinics were located mainly in urban areas.514 This approach was modified by the Total Integrated Development Approach (1975) and the National Population Family Planning Outreach Program (1977), which utilized a community-based approach to integrate family planning services with other development activities in rural areas.515 In the late 1980s, the Philippine Population Program underwent another notable transformation by adopting a quality-of-life approach, in lieu of a strict population-reduction approach, which included family formation, the status of women, maternal and child health, child survival, and mortality and morbidity as key considerations.516 Laws and policies In the 1990s, the Philippine Population Program adopted the Population and Sustainable Development Framework,517 which recognizes the interconnectedness between population levels, resources, and the environment, and aims to balance them. This approach takes into consideration how fertility,

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mortality, and migration affect population size, structure, and distribution, and how population growth affects the government’s ability to provide basic services such as education, health, and employment.518 The PPMP, under the guidance of the Population and Sustainable Development Framework, seeks to fulfill the reproductive health and family planning needs of Filipino citizens in order to facilitate the country’s development and improve citizens’ quality of life.519 The PPMP Directional Plan (2001–2004) identifies four major areas of concern: reproductive health and family planning; adolescent health and youth development; population and development integration; and resource generation, programming, and mobilization.520 It enumerates the following important objectives: ■ help couples and parents achieve their desired family size within the context of responsible parenthood for sustainable development; ■ improve the reproductive health of individuals, and reduce maternal, infant, and under-five mortality; and ■ develop policies for sustainable development through balancing population distribution, economic activities, and the environment.521 To achieve these objectives, the program utilizes the following strategies: ■ providing information and services to assist families in achieving their desired family size through the Responsible Parenthood/Family Planning Program; advocating for reproductive health and family planning issues and gender equity; and designing strategies to increase male responsibility in reproductive health and family planning; ■ ensuring the accessibility of reproductive health and population IEC activities and services for adolescents; ■ integrating population variables into national, regional, and local development policies, plans, and programs, as well as advocating for their integration; and ■ mobilizing budgetary allocations, private-sector partnerships, NGOs, and donor agencies to make the PPMP financially sustainable.522 Implementing agencies The main government agency tasked with addressing population concerns is POPCOM, under the Department of Health.523 POPCOM, founded in 1971 through Republic Act No. 6365, the Population Act of the Philippines, is the primary government body that deals with population issues,524 although subsequent revisions to the act have created a larger role for input from public and private orga-

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nizations and individuals with respect to diverse religious beliefs and values.525 POPCOM operates under the leadership of a 14-member Board of Commissioners, which represents both the public and private sectors.526 The central office of POPCOM is headed by the Office of the Executive Director; the technical and support services divisions of this office manage the population program on a national level, while 15 regional POPCOM offices are in charge of regional operations.527 Responsibility for the oversight of POPCOM has changed hands several times over the years. In 1987, the commission was transferred from the Office of the President to the Department of Social Welfare and Development,528 where government funding for family planning services was effectively frozen because of the department’s failure to prioritize the family planning program.529 Consequently, in 1988, the Department of Health took over responsibility for implementing family planning services, while POPCOM retained its focus on coordinating population and development issues.530 In June 1990, POPCOM was transferred back under the Office of the President,531 and then in 1991, to the National and Economic and Development Authority.532 Finally, in March 2003, it was again transferred to the Office of the President and placed under the control and supervision of the Department of Health.533 The reason cited for this move was “to facilitate coordination of policies and programs relative to population….”534 Since the health care devolution policy was instituted in 1991, LGUs have assumed a prominent role in the development and implementation of population programs and projects. The LGUs’ work includes strengthening local population offices, and identifying, generating, and allocating resources for local population programs.535 An important aspect of POPCOM’s current mandate is to ensure “high quality professional development programs for Population, Responsible Parenthood and Reproductive Health, which will enhance the competencies and strengthen the capability of LGUs,” thereby “[e]nabling men, women, couples and families to make responsible decisions to meet their expressed needs in timing, spacing and number of children.”536 Thus, POPCOM functions as a technical and information resource provider for LGUs (i.e., it identifies, generates, and allocates resources); as an advocate for strategic partnerships and policies for the Philippine Population Program; and as the coordinating, supervising, and evaluating agency for LGUs that implement population programs and projects.537

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III. Legal Status of Women and Girls The health and reproductive rights of women and girls cannot be fully understood without taking into account their legal and social status. Laws relating to their legal status not only reflect societal attitudes that shape the landscape of reproductive rights, they directly impact their ability to exercise these rights. A woman or adolescent girl’s marital status, her ability to own property and earn an independent income, her level of education, and her vulnerability to violence affect her ability to make decisions about her reproductive and sexual health and to access appropriate services. The following section describes the legal status of women and girls in the Philippines. A. RIGHTS TO EQUALITY AND NONDISCRIMINATION

The constitution guarantees that “[n]o person shall be deprived of life, liberty or property without due process of law, nor shall any person be denied equal protection of the laws.”538 In its Declaration of Principles and State Policies, the constitution provides that the state “values the dignity of every human person and guarantees full respect for human rights.”539 It also “recognizes the role of women in nationbuilding, and shall ensure the fundamental equality before the law of women and men.”540 The 1992 Women in Development and Nation Building Act further assures women the “rights and opportunities equal to that of men.”541 To this end, the state is obliged to allocate a “substantial portion” of official development assistance funds for women’s programs and activities;542 to ensure that women benefit from and participate directly in development programs and projects;543 and to remove gender bias in government agency regulations, directives, and procedures.544 The act guarantees women the right to enter into contracts;545 to become a member of any club or other public organization;546 and to equal opportunities for appointments, admission, training, graduation, and commissioning in all military schools.547 In the case of full-time homemakers, the act provides for insurance or social security coverage of up to onehalf of the salary and compensation of the working spouse, with the working spouse’s consent.548 The Indigenous Peoples Rights Act of 1997 provides that women from indigenous communities shall have equal social, economic, political, and cultural rights and opportunities as men in their communities.549 It affords “due respect and recognition” for the participation of indigenous women in all levels of decision-making and the development of society.550

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The act also legally guarantees full access to education, maternal and child health care, health and nutrition, and housing services, as well as vocational, technical, professional, and other forms of training for indigenous women.551 In addition, several national policies seek to ensure women’s equality, particularly within the area of development. The Philippine Plan for Gender-Responsive Development (PPGD) for 1995–2025 is the government’s 30-year blueprint formulated to guide policies, programs, and projects for “pursuing full equality and development for women and men.”552 The plan envisions development that is “equitable, sustainable, and free from violence, respectful of human rights, supportive of self-determination and the actualization of human potentials, and participatory and empowering.”553 The PPGD incorporates the goals of the Beijing Platform of Action and seeks to eliminate gender-based discrimination, and focuses on the advancement and empowerment of women as a disadvantaged group.554 It sets forth a collaborative strategy between government, NGOs, and the private sector555 to achieve its gender-related goals,556 which all government agencies and entities at the national, subnational, and local levels are required to fully implement.557 The Framework Plan for Women 2001–2004 is an interim program within the context of the PPGD that sets forth “more specific, doable and results-focused” strategies and interventions than the PPGD.558 This plan has focused on the three following priorities: ■ the economic empowerment of women (through measures such as enhancing their access to capital, markets, information, and technology; offering women skills training; ensuring equal treatment of women workers; and giving women greater participation in economic decision-making bodies); ■ the protection and fulfillment of women’s human rights (by strengthening delivery of basic social services; instituting an effective judicial system for survivors of violence against women; and enacting antidiscrimination legislation); and ■ gender-responsive governance (through encouraging “active and meaningful” participation of women in decision-making bodies, and the proper utilization of the gender and development budget).559 The Implementing Rules and Regulations for the Women in Development and Nation Building Act (1992) directs all government agencies to allocate 5–30% of foreign and domestic official development assistance funds for programs and activities for women.560 This was later modified by the 1998 General Appropriations Act, which ordered all government agencies and instrumentalities, including LGUs, to set aside a minimum of 5% of their total appropriations, not just of official development

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funds, for gender and development programs and projects.561 Formal institutions and policies The National Commission on the Role of Filipino Women (NCRFW), created in 1975 by presidential decree, is the main governmental body focused specifically on women’s affairs under the Office of the President.562 The NCRFW, in coordination with the National Economic Development Authority, is responsible for monitoring various government agencies’ implementation of the PPGD for 1995–2025,563 and conducts periodic assessments and updates to the plan.564 Pursuant to its mission, the NCRFW is authorized to issue orders, circulars, or guidelines and to constitute appropriate interagency committees.565 In addition to its monitoring functions, the NCRFW is responsible for ensuring the gender-responsiveness of national development plans, as well as for coordinating the preparation, assessment, and updating of the 1989–1992 Philippine Development Plan for Women and ensuring its effective implementation.566 The Planning, Monitoring and Evaluation Division of the NCRFW has a specific mandate to monitor and assess national implementation and compliance with international treaties and policy documents on women, such as CEDAW and the Beijing Platform for Action.567 It fulfills this obligation by being part of a multiagency mechanism for monitoring and implementing the country’s international obligations. The NCRFW is a member of a working group on Economic, Social, and Cultural Rights within the Inter-agency Coordinating Committee on Human Rights, which monitors implementation of CEDAW and other treaties, and prepares government responses to issues involving economic, social, and cultural rights, including those arising from the promotion and protection of women’s rights.568 The Philippine Commission on Human Rights was created by the 1987 constitution.569 The commission performs a number of important functions, which include monitoring the government’s compliance with international treaty obligations on human rights.570 In collaboration with the Interagency Coordinating Committee on Human Rights created in 1997,571 the commission responds to urgent requests for information about human rights violations allegedly committed in the country and prepares up-to-date and comprehensive reports for timely submission to United Nations human rights treaty monitoring bodies.572 The task of monitoring the progress of the PPGD for 1995– 2025 and the status of women generally has been enhanced by a conscious effort in government to generate gender statistics. The Women in Development and Nation Building Act (1992) instituted a sex-disaggregated national data collection system for both monitoring and programming purposes.573 The

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National Statistical Coordination Board has also enjoined all agencies to promote gender concerns in the generation of statistics.574 Currently pending in Congress is House Bill No. 2051, which aims to “ensure that the rights of persons discriminated against shall be protected and respected” and creates an antidiscrimination board to that end.575 The bill further provides that it will be the policy of the state “to work actively for the elimination of all forms of discrimination that offends the equal protection clause of the Bill of Rights and the State obligations under human rights instruments acceded to by the Republic of the Philippines, particularly those discriminatory practices based on sex or sexual orientation.” 576 Homosexual activity is not an offense under Philippine law. However, there is currently no law explicitly protecting homosexuals from discrimination or recognizing and promoting their particular rights. Non-discrimination on the basis of sexual orientation Since the mid-1990s, a number of legislative efforts have sought to protect the rights of homosexuals. Among recent bills is the Anti-discrimination Act passed by the House of Representatives in 2004, which prohibits discrimination based on sexual orientation in areas such as employment, education, health services, public service (including military service), and commercial and medical establishments.577 Also, a bill is pending in the House of Representatives that penalizes the discriminatory acts defined above.578 B. CITIZENSHIP

Article IV of the constitution sets out the particulars of citizenship. Philippine citizenship is conferred automatically to those whose fathers or mothers are citizens of the Philipinnes; in addition, it may be acquired by those born to Filipino mothers before January 17, 1973 who elect to obtain citizenship upon attaining the age of majority.579 C. MARRIAGE

The constitution recognizes the family as the foundation of the nation,580 and affords state protection to the “inviolable social institution” of marriage, which serves as the foundation of the family.581 The constitution also mandates the state to defend “the right of spouses to found a family in accordance with their religious convictions and the demands of responsible parenthood.”582 In general, marriages and family relations in the Philippines are governed by the Family Code and the Civil Code. If both parties are Muslims, the Code of Muslim Personal Laws applies.583 If only the male party is a Muslim, the code will apply upon both parties’ agreement.584 Provisions in the Family Code and other laws recognize

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the customary laws and practices of indigenous peoples. The Indigenous Peoples Rights Act recognizes the rights of indigenous groups to use “their own … customary laws and practices within their respective communities and as may be compatible with the national legal system and with internationally recognized human rights.”585 The Family Code provides that Muslims and members of ethnic cultural communities may be exempt from the requirement of a marriage license, so long as these marriages are solemnized according to the communities’ customs, rites, or practices.586 The Family Code states that “[m]arriage is a special contract of permanent union between a man and a woman entered into in accordance with law for the establishment of conjugal and family life.”587 Two essential requisites for marriage are the legal capacity of the contracting parties and voluntary consent before a solemnizing officer.588 In addition, the marriage must be solemnized before an authorized official,589 with at least two witnesses of legal age, and the parties must obtain a valid marriage license.590 The absence of any of these requisites renders the marriage void.591 Any individual at or above the age of 18 may contract marriage in accordance with the law.592 A marriage between individuals aged 18–21 who have never been married requires written parental consent;593 without such consent it may be annulled.594 (Individuals aged 21–25 intending to marry are legally obligated to seek parental “advice.”595) Both parties involved in a marriage requiring parental consent must undergo marriage counseling.596 In the absence of these two prerequisites, the issuance of the marriage license is suspended for three months.597 No marriage license is required for the marriage between a man and a woman who have lived together as husband and wife for at least five years, and who have no legal impediment to marry each other.598 The Family Code requires that a husband and wife live together; observe mutual love, respect, and fidelity; and render mutual help and support.599 The code prescribes an obligation of support between spouses, legitimate ascendants and descendants, parents and their children, and legitimate brothers and sisters.600 A spouse who in bad faith refuses to comply with these obligations may be held liable for damages under the Civil Code.601 Spouses are jointly responsible for deciding the location of the family residence,602 supporting their family using their communal property or the income from their separate properties,603 and managing their household.604 Either spouse may also engage in a profession without the consent of the other, but either spouse may object to the other’s profession on “valid, serious and moral grounds.”605 The Family Code prescribes monogamy, and bigamous

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marriages are voidable and illegal; bigamy is punishable with imprisonment of 6–12 years.606 In addition, the code prohibits marriages among blood relatives (ascendants, descendants, and siblings), collateral relatives (up to the fourth civil degree), relatives by marriage (affinal relatives within the third degree, stepparents, and stepchildren), and relatives by adoption.607 The Revised Penal Code criminalizes certain acts of marital infidelity and prescribes different degrees of punishment for men and women. A married woman is considered guilty of adultery upon engaging in sexual intercourse with a man other than her husband;608 she may be punished with two to six years of imprisonment.609 A married man is guilty of the crime of concubinage if he keeps his mistress in the conjugal dwelling, has sexual intercourse with a woman who is not his wife under “scandalous circumstances,” or cohabits with the woman in any other place.610 Men found guilty of concubinage are penalized with imprisonment of six months to four years.611 A bill aiming to correct the disparity between the treatment of husbands and wives in the matter of marital infidelities is currently pending in the House of Representatives.612 There is no legal recognition of marriage or partnership between individuals of the same sex.613 Marriage between Muslims Marriages between Muslims are regulated under the Code of Muslim Personal Laws, and the requisites for a valid Muslim marriage are the legal capacity to marry, freely given consent, an offer (ijab) and an acceptance (gabul), and a stipulation of customary dower (mahr).614 Muslim males age 15 and above and Muslim females who have reached puberty, presumed to be at age 15, may marry.615 Muslim females who attain puberty between the ages of 12 and 15 may marry upon petition by their guardian (wali) to the Sharia district court.616 Such a marriage, however, is regarded as a betrothal and may be annulled upon the petition of either party within four years after he or she has reached puberty, provided no voluntary cohabitation has taken place and the wali who contracted the marriage was anyone other than the girl’s father or paternal grandfather.617 Echoing the Family Code, the Code of Muslim Personal Laws also provides that husband and wife must live together and observe mutual love, respect, and fidelity, and render mutual help and support.618 The husband decides the location of the family residence, but the wife is not compelled to live with her husband if her dower is not satisfied as stipulated, or if the conjugal residence does not match her social standing or is unsafe for her family or property.619 The wife manages household affairs and purchases necessities for the family with her husband’s income,620 and is entitled to support during the marriage.621 The wife may engage in a profession or business with the consent of her husband, but only if such profession or

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business is in accordance with Islamic modesty and virtue.622 The code recognizes that men are permitted to have multiple wives under Islamic law, but advises that a man should practice monogamy “unless he can deal with them with equal companionship and just treatment…and only in exceptional cases.”623 The Code of Muslim Personal Laws prohibits marriages among parties of consanguinity (ascendants, descendants, and siblings within the third degree), of affinity (affinal relatives within the third degree, stepparents, and stepchildren), and of fosterage.624 D. DIVORCE

There is no specific divorce law for non-Muslims in the Philippines, but the Family Code outlines provisions for legal separation, marriage annulment, and declaration of nullity.625 Marriages may be declared null and void from the inception where there is bigamy or polygamy,626 incest,627 psychological incapacity to comply with the essential marital obligations,628 or an underage (below 18 years of age) spouse, even when the marriage had the consent of parents or guardians.629 A marriage may be annulled if the following grounds existed at the time of the contract: ■ lack of written parental consent for those marrying who are aged 18–21; ■ unsoundness of mind of either party; ■ consent by either party was obtained through fraud, force, intimidation, or undue influence;630 ■ physical incapacity to consummate the marriage; or ■ affliction with a serious and incurable STI.631 The concealment of either partner’s homosexuality or the wife’s pregnancy by a man other than her husband at the time of the marriage constitute fraud632 and may be grounds for the annulment of the marriage.633 A judicial annulment pronounced by a court enables either party to remarry.634 The Family Code also provides that when a foreigner enters into a valid marriage with a Filipino citizen and subsequently obtains a divorce enabling the foreign spouse to remarry, the Filipino spouse also gains the capacity to remarry under Philippine law.635 The law creates certain restrictions on the ability of women to remarry. A “divorced”636 woman who remarries within 301 days of the annulment or dissolution of her marriage, or before the date of her delivery if she is pregnant by her exhusband, may be punished with one to six months’ imprisonment and a fine.637 A widow faces the same penalty if she remarries within 301 days of the death of her husband, or before having delivered if she was pregnant at the time of her husband’s death.638 Since December 2004, a bill has been

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pending in the House of Representatives bill that seeks to abolish this penalty and allow “divorced” or widowed women to remarry within 40 days of the date of the dissolution or annulment, or the husband’s death.639 The Family Code also provides for legal separation, a petition for which may be filed on a number of grounds, including the following: ■ repeated physical violence or gross abuse against the petitioner, or against a common child or a child of the petitioner; ■ attempts to connive the petitioner, a common child, or a child of the petitioner to engage in prostitution; ■ conviction of the respondent to more than six years’ imprisonment, even if pardoned; ■ drug addiction or habitual alcoholism of the respondent; ■ lesbianism or homosexuality of the respondent; ■ subsequent contract by the respondent in a bigamous marriage, whether in the Philippines or abroad; ■ sexual infidelity or perversion; ■ attempt by the respondent against the life of the petitioner; or ■ unjust abandonment for more than one year.640 While legal separation entitles the couple to live separately from each other, the marital bond is not severed and thus neither party is permitted to remarry.641 During proceedings for legal separation or annulment, the Family Code provides that spouses and their children are supported by the properties of the “absolute community” (all common property between both spouses)642 or the conjugal partnership.643 After a final judgment granting the petition for legal separation or annulment of marriage, the obligation of mutual support between the spouses ceases.644 The court may order the guilty spouse in the proceedings for legal separation to support the innocent spouse, specifying the terms of such an order.645 The amount of support may be adjusted on the basis of the needs of the recipient and the resources of the payer.646 Divorce laws governing Muslims Under the Code of Muslim Personal Laws, Muslims married under its provisions may divorce “only after the exhaustion of all possible means of reconciliation between the spouses.”647 A Muslim divorce may be performed in different ways, depending upon the circumstances.648 A divorce by talaq may be effectuated with a husband’s single verbal or written repudiation of his wife.649 The husband has the right to revoke his repudiation within the prescribed waiting period (idda)650 by resuming cohabitation with his wife, provided that such repudiation occurs only once or twice.651 Otherwise, the repudiation becomes irrevocable (talaq bain sugra).652

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In cases of ila, the wife may obtain a judicial decree of divorce after due notice and a hearing where the husband has kept a vow to abstain from sexual relations with his wife for a period of at least four months.653 Divorce by zihar, or injurious assimilation, occurs when the husband likens his wife to his mother, sister, or any relative within the third degree.654 A husband who makes such statements must complete the prescribed expiation, or acts of redemption,655 before resuming sexual relations.656 The wife may ask the court to order her husband to perform these redeeming acts; alternatively, she may petition for a divorce if the husband refuses to comply, without prejudice to her right to other appropriate remedies.657 Divorce by li’an may be granted if a husband accuses his wife of adultery in a court and provides witnesses to the adultery, or swears to the truth of his testimony. 658 In divorce by khul, a woman may petition for a judicial decree of divorce after having offered to return or renounce her dower, or pay any other lawful consideration for her release from the marriage bond.659 Divorce by tafwid is possible if a wife invokes the right to divorce delegated to her by her husband at the time of the marriage ceremony or thereafter.660 The wife’s delegated right is equally as effective as her husband’s right.661 In divorce by faskh, a wife may petition the court for a decree of divorce on certain specific grounds, including the following: ■ the husband’s neglect or failure to provide support for the family for at least six consecutive months; ■ the husband’s impotence; or ■ the husband’s insanity or affliction with an incurable disease that would make continuance of the marriage injurious to the family.662 In addition, the court may grant the wife a decree of faskh on the ground of unusual cruelty by the husband, which is defined as the following: ■ the wife is the habitual object of her husband’s mental or physical cruelty; ■ the husband associates with persons of ill repute, leads an infamous life, or attempts to force his wife to live an immoral life; ■ the husband compels his wife to dispose of her exclusive property or prevents her from exercising her legal rights over it; ■ the husband obstructs his wife’s observance of her religious practices; or ■ the husband does not treat his wife “justly and equitably as enjoined by Islamic law.”663 As soon as the divorce is effectuated, the marriage bond

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is severed and the spouses may contract another marriage in accordance with the Code of Muslim Personal Laws.664 A divorced or widowed woman may generally not remarry unless she has observed a prescribed waiting period of idda, counted from the date of divorce or the husband’s death, as the case may be.665 If a woman is pregnant at the time of divorce or her husband’s death, she can remarry only after delivery of the child.666 The code fines any widow or divorced woman married under Muslim law who remarries before the expiration of the prescribed idda with up to 500 pesos (USD 9).667 Under the code, divorcing Muslim women have a right to support throughout the idda668 and until delivery if the wife is pregnant at the time of the separation.669 Any divorced nursing mother who continues to breast-feed her child is entitled to receive support until the time of weaning.670 The husband remains obligated to support his wife even if his resources are so reduced that he cannot support her without neglecting his own needs and those of his family.671 Furthermore, the wife is entitled to her entire dower from her husband if the divorce was effectuated after the marriage was consummated, or to one-half of her dower if the divorce occurred before consummation.672 Parental rights Parental authority is shared between spouses over their common children, but in cases of disagreement, the husband’s decision prevails, unless there is a judicial order to the contrary.673 A similar provision exists in the Code of Muslim Personal Laws.674 In case the parents are divorced, parental authority is exercised by the parent who is designated by the court.675 If the parents are legally separated and the separation is granted because of an act of bad faith by one spouse, the “innocent” spouse receives custody of the minor children.676 Several statutes mandate that children under age seven may not be separated from their mother in the absence of “compelling reasons”;677 the Supreme Court has held that such reasons include the mother being guilty of or responsible for the following: ■ neglect, abandonment,678 or maltreatment of the child;679 ■ unemployment or immorality;680 ■ habitual drunkenness681 or drug addiction;682 ■ insanity; or ■ affliction with a communicable disease.683 Generally, courts give paramount consideration to the welfare and best interests of the child.684 Pursuant to the AntiViolence Against Women and Their Children Act of 2004, a woman who is a victim of domestic violence is entitled to the custody and support of her children.685 The Code of Muslim Personal Laws states that mothers

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shall be given the care and custody of children under the age of seven in the event of the parents’ divorce.686 Prepubescent children aged seven and older may choose which parent they wish to reside with.687 Unmarried daughters who have reached the age of puberty at the time of the divorce remain with the father, while unmarried sons who have reached puberty remain with the mother.688 E. ECONOMIC AND SOCIAL RIGHTS

Ownership of property and inheritance The constitution provides that “no person shall be deprived of … property without due process of law.”689 It enjoins the government to give highest priority to enacting legislation for the protection and enhancement of people’s rights, and to remove social, economic, and cultural imbalances by equitably distributing wealth and political power for the common good.690 To that end, the constitution requires the state to regulate the acquisition, ownership, use, and disposal of property and income derived from property.691 The Indigenous Peoples Rights Act of 1997 requires the state to protect the rights of indigenous cultural communities and peoples to their ancestral domains, and to recognize their customary laws in matters of property rights and issues of ownership and the extent of ancestral domain.692 It further provides that indigenous peoples are entitled to special measures to improve their economic and social conditions. The act makes special mention of indigenous women, youth, and children as needing particular attention.693 The property rights of married Filipinos are governed in the following order: by prenuptial agreements executed before marriage, by provisions in the Family Code of the Philippines, and by local custom.694 In the absence of a prenuptial agreement, or in cases where the arrangement agreed upon is void, the principle of “absolute community property” applies,695 and both spouses jointly administer and share ownership over all property that was owned by the spouses at the time of marriage or acquired thereafter (the “community property”).696 Property rights in marriages contracted prior to the enactment of the Family Code (i.e., before August 4, 1988) are governed under the system of “conjugal property of gains.”697 Pursuant to this earlier regime, each spouse has exclusive ownership of certain types of property, including property that is: ■ brought to the marriage as his or her own; ■ acquired during the marriage by gratuitous title; ■ acquired by barter or exchanged with property belonging to only one of the spouses; or ■ purchased with the exclusive money

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of the wife or the husband.698 Conjugal partnership property includes property acquired during the marriage that was paid for by the married couple’s common funds; property that was obtained from the labor or profession of either or both spouses; the gains received from the couple’s common property; and the net gains from the exclusive property of each spouse.699 In cases of disagreement over the administration or enjoyment of community or conjugal property, the husband’s decision prevails.700 However, the wife may contest the decision in court within five years from the date of the contract implementing the husband’s decision.701 The Family Code also provides for property rights in unions outside of marriage.702 A woman and man who have the legal capacity to marry and who live exclusively with each other as husband and wife are equal co-owners of the wages, salaries, and property they acquire through their work or industry.703 Unless there is proof otherwise, property acquired during their cohabitation is presumed to be obtained through their joint efforts, and is owned by them in equal shares.704 The efforts of one party in the care and maintenance of the family is regarded as equal contribution to the acquisition of property.705 In unions between a man and a woman who lack the legal capacity to marry and do not cohabit exclusively with each other, the parties have common ownership only over property acquired by both parties, in proportion to their respective contribution to the acquisition of such property.706 In the absence of proof to the contrary, their contributions and corresponding shares are presumed to be equal.707 Under the Family Code, a minor can own property, but his or her parents jointly exercise legal guardianship over the property until the minor reaches the age of majority (age 18).708 In matters of inheritance, the Civil Code provides that female and male heirs inherit equally.709 Laws governing Muslims The Code of Muslim Personal Laws provides for exclusive property ownership in the absence of any prenuptial agreement stipulating the contrary.710 Under the code, the wife retains ownership and administration of all properties brought by her to the marriage,711 and may own, possess, administer, enjoy, and dispose of her exclusive estate without the consent of her husband.712 However, the husband’s consent is required in order for the wife to acquire property by gratuitous title, “except from her relatives who are within the prohibited degrees in marriage.”713 In matters of inheritance, the code provides that a surviving husband has a greater share in the inheritance estate than does a surviving wife,714 and that sons are entitled to double

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the share of daughters.715 Upon divorce, the spouses lose their mutual rights of inheritance.716 Rights to agricultural land The Comprehensive Agrarian Reform Law of 1988 stipulates that qualified rural women have equal rights as men to land ownership, shares in agricultural production, and representation in advisory and decision-making bodies.717 Labor and employment The number of women employed in major industries has steadily increased recently, rising to an estimated 11.8 million women in 2001718 from 9.13 million women in 1995.719 The vast majority of women are employed in three major industry groups: shop and market sales (including wholesale, retail, and repairs); agriculture (including hunting and forestry); and manufacturing.720 Approximately 1.8 million women (compared with 1.3 million men) are employed as officials of government and special interest organizations, corporate executives, managers, managing proprietors, and supervisors; an additional estimated 1.4 million women (compared with 1.2 million men) are service workers and shop and market sales workers.721 The Philippines is the second largest labor exporter in the world.722 Government statistics indicate that as of late 2003, about 3.4 million Filipinos were abroad solely for employment reasons.723 About 75% of all migrant workers are women,724 comprising 90% of all migrant workers in the service sector and 85% of all migrants in the professional and technical sectors.725 The constitution mandates the state to “afford full protection of labor, local and overseas, organized and unorganized, and promote full employment and equality of employment opportunities for all.”726 It guarantees the rights of all workers to “self-organization, collective bargaining and negotiations, and peaceful concerted activities, including the right to strike in accordance with law.”727 Workers are further entitled to “security of tenure, humane conditions of work, and a living wage.”728 The constitution also enjoins the state to protect working women by “providing safe and healthful working conditions, taking into account their maternal functions, and such facilities and opportunities that will enhance their welfare and enable them to realize their full potential in the service of the nation.”729 The Labor Code contains provisions prohibiting discrimination against female employees based on their sex, marital status, or pregnancy.730 Prohibited acts of sex-based discrimination include providing lesser pay or benefits to female employees than male employees for work of equal value,731 and favoring male employees over female employees solely on account of their sex in promotions, training opportunities, and study and scholarship grants.732 The code further prohibits

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employers from expressly or tacitly stipulating marital status (either single or married) as a condition for hiring or continued employment, and from dismissing female employees or discriminating against them in any way solely on account of their marital733 or pregnancy status.734 In the 1997 case Philippine Telegraph and Telephone Corp. v. National Labor Relations Commission, the Supreme Court held that an employer’s policy of disqualifying married women workers from employment “runs afoul of the test of, and the right against, discrimination, afforded all women workers by our labor laws and by no less than the Constitution.”735 The court further noted that such policy “assaults good morals and public policy, tending as it does to deprive a woman of the freedom to choose her status, a privilege that by all accounts inheres in the individual as an intangible and inalienable right.”736 As a means to protect women, labor laws generally prohibit certain types of work, such as night work for women.737 Exceptions to this rule include work done in response to emergency situations, urgent work required to avoid serious loss to the employer, work in the health and welfare sectors, and work in managerial or technical positions.738 The Social Security Act of 1997 and the Administrative Code of 1987 provide certain benefits and services for working pregnant women and mothers.739 In the private sector, employees are entitled to 60 days of fully paid maternity leave for their first four deliveries.740 In cases of cesarean delivery, employees may receive 78 days of fully paid maternity leave.741 In the government sector, female employees who have rendered an aggregate of at least two years of service are entitled to 60 days of maternity leave, irrespective of the number of their deliveries.742 These rules were amended in 2002 to afford all female employees, irrespective of marital status, maternity leave benefits.743 The Paternity Leave Act of 1996 provides that legally married male employees in the private and government sectors may receive seven days of paid paternity leave for each of their wife’s first four deliveries.744 The Labor Code requires employers to establish appropriate facilities for women in the workplace, such as separate toilets and dressing rooms, and nurseries.745 The code further requires employers who are required by law to maintain a clinic to provide free family planning services and counseling to their employees, including counseling regarding the use of contraceptives and IUDs, and to offer “incentive bonus schemes to encourage family planning among female workers….”746 The law also mandates that day care centers be established in every barangay to provide care for working women’s children up to age six.747 Access to credit The Women in Development and Nation Building Act

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(1992) states that women and men, regardless of marital status, have equal capacity to enter into contracts.748 As such, women can obtain loans and execute security and credit arrangements under the same conditions as men, and they have equal access to programs providing agricultural credit, loans, and nonmaterial resources.749 The law also mandates government financing institutions to provide loans to women who are, or wish to be, engaged in micro and cottage businesses.750 Any Filipino woman aged 18 and older, regardless of marital status, is eligible to apply for a loan, although existing businesses with assets above a specified amount receive priority.751 To ensure the availability of these loans, government financing institutions are required to set aside 5% of their loan portfolio for the implementation of this law.752 There are some obstacles to women’s legal right to access credit. In practice, banks usually require the husband’s consent for large loans requiring property as collateral.753 Women are also sometimes denied credit because they do not have negotiable property, as titles to land are usually in men’s names.754 Education Although literacy rates among Filipinos aged ten and older do not vary by gender (i.e., 93.7% among females and 94.0% among males),755 enrollment in elementary schools is slightly higher among boys (42.3%) than among girls (39.2%).756 The literacy rate is comparatively lower in the Autonomous Region of Muslim Mindanao (e.g., 71.4% among females and 75.6% among males).757 Gender differentials are clear in the choice of higher education courses, with a disproportionately high number of female students enrolled in education and teacher training courses; home economics; service trades; medicine and allied sciences; and the trade, craft, and industrial disciplines.758 Male students usually enroll in courses on engineering, technology, religion, and theology.759 In an article of the constitution devoted specifically to “Education, Science and Technology, Arts, Culture, and Sports,” the state is mandated to “protect and promote the right of all citizens to quality education at all levels of education and … take appropriate steps to make such education accessible to all.”760 It further requires the state to “[e]stablish and maintain a system of free public education in the elementary and high school levels,” and makes elementary education compulsory for all children of school age.761 In addition, the state is required to take the following measures: ■ establish and maintain a system of scholarship grants, student loan programs, subsidies, and other incentives to be made available to students in private and public schools, especially underprivileged students; ■ encourage nonformal, and indigenous learning systems, as well as self-learning, independent, and out-

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of-school study programs; and ■ provide adults, the disabled, and out-of-school youth with training in civics, vocational training, and other skills.762 The 1988 Free Public Secondary Education Act further mandates the government to provide free public secondary education to all qualified Filipino citizens and to promote quality education at all levels.763 The Education Act of 1982 governs formal and nonformal education, and establishes the rights and duties of parents, students, and schools.764 That act also reaffirms the government’s obligation to contribute to the financial support of educational programs and to adopt measures to broaden access to education through financial assistance and other forms of incentives.765 Women are further provided with free technical training in the operation of a micro or cottage business under the provisions of Republic Act No. 7882, titled An Act Providing Assistance to Women Engaging in Micro and Cottage Business Enterprises, and for Other Purposes, which was approved by the president of the Philippines on February 20, 1995.766 Since the 1960s, the government has undertaken measures to accelerate the educational advancement of Muslim Filipinos, who, along with indigenous groups, face particular obstacles to higher education.767 These measures include offering scholarships, funds, grants, and other privileges to Muslim Filipino students for elementary and higher education, and creating the Commission on National Integration to institute and widen programs that improve the welfare of Muslims.768 The Indigenous Peoples Rights Act guarantees the right of indigenous cultural communities and indigenous peoples to education as part of their right to “special measures for the immediate, effective and continuing improvement of their economic and social conditions.”769 The act calls for particular attention to be given to the rights and needs of indigenous women, elderly, youth, children, and persons with disabilities. Indigenous communities may exercise their right to education within the context of their cultures, customs, traditions, interests, and beliefs.770 Sex education In 1972, the Department of Education, then referred to as the Department of Education, Culture and Sports introduced PopEd in all public and private elementary and secondary schools.771 In 1996, the program was revitalized to cover a broad range of issues, including reproductive health and human sexuality. Population education is not taught as a single subject, but is integrated into the curriculum of other subjects.772 Currently, private elementary and secondary schools are no longer obligated to teach population education. The current population education curriculum is divided

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into the following four major components:773 ■ Family Life and Responsible Parenthood, which encourages delayed marriage, and discusses responsible sexual behavior, the need to plan family size rationally and responsibly, and the different family planning methods and their advantages and disadvantages;774 ■ Gender and Development, which discusses issues such as equal rights for women and men, changing gender roles, and women’s empowerment as a tool for self-enhancement and nation building;775 ■ Population and Reproductive Health, which promotes reproductive rights and discusses the importance of reproductive health care and threats to reproductive health;776 and ■ Population, Resources, Environment and Sustainable Development, which discusses the principles of sustainable development and the relationship between quality of life and sustainable development.777 The promotion of sex education is also supported by the PPMP, which specifically calls for the Department of Education to integrate reproductive health concepts and concerns into PopEd.778 The government has also introduced nonformal education programs that address the reproductive health of adolescents. Population Awareness and Sex Education is a population and sexuality education program administered by the Department of Social Welfare that specifically targets out-of-school youth.779 F. PROTECTIONS AGAINST PHYSICAL AND SEXUAL VIOLENCE

Rape Under the Anti-Rape Law of 1997, which amended the Revised Penal Code, rape is committed when a man has “carnal knowledge” of a woman under any of the following circumstances: ■ through force, threat, or intimidation; ■ when the woman is deprived of reason or is otherwise unconscious; ■ through fraud or grave abuse of authority; ■ when the woman is “demented”; or ■ when the woman is under the age of 12.780 The Supreme Court has further clarified that minimal vaginal contact is sufficient to constitute carnal knowledge under the crime of rape.781 Rape is also committed when any person, under any of the aforementioned circumstances, “insert[s] his penis into another person’s mouth or anal orifice, or any instrument or object, into the genital or anal orifice of another person.”782 Prior to

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the enactment of the Anti-Rape Law, rape was considered a crime against chastity and its definition was limited.783 Marital rape is considered a crime, but the wife’s forgiveness invalidates the criminal action or penalty; however, if the marriage is void ab initio, the crime or penalty still stands.784 The rapist may be absolved of criminal action or penalty if the victim enters into a legally valid marriage with him.785 Rape is penalized with either imprisonment of up to 30 years or death.786 The death penalty is imposed in the following circumstances: ■ the rape results in homicide;787 ■ the victim is under the custody of the police, military authorities, or any law enforcement or penal institution; ■ the rapist knows that he is infected with HIV or any other STI and transmits the virus or infection to the victim; ■ the rapist is a member of the Armed Forces of the Philippines or its paramilitary units, the Philippine National Police, or any law enforcement agency or penal institution taking advantage of his position to facilitate the rape; ■ the rapist knew of the religious vocation, pregnancy, mental disorder, or physical handicap of the victim at the time the rape was committed; ■ the victim is below seven years of age; ■ the victim suffers permanent physical mutilation or disability from the rape;788 or ■ the victim is below the age of 18 and the rapist is a parent, ascendant, stepparent, guardian, relative by consanguinity or affinity within the third degree, or the common-law spouse of the parent of the victim.789 The Revised Penal Code also provides criminal sanctions against acts of lasciviousness, which involve sexual assaults other than rape that are committed by any person against another person of either sex under the same circumstances as rape. Such acts are punishable with terms of imprisonment from six months and one day to six years.790 Punishments for rape are also prescribed by the Anti-Violence Against Women and Their Children Act of 2004.791 The penalties for committing rape against a wife, former wife, or women with whom the perpetrator shares or shared a sexual relationship or common child are fines of 100,000–300,000 pesos (USD 1,800–5,399), mandatory psychological or psychiatric treatment, and imprisonment or death.792 In addition, a House of Representatives bill entitled “An Act Strengthening Further the Right of Daughters against Incestuous Rape by Penalizing Mothers Who Refrain From

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Proceeding Against the Father-Rapists or Tolerate Its Commission” has been pending with the Committee on Justice since August 2001.793 Domestic violence The Philippines has no specific national law on domestic violence. However, the Family Courts Act of 1997, which established family courts, defines domestic violence against women as “acts of gender based violence that result, or are likely to result in physical, sexual or psychological harm or suffering to women; and other forms of physical abuse such as battering or threats and coercion which violate a woman’s personhood, integrity and freedom of movement.”794 When committed against children, domestic violence includes “the commission of all forms of abuse, neglect, cruelty, exploitation, violence, and discrimination and all other conditions prejudicial to their development.”795 Family courts have exclusive original jurisdiction over cases of domestic violence796 and the authority to issue restraining orders against the abuser in cases of violence among immediate family members living in the same domicile or household.797 The Anti-Violence Against Women and Their Children Act of 2004 penalizes a broad range of acts of violence against women and their children committed by current and former spouses or intimate partners.798 The act reaffirms the definition of domestic violence in the Family Courts Act of 1997, and recognizes the additional conditions of economic abuse (acts that make or attempt to make a woman financially dependent on the perpetrator), and harassment.799 Acts of violence against women and their children include, inter alia, the following: ■ causing, threatening, or attempting to cause physical harm to the woman or her child; ■ placing the woman or her child in fear of imminent physical harm; ■ compelling or attempting to compel the woman or her child to engage in conduct they have a right to desist from, or compelling them to desist from conduct they have a right to engage in; ■ restricting or attempting to restrict the freedom of movement or conduct of the woman or her child by force or threat of force, such as with physical or other harm or threat of such harm or intimidation (including depriving or threatening to deprive the woman or her child of custodial rights, access to family, financial support legally due, or legal rights), or preventing the woman from engaging in any legitimate profession or activity, or depriving access to her separate or conjugal money or properties; ■ inflicting or threatening to inflict physical harm on

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oneself for the purpose of controlling the woman’s actions or decisions; ■ causing or attempting to cause the woman or her child to engage in any sexual activity that does not constitute rape; ■ engaging in purposeful, knowing or reckless conduct, personally or through another, that alarms or causes substantial emotional or psychological distress to the woman or her child (including stalking, unlawful trespass, destruction of property, inflicting harm on pets, and any form of harassment or violence); or ■ causing mental or emotional anguish, public ridicule, or humiliation to the woman or her child.800 The act provides detailed mechanisms for effecting protection orders and other necessary relief for female victims of violence.801 In addition, victims who are found by the courts to be suffering from “battered woman syndrome” (defined in the act as a “scientifically defined pattern of psychological and behavioral symptoms found in women living in battering relationships as a result of cumulative abuse”) do not incur any criminal and civil liability for acts committed in response to the violence perpetrated on them, even if formal elements of self-defense, as prescribed by the Revised Penal Code, are absent.802 A victim suffering from battered woman syndrome is also not disqualified from having custody of her children, and under no circumstance may the custody of children be given to the perpetrator.803 The act also provides female and underage victims of violence the rights to be treated with respect and dignity, receive legal assistance from the Department of Justice or any public legal assistance office, obtain support services, have access to all legal remedies, be given support as provided for under the Family Code, and be informed of the rights and services available to them, including their right to apply for a protection order.804 Moreover, the act mandates the Department of Social Welfare and Development, and LGUs to provide victims with temporary shelter, counseling, psychosocial services, recovery and rehabilitation programs, and livelihood assistance; the act further specifies that the Department of Health shall provide medical assistance in these cases.805 The Rape Victim Assistance and Protection Act of 1998 established rape crisis centers in every province and city.806 In addition to the remedies prescribed under the Family Courts Act of 1997 and the Anti-Violence Against Women and Their Children Act of 2004, female victims may invoke provisions of the Revised Penal Code in cases of domestic violence.807 Additional recourse is available under the Family Code, which provides that repeated physical violence or grossly abusive con-

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duct may be cited as a ground for legal separation.808 Sexual harassment The Anti-Sexual Harassment Act of 1995 prohibits all forms of sexual harassment in employment, education, and training environments;809 sexual harassment is committed when a person in a position of power, influence, or moral authority over another person in such an environment demands, requests, or requires any sexual favor from the other, regardless of whether that favor is accepted.810 Convicted violators are penalized with a maximum of six months’ imprisonment, a fine, or both, depending on the discretion of the court;811 violators may face civil action for damages and other affirmative relief.812 An employer or the head of an academic or training institution who fails to take immediate action upon being informed by the victim of the sexual harassment may be held liable for damages.813 In 2001, the Civil Service Commission issued the Administrative Disciplinary Rules on Sexual Harassment Cases, which outline the definition of such cases and the procedures for investigating and resolving them in the public sector.814 The rules define the administrative offense of sexual harassment as “any unwelcome sexual advance, request or demand for a sexual favor, or other verbal or physical behavior of a sexual nature, committed by a government employee or official in a work-related, training or education environment.”815 Under the rules, a head of office who fails to investigate a properly filed complaint of sexual harassment within 15 days may be charged with neglect of duty.816 Penalties for persons found guilty of sexual harassment range from reprimand to dismissal, depending on the gravity of the offense.817 Although there have been no Supreme Court cases resulting from the Anti-Sexual Harassment Act, the court has decided labor cases involving sexual harassment.818 Furthermore, although some cases have been filed in the lower courts under the act, most of these have not resulted in a finding of a violation.819 Commercial sex work and sex-trafficking Prostitution is illegal in the Philippines. Imprisonment of 8–12 years may be imposed upon any person who engages in the business of or profits by prostitution, or who enlists the services of any other for the purpose of prostitution.820 Any person who prostitutes his or her current or former wives, intimate partners, or children violates the Anti-Violence Against Women and Their Children Act of 2004, and may be punished by fines, imprisonment, or death.821 Several pieces of proposed legislation concerning prostitution are pending in the Philippine Congress, including, among others, a resolution on Laws and Regulations Governing the Fight against Prostitution in All Forms, which was approved

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by the House of Representatives in May 2002 and referred to the Committee on Rules;822 and the Anti-Prostitution Act, which is currently before the House of Representatives, and has been pending in the Committee on the Revision of Laws since October 2004.823 Other House of Representatives bills addressing the definition of the crime of prostitution and penalties were also referred to the committee in 2004.824 Despite the illegality of prostitution in the Philippines, sex work nonetheless reportedly takes place in entertainment establishments as well as in designated neighborhoods.825 Women working as prostitutes in entertainment establishments are required to have a current “clean” health card from local health authorities to demonstrate that they are free of STIs and diseases.826 The lack of updated health cards among employees constitutes grounds for the closure of such establishments.827 The Anti-Trafficking in Persons Act of 2003 criminalizes specific acts such as the “recruitment, transportation, transfer or harboring, or receipt of persons,” for the purpose of exploitation and the promotion of such activities.828 The act prohibits all types of domestic and international trafficking for the purpose of exploitation, including trafficking by “threat or use of force, … coercion, abduction, fraud, deception, abuse of power or of position, taking advantage of the vulnerability of the person, … [and] the giving or receiving of payments or benefits to achieve the consent of a person having control over another person.”829 Exploitation is defined to include forced prostitution, sexual slavery, and other forms of sexual exploitation.830 The act specifically prohibits any type of trafficking in children or the disabled for the purpose of exploitation.831 Persons convicted of trafficking are subject to imprisonment of up to 20 years and a fine of one to two million pesos (USD 17,995–35,991).832 Persons found guilty of promoting trafficking may be sentenced to 15 years’ imprisonment and a fine of 500,000–1,000,000 pesos (USD 8,998–17,995).833 Trafficked persons are regarded as victims and are not penalized,834 but persons who buy or engage the services of trafficked persons for prostitution are penalized with community service, fines, or imprisonment.835 The act also created the Inter-agency Council against Trafficking,836 and it further directs various government agencies to establish and implement preventive, protective, and rehabilitative programs to provide specific mandatory services to trafficked persons.837 Sexual offenses against minors The Special Protection of Children against Child Abuse, Exploitation and Discrimination Act (1992) prohibits all forms of child-targeted abuse (i.e., physical, psychological, and sexual), neglect, cruelty, exploitation, and discrimination.838

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The act provides that sexual intercourse with a child below 12 years of age constitutes the crime of rape, and carries a penalty of death or imprisonment of 20–40 years.839 Other forms of sexual conduct with a child below the age of 12 are prosecuted under the crime of acts of lasciviousness, and are punishable by imprisonment of 15–18 years.840 In addition, the Revised Penal Code criminalizes sexual relations with girls over age 12 and under 18.841 More specifically, it prescribes punishments for “qualified seduction,” which is defined as a public authority figure or any person entrusted with the custody or the education of the victim inducing a female virgin between 12 and 18 years of age into having sexual intercourse.842 The crime is punishable by imprisonment of 6–50 months,843 or by imprisonment of 6–10 years if the victim is below 12 years of age.844 The code defines “simple seduction” as sexual intercourse obtained by means of deceit with a “single woman or a widow of good reputation” aged 12–18,845 which is punishable with a prison term of one to six months.846 The Special Protection of Children against Child Abuse, Exploitation and Discrimination Act (1992) specifically addresses child prostitution, and prescribes prison terms of 15–40 years for individuals who engage in, promote, facilitate, or induce child prostitution;847 have sexual intercourse or other sexual conduct with a child exploited in prostitution or subjected to other sexual abuse;848 or derive profits or advantages from child prostitution.849 Attempted involvement in child prostitution, whether as a procurer or a client,850 is subject to imprisonment of 6–12 years.851 The act prescribes longer terms of imprisonment if the child prostitute is under 12 years of age.852 Child trafficking is specifically prohibited by the Special Protection of Children against Child Abuse, Exploitation and Discrimination Act. Any person who engages in “trading and dealing with children, including … buying and selling of a child for money, or for any other consideration, or barter” may be punished by imprisonment of 12–30 years, with the maximum penalty imposed if the victim is below 12 years old.853 Attempted child trafficking is also punishable under the act by six months to six years of imprisonment.854 Acts of attempted child trafficking include, inter alia, sending a child alone to a foreign country without valid reason or parental consent;855 the alteration of birth record data by medical personnel or civil officials for the purpose of aiding child trafficking;856 and the recruiting of women, couples, or low-income families to bear and surrender their child for the purpose of child trafficking.857

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ENDNOTES 1. See Central Intelligence Agency (CIA), U.S. Government, Philippines, in The World Factbook (2005), http://www.cia.gov/cia/publications/factbook/geos/rp.html (last visited May 4, 2005) [hereinafter CIA World Factbook]. 2.U.S. Department of State, Background Notes: Philippines (2004), http://www. state.gov/r/pa/ei/bgn/2794.htm (last visited May 4, 2005) [hereinafter U.S. Department of State Background Notes]. 3. Id. 4. Id.; Federal Research Division, Library of Congress, Philippines: A Country Study, ch. 1, Spanish-American War and Philippine Resistance, Outbreak of War 1898 (Ronald E. Dolan ed., 1991), http://lcweb2.loc.gov/frd/cs/phtoc.html (last visited May 4, 2005) [hereinafter Library of Congress Country Studies, Philippines]. 5. U.S. Dep’t of State Background Notes, supra note 2. The Malolos Constitution was subsequently promulgated on January 21, 1899 and inaugurated Aguinaldo as its president two days later. Library of Congress Country Studies, Philippines, supra note 4, ch. 1, The Malolos Constitution and the Treaty of Paris. 6. U.S. Dep’t of State Background Notes, supra note 2. A war of resistance against U.S. rule started the Philippine-American War in 1899 led by Revolutionary President Aguinaldo until it gradually died out upon his capture and oath of allegiance to the United States in 1901. Id. The Treaty of Paris included the cession of the Philippines, Guam, and Puerto Rico to the United States while Cuba was granted independence. Library of Congress Country Studies, Philippines, supra note 4, ch. 1, The Malolos Constitution and the Treaty of Paris. 7. See U.S. Dep’t of State Background Notes, supra note 2. 8. Id. The Philippines gained its independence under the Tydings-McDuffie Act. Id. 9. Id. 10. Id. 11. Id. 12. Id. Marcos used a provision of the 1935 constitution to declare martial law. Id. He shut down Congress and most newspapers, jailed his political opponents, assumed dictatorial powers, and ruled by presidential decree. Library of Congress Country Studies, Philippines, supra note 4, ch. 1, Proclamation 1081 and Martial Law. 13. See U.S. Dep’t of State Background Notes, supra note 2. 14. Id. Aquino was shot in the head and killed as he was escorted off an airplane at Manila International Airport by the Aviation Security Command. Library of Congress Country Studies, Philippines, supra note 4, ch. 1, From Aquino’s Assassination to People’s Power. 15. EDSA stands for “Epifanio de los Santos Avenue,” a ring road around Manila that was the site of the EDSA Revolution. Library of Congress Country Studies, Philippines, supra note 4, Glossary. 16. CIA World Factbook, supra note 1. 17. U.S. Dep’t of State Background Notes, supra note 2. 18. See id. 19. Id. 20. Id. 21. Id. 22. Id. 23. Id. 24. CIA World Factbook, supra note 1. 25. Muslim insurgency groups include the Moro Islamic Liberation Front and the Abu Sayyaf Group. Communist groups include the New People’s Army, which is the military arm of the Communist Party of the Philippines. See Wikipedia,The Free Encyclopedia, Moro Islamic Liberation Front, http://en2.wikipedia.org/wiki/Moro (last visited May 4, 2005); see also Who are the Abu Sayyaf?, BBC News, Dec. 30, 2000, http://news.bbc.co.uk/2/hi/asia-pacific/719623.stm (last visited May 4, 2005); Library of Congress Country Studies, Philippines, supra note 4, National Security. 26. See United Nations Populations Fund,The State of World Population 2004 107 (2004). The total population is projected to be 87.8 million as of July 2005. CIA World Factbook, supra note 1. UNFPA estimates that the projected population of the Philippines will be 127 million by 2050. United Nations Populations Fund, supra, at 107. 27. The World Bank, GenderStats, Summary Gender Profile (estimates for 2000), http://genderstats.worldbank.org (last visited May 4, 2005). 28. CIA World Factbook, supra note 1; U.S. Dep’t of State Background Notes, supra note 2. 29. U.S. Dep’t of State Background Notes, supra note 2. 30. See CIA World Factbook, supra note 1. 31. U.S. Dep’t of State Background Notes, supra note 2; Bureau of Democracy, Human Rights, and Labor, U.S. Department of State, Philippines Country Report on Human Rights Practices 2004, http://www.state.gov/g/drl/rls/ hrrpt/2004/41657.htm (last visited May 4, 2005). 32. See CIA World Factbook, supra note 1. 33. United Nations, List of Member States, http://www.un.org/Overview/unmember.html (last visited May 4, 2005). 34. Association of Southeast Asian Nations, Member Countries, http://www. aseansec.org/74.htm (last visited May 4, 2005). 35. Asia-Pacific Economic Cooperation, Member Economies, http://www.apecsec. org.sg/apec/member_economies.html (last visited May 4, 2005).

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36. The Non-Aligned Movement, Member States, http://www.nam.gov.za/background/members.htm (last visited May 4, 2005). 37. CIA World Factbook, supra note 1; Phil. Const. Members of the Constitutional commission were appointed by then President Aquino who stated that the Philippines could not afford the time or expense of an election. Delegates represented a range of political stances, from leftists to nationalists but the majority were moderate conservatives. There were 30 lawyers including two former Supreme Court justices. Representing the interests of the Catholic Church were a nun, a priest, and a bishop. Five seats were members of Marcos’s New Society Movement including former Blas Ople with a total of 48. Library of Congress Country Studies, Philippines, supra note 4, ch. 4, Constitutional Framework. 38. Phil. Const. art. II, § 1. 39. U.S. Dep’t of State Background Notes, supra note 2. 40. Phil. Const. art. VII, § 1. 41. Id. art. VII, § 18. 42. The Commission on Appointments consists of the Senate President, as ex officio Chair, twelve Senators, and twelve Members of the House of Representatives, elected by each House on the basis of proportional representation from the political parties and party-list representatives. Id. art. VI, § 18. 43. Id. art. VII, § 16. 44. Id. art. VII, § 17. 45. Id. art. VII, § 4. To qualify as a candidate for President and Vice-President, a person must be a citizen of the Philippines, at least forty years of age, and a resident of the Philippines for at least ten years immediately preceding such election. Id. art. VII, §§ 2–3. 46. Id. art. VII, § 1. See id. §§ 16-17. 47. Id. art. VII, § 4. 48. Id. art. VII, § 3. 49. Id. art. VII, § 8. 50. Id. art. XI, § 2. 51. Id. art. XI, § 3(6). 52. Id. art. VI, § 1. 53. Id. 54. Id. art. VI, §§ 2, 4. To qualify as a candidate for Senator, a person must be a Philippine citizen, at least thirty-five years old, and a resident of the Philippines for not less than two years immediately preceding the day of the election. Id. art. VI, § 3. 55. Id. art. XVIII, § 2. Thirteen senators were elected in May 2001. Election watchPhilippines, CNN World, http://www.cnn.com/WORLD/election.watch/asiapcf/ philippines3.html (last visited May 4, 2005). 56. Phil. Const., art. VI, § 5(1). 57. Id. art. VI, § 5(2); Party-List System Act, Republic Act No. 7941, §§ 2, 11 (1995). 58. Phil. Const., art. VI, § 7. To qualify as a candidate for the House of Representatives, a person must be a Philippine citizen, at least 25 years old, and a registered voter in the district in which he or she shall be elected for a period of at least a year immediately preceding the day of the election. Id. art. VI, § 6. This latter requirement does not apply to the 20% of those elected to the House of Representatives through party-list representation. Id. 59. See id. art. VI, § 24; Philippines Senate, Legislative process, Preliminary Procedures, http://www.senate.gov.ph/about/legpro.htm (last visited May 4, 2005). 60. Phil. Const., art. VI, § 24. 61. Id. art. VI, §§ 26(2), 27(1). 62. Id. art. VI, § 27(1). 63. Id. 64. Id. 65. Id. art. VI, § 32. 66. Id. art. XVII, § 1(1). 67. Id. art. XVII, § 1(2). 68. Id. art. XVII, § 4. 69. Id. art. XVII, § 2. 70. Id. art. XVII, § 4. 71. Flores and Reynolds, Foreign Law, Current Sources of Codes and Basic Legislation in Jurisdictions of the World (2000). 72. Judiciary Reorganization Act of 1980, No. 129 (1980) (Phil.). 73. Id. § 13. 74. Library of Congress Country Studies, Philippines, supra note 4, ch. 4, Judicial Department. 75. Chan Robles Virtual Law Library, Philippine Judicial System, Special Courts, http://www.chanrobles.com/ (last visited May 5, 2005); id. Sandiganbayan. 76. Phil. Const., art. VIII, § 4(1). 77. Id. art. VIII, §§ 4(2), 5(2). See id. art. VIII, § 5(1). The Supreme Court may review the sufficiency of the factual basis of the proclamation of martial law or the suspension of the privilege of the writ of habeas corpus. Id. art. VII, § 18. 78. Id. art. VIII, § 9. The Judicial and Bar Council is under the supervision of the Supreme Court, composed of the Chief Justice as ex officio Chair, the Secretary of Justice, and a representative of the Congress as ex officio Members, a representative of the Integrated Bar, a professor of law, a retired Member of the Supreme Court, and a representative of the private sector. Id. art. VIII, § 8(1). 79. Id. art. VIII, § 11. To qualify for appointment as a Member of the Supreme Court, a person must be a citizen of the Philippines, at least 40 years of age, and must have been a judge of a lower court or engaged in the practice of law in the Philippines for 15 years or more. Id. art. VIII, § 7.1.

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80. Id. art. VIII, § 11. 81. Judiciary Reorganization Act of 1980, No. 129, § 3 (1980) (Phil.). 82. Id. § 9; St. Martin Funeral Home v. National Labor Relations Commission, et al., G. R. No. 130866 (1998) (Phil.). The High Court held that Section 9 of B. P. No. 129 referring to appeals from the NLRC to the Supreme Court is interpreted to refer to petitions for certiorari under Rule 65 and, consequently, all such petitions should be initially filed in the Court of Appeals. The Court of Appeals also has exclusive appellate jurisdiction over the Securities and Exchange Commission, the Social Security Commission, and the Employees Compensation Commission. Judiciary Reorganization Act of 1980 § 9(3). 83. Judiciary Reorganization Act of 1980 § 13. 84. Id. § 22. 85. Id. § 19(5). 86. Family Courts Act of 1997, Republic Act No. 8369, § 3 (1997) (Phil.). The Family Courts have exclusive original jurisdiction of, among others, criminal cases where the accused is below 18 years of age or where the victim is a minor; petitions for guardianship, custody of children, habeas corpus of children; petitions for adoption of children; complaints for annulment of marriage; declaration of nullity of marriage and those relating to marital status and property relations of husband and wife; petitions for support and/or acknowledgment; petitions for declaration of status of children as abandoned, dependent or neglected; petitions for voluntary or involuntary commitment of children; the suspension, termination, or restoration of parental authority; and petitions for the constitution of the family home. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act. No. 7610 (1992), amended by Republic Act No. 7658, § 5 (1993). The Family Courts also have exclusive original jurisdiction on cases of domestic violence against women and children. Family Courts Act of 1997 § 5(k). 87. Family Courts Act of 1997 § 25. 88. These include all violations of city or municipal ordinances, offenses punishable with imprisonment not exceeding six years, civil actions where the value of the personal property, or amount of the demand does not exceed 100,000 pesos or, in Metro Manila where such personal property, or amount of the demand does not exceed 200,000 pesos. Judiciary Reorganization Act of 1980, No. 129, §§ 32.2, 33.1 (1980) (Phil.). 89. Chan Robles Virtual Law Library, Philippine Judicial System, Municipal Trial Courts, supra note 75. It is referred to as such if it covers only one municipality; otherwise, it is called Municipal Circuit Trial Court if it covers two or more municipalities. Id. 90. Administrative Circular No. 14-93, § I (1993) (Phil.). The exceptions, inter alia, are where one party is the government; where one party is a public officer or employee and the dispute involves the performance of his official duties; generally, disputes involving parties who actually reside in barangays of different cities or municipalities; offenses for which the law prescribes a maximum penalty of imprisonment exceeding one year or a fine of over 5,000 pesos; disputes where urgent legal action is necessary to prevent injustice from being committed or further continued; and labor disputes arising from employer-employee relations. Id. 91. Administrative Circular No. 14-93 § IV. 92. Chan Robles Virtual Law Library, Philippine Judicial System, Court of Tax Appeals, supra note 75. 93. See An Act to Strengthen the Functional and Structural Organization of the Sandiganbayan, Amending for that Purpose Presidential Decree No. 1606, as amended, Republic Act No. 7975, § 2 (1995); An Act Further Defining the Jurisdiction of the Sandiganbayan, Amending for the Purpose Presidential Decree No. 1606, as amended, Providing Funds Therefor, and for Other Purposes, Republic Act No. 8249, § 4 (1997) (Phil.). 94. Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 137 (1977) (Phil.). 95. Id. art. 154. 96. Id. art. 144; Chan Robles Virtual Law Library, Philippine Judicial System, Background on Philippine Judicial System, supra note 75. Sharia district courts are presided over by one judge. Code of Muslim Personal Laws of the Philippines art. 138. 97. See Code of Muslim Personal Laws of the Philippines. 98. An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao, Republic Act No. 6734, art. IX, §§ 2–12 (1989) (Phil.). It might seem confusing that the Sharia Circuit and District Courts are created by one Act – the Code of Muslim Personal Laws, while the Sharia Appellate Court is created under another Act – the Act for the Autonomous Region in Muslim Mindanao. This is because the Sharia Circuit and District Courts were created in 1977, before there ever was an Autonomous Region. The Autonomous Region was created in 1989 and, as a result, a Sharia Appellate Court was also created to add to the already existing Sharia Circuit and District Courts in Muslim Mindanao. Id. art. IX, § 2. The Sharia Appellate Court is comprised of one Presiding Justice and two Associate Justices. Id. art. IX, § 3. 99. An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao art. IX, § 5(2). 100. See id. art. IX, § 6. 101. Id. art. IX, § 14; An Act Providing for an Organic Act for the Cordillera Autonomous Region, Republic Act No. 6766, art. VII, § 1 (1989) (Phil.). 102. An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao art. IX, § 14. 103. Id. art. IX, § 17(1). 104. Id. art. IX, § 17(3). 105. Press Release, Integrated Bar of the Philippines, MOU on Katarungang Pambarangay Law signed (Nov. 2002), http://www.ibp.org.ph/mainframe/pressrelease/pressrelease.php?id=30 (last visited May 5, 2005); Bernardo T. Ponferrada, Barangay Justice System and Other Alternative Dispute Resolution Mechanics (Mediation) in

WOMEN OF THE WORLD:

the Philippines 1, http://www.moj.go.jp/ENGLISH/RATI/ICD/icd-29.pdf (last visited May 5, 2005). 106. Ponferrada, supra note 105, at 1. 107. Pursuant to section 2, rule VI of the 1991 Katarungang Pambarangay Implementing Rules. Ponferrada, supra note 105, at 2. 108. Ponferrada, supra note 105, at 1; Local Government Code of 1991, Republic Act No. 7160, bk. III, tit. 1, ch. 7 (1991) (Phil.). A Supreme Court – UNDP Issue Paper on Local Autonomy and Administration of Justice conducted by the Ateneo School of Government, indicates that in 1988 alone, a total of 279,115 barangay disputes were recorded nationally. Out of this total, 236,452 cases were settled (84% resolution rate). Id. at 2. 109. Ponferrada, supra note 105, at 1. 110. Id. at 2. 111. Id. 112. Id. 113. Id. 114. Id. at 6. Some Alternative Dispute Resolution mechanisms are unwritten based on one’s honor and are effective among the cultural minorities. Id. at 1. 115. Alternative Dispute Resolution Act of 2004, Republic Act No. 9285 (2004) (Phil.). 116. The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371, § 15 (1997) (Phil.). 117. National Statistical Coordination Board, Philippine Statistical System, Databases, Philippine Standard Geographic Codes, List of regions, (figures as of June 2005) http://www.nscb.gov.ph/activestats/psgc/listreg.asp (last visited Sept. 22, 2005). 118. Phil. Const., arts. II, § 25, X, §§ 1–2; Local Government Code of 1991, Republic Act No. 7160, §§ 440–442, 448–453, 459–462 (1991) (Phil.); National Statistical Coordination Board, A City and a Barangay Were Created (2004) (figures as of Dec. 31, 2004), http://www.nscb.gov.ph/factsheet/pdf05/fs1_05.asp (Jan. 27, 2005). A barangay is made up of a number of sitios (neighborhoods) which are groups of households that form the basic foundations of society above the family level. Each sitio comprises about 15 to 30 households (mostly part of the same family), and most barangays number from 150 to 200 households. Groups of barangays are combined into municipalities. See Library of Congress Country Studies, Philippines, supra note 4, ch. 2, Rural Social Patterns. 119. Wikipedia,The free encyclopedia, Regions of the Philippines, http:// en.wikipedia.org/wiki/Regions_of_the_Philippines (last modified Apr. 6, 2005). 120. Id. 121. Id. 122. See Library of Congress, Philippines, supra note 4, ch. 4 Organization. Congress passed a law creating an Autonomous Region in Cordillera, but a 1990 referendum held in five provinces of the region failed to ratify autonomy. In 1991, the Supreme Court voided the Cordillera Autonomous Region, stating that Congress never intended for a single province to constitute an autonomous region. Id. ch. 4, Regional Autonomy. 123. Id. ch. 4. 124. Id. 125. Id. 126. Id. 127. Local Government Code of 1991, Republic Act No. 7160, §§ 465–466 (1991) (Phil.). 128. Id. §§ 455–456. 129. Id. §§ 444–445. 130. Id. §§ 389(a), 423(a). 131. Id. §§ 390, 447, 457, 467. 132. Id. §§ 446(a), 457(a), 467(a). 133. Id. §§ 446(b), 457(b), 467(b). 134. Id. § 384. 135. Id. § 384. See Administrative Circular No. 14-93 (1993) (Phil.). 136. Local Government Code of 1991 § 423(a). 137. Id. § 430. 138. Local Government Code of 1991, Republic Act No. 7160, § 43 (1991) (Phil.), amended by Republic Act No. 8524, § 1 (1998) (Phil.). 139. Phil. Const., art. X, § 3. See Local Government Code of 1991 tit. 9, ch. 2 . 140. Phil. Const., art. X, § 5. See Local Government Code of 1991 §§ 384–386, 440– 442, 448–453, 459–462. 141. Phil. Const., art. X, § 2. 142. Id. art. X, § 4. 143. An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao, Republic Act No. 6734, art. IV, § 2 (1989) (Phil.). The first regular elections for regional governor, regional vice-governor and members of the Regional Legislative Assembly of the Autonomous Region in Muslim Mindanao were held in March, 1993. An Act Providing for the Date of Regular Elections for Regional Governor, Regional Vice-governor and Members of the Regional Legislative Assembly of the Autonomous Region in Muslim Mindanao and for other Purposes, Republic Act No. 7647, § 1 (1993) (Phil.) amended by Republic Act No. 8746, § 1 (1999) (Phil.). 144. An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao art. VIII. In case of death, permanent disability, removal from office, or resignation of the Governor, the Vice-Governor shall become Governor to serve the unexpired term. In case of death, permanent disability, removal from office, or the resignation of both the Governor and the Vice-Governor, the Speaker of the Regional Assembly shall act as Governor until the Governor and Vice-Governor are elected and qualified in a special election called for the purpose. Id. art. VIII, § 10. The Regional Governor or the

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Vice-Governor may be removed from office for culpable violation of the Constitution or the Organic Act, treason, bribery, graft and corruption, other high crimes or betrayal of public trust by a three-fourths (3/4) vote of all the Members of the Regional Assembly. Id. art. VIII, § 12. 145. Id. art. VIII, § 6(1)–(2). To qualify as a governor and vice-governor, one must be a Philippine citizen, a registered voter of the autonomous region, at least 35 years old, and a resident of the autonomous region for at least five years immediately preceding the election. Id. art. VIII, §§ 3–4. 146. Id. art. VIII, § 2. 147. Id. art. VIII, § 17. 148. Id. art. VIII, § 4. The Vice-Governor serves for three-year terms for a maximum of two consecutive terms. Id. art. VIII, § 6(1)–(2). 149. Id. art. VIII, § 18. 150. Id. 151. Id. art. VII, § 1. The organic act of autonomous regions shall provide for legislative powers over: (1) administrative organization; (2) creation of sources of revenues; (3) ancestral domain and natural resources; (4) personal, family, and property relations; (5) regional urban and rural planning development; (6) economic, social, and tourism development; (7) educational policies; (8) preservation and development of the cultural heritage; and (9) such other matters as may be authorized by law for the promotion of the general welfare of the people of the region. Phil. Const., art. X, § 20. 152. An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao, Republic Act No. 6734, art. VII, § 4 (1989) (Phil.). 153. Id. art. VII, § 5. No person shall be a Member of the Regional Assembly unless he or she is: (1) a natural-born citizen of the Philippines; (2) at least 21 years of age on the day of the election; (3) able to read and write; (4) a registered voter of the district in which he or she shall be elected on the day he or she files the certificate of candidacy; and (5) a resident thereof for a period of not less than five years immediately preceding the day of the election. Id. art. VII, § 7. 154. Id. art. VI, § 1; Phil. Const., art. X, § 16. 155. Phil. Const., art. X, § 21. 156. See The Official Government Portal of the Republic of the Philippines, About the Philippines, http://www.gov.ph/aboutphil/general.asp (last visited May 9, 2005) . 157. The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371, § 3(i) (1997) (Phil.). 158. Id. § 18. 159. Randall A. Chamberlain, Regulating Civil Society:The Philippine Council for NGO Certification (PCNC) 8 (2000), http://www.pcnc.com.ph/CivilSoc.PDF (last visited May 6, 2005). 160. Peace Corps, An NGO Training Guide for Peace Corps Volunteers, Module 1: The Role of NGOs in a Civil Society 22, http://www.peacecorps.gov/library/pdf/ m0070/M0070_mod1.pdf (last visited May 6, 2005). 161. Phil. Const., art. II, § 23. 162. Chamberlain, supra note 159, at 8-9. 163. Philippine Council for NGO Certification (PCNC), PCNC: Background and Rationale, http://www.pcnc.com.ph/background-and-rationale.html (last visited May 6, 2005). 164. Id. 165. Flores and Reynolds, supra note 71, citing S.M. Santos, Jr., “Common law elements in the Philippine mixed legal system” in 2 Australian journal of Asian law 34 (2000) at p. 34. See Library of Congress Country Studies, Philippines, supra note 4, ch. 5, Penal Law. 166. See Library of Congress Country Studies, Philippines, supra note 4, ch. 4, Constitutional Framework. 167. Phil. Const., art. III, §§ 1, 5, 11. 168. Id. art. XIII, § 1. 169. Id. art. XIII, § 17. Commission on Human Rights is vested with several powers, including the power to investigate human rights violations; provide appropriate legal measures for the protection of human rights; promote human rights through education and research; and monitor the Philippine government’s compliance with international treaty obligations, amongst others. Id. art. XIII, §§ 17–18(1), (3), (5), (7). 170. Id. arts. II, XV. 171. Id. art. II, § 6. 172. Id. art. II, § 12. 173. Id. art. II, § 22. 174. Civil Code of the Philippines, Republic Act No. 386 (1949); Revised Penal Code of the Philippines, Republic Act No. 3815 (1930); Family Code of the Philippines, Executive Order No. 209 (1987); Labor Code of the Philippines, Presidential Decree No. 442, as amended (1974); Child and Youth Welfare Code of the Philippines, Presidential Decree No. 603 (1974). 175. Flores and Reynolds, supra note 71, citing S.M. Santos, Jr., “Common law elements in the Philippine mixed legal system” in 2 Australian Journal of Asian Law 34 (2000) at 34. See The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371 (1997) (Phil.); see also Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083 (1977) (Phil.); see also An Act Providing for an Organic Act for the Autonomous Region in Muslim Mindanao, Republic Act No. 6734 (1989) (Phil.). The National Commission on Indigenous Peoples (NCIP) was created to formulate and implement policies and programs protecting and promoting the rights of indigenous peoples. The Indigenous Peoples Rights Act of 1997 § 3(k).

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176. Code of Muslim Personal Laws of the Philippines, bk. II, tit. I, arts. 8–9. 177. Id. bk. IV, tit. I, art. 137. 178. Id. bk. V, tit. V. 179. The Indigenous Peoples Rights Act of 1997. 180. Phil. Const., art. II, § 11. 181. Id. art. II, § 9. 182. Id. art. II, § 10. 183. See Nat’l Econ. & Dev. Auth., Republic of the Phil, Medium Term Philippine Development Plan 2004–2010 (PowerPoint presentation), http://www.neda.gov. ph/econreports_dbs.asp (Jan. 24, 2005) [hereinafter NEDPA PowerPoint presentation]; see also Nat’l Econ. & Dev. Auth., Republic of the Phil., Medium Term Philippine Development Plan 2004–2010 (Press Release), http://www.news.ops.gov.ph/mtpdp2004-2010.htm (last visited May 9, 2005). 184. National Economic and Development Authority, Republic of the Philippines, Medium Term Philippine Development Plan 2004–2010 (2004), available at http://www.neda.gov.ph/../ads/mtpdp/MTPDP2004-2010/MTPDP%2020042010%20NEDA%20v11-12.pdf (last visited May 10, 2005) [hereinafter NEDA Medium Term Development Plan]. 185. Phil. Const., art. VII, § 21. 186. Id. art. II, § 2. 187. Convention on the Elimination of All Forms of Discrimination against Women, adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981) (ratified by the Philippines Sept. 4, 1981); Optional Protocol to the Convention on the Elimination of Discrimination against Women, Oct. 6, 1999, G.A. Res. 54/4, U.N. GAOR, 54th Sess., U.N. Doc A/Res/54/4 (1999) (entered into force Dec. 22, 2000) (ratified by the Philippines Feb. 12, 2004). 188. Convention on the Rights of the Child, adopted Nov. 20, 1989, G.A. Res. 44/25, annex, U.N. GAOR, 44th Sess., Supp. No. 49, at 166, UN Doc. A/44/49 (1989) reprinted in 28 I.L.M. 1448 (entered into force Sept. 2, 1990) (ratified by the Philippines Sept. 20, 1990). 189. Optional Protocol to the Convention of the Rights of the Child on the involvement of children in armed conflict, adopted May 25, 2000, G.A. Res. 54/263, U.N. GAOR, 54th Sess., U.N. Doc No. A/RES/54/263 (entered into force Feb. 12, 2002) (ratified by the Philippines Sept. 26, 2003). 190. Optional Protocol to the Convention of the Rights of the Child on the sale of children, child prostitution and child pornography, adopted May 25, 2000, G.A. Res. 54/263, U.N. GAOR, 54th Sess., U.N. Doc A/RES/541263 (2000) (entered into force Jan. 18, 2002) (ratified by the Philippines June 28, 2002). 191. International Convention on the Elimination of All Forms of Racial Discrimination, 660 U.N.T.S. 195 (entered into force Jan. 4, 1969) (ratified with declaration by the Philippines Jan. 4, 1969). 192. International Covenant on Civil and Political Rights, adopted Dec. 16, 1966, G.A. Res. 2200A (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, U.N. Doc A/6316 (1966), 999 U.N.T.S. 171 (entered into force Mar. 23, 1976) (ratified with declaration by the Philippines Jan. 23, 1987). 193. Optional Protocol to the International Covenant on Civil and Political Rights, G.A. Res. 2200A (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, at 59, U.N. Doc. A/6316, 999 U.N.T.S. 302 (entered into force Mar. 23, 1976) (accession by the Philippines Nov. 22, 1989). 194. International Covenant on Economic, Social and Cultural Rights, G.A. Res. 2200A (XXI), U.N. GAOR, Supp. No. 16, at 49, U.N. Doc A/6316 (1966), 999 U.N.T.S. 3 (entered into force Jan. 3, 1976) (ratified by the Philippines Jan. 3, 1976). 195. Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, adopted Dec. 10, 1984, G.A. Res. 39/46, U.N. GAOR, 39th Sess., Supp. No. 51, at 197, U.N. Doc. A/39/51 (1984), 1465 U.N.T.S. 85 (entered into force June 26, 1987) (accession with declarations by the Philippines June 26, 1987). 196. International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, adopted Dec. 18, 1990, G.A. Res. 45/158, Annex 45, U.N. GAOR, 45th Sess., Supp. No. 49A, at 262, U.N. Doc. A/45/49 (1990) (entered into force July 1, 2003) (ratified by the Philippines July 1, 2003). 197. Vienna Declaration and Programme of Action, World Conference on Human Rights, Vienna, Austria, June 14–25, 1993, U.N. Doc. A/CONF.157/23 (1993); Programme of Action of the International Conference on Population and Development, Cairo, Egypt, Sept. 5–13, 1994, U.N. Doc. A/CONF.171/13/Rev.1 (1995); Beijing Declaration and the Platform for Action, Fourth World Conference on Women, Beijing, China, Sept. 4–15, 1995, U.N. Doc. A/CONF.177/20 (1995); Millennium Declaration, Millennium Assembly, New York, United States, Sept. 6–8, 2000, U.N. GAOR, 55th Sess., U.N. Doc. A/Res/55/2 (2000). 198. Phil. Const., art. II, § 15. 199. Id. art. II, § 9. 200. Id. art. XIII, § 11. 201. NEDA Medium Term Development Plan, supra note 184; Department of Health, Republic of the Philippines, National Objectives for Health, Philippines 1999–2004, at 17 (1999); Department of Health, Republic of the Philippines, Health Sector Reform Agenda, at iii (1999). See Department of Health, Republic of the Philippines,The Philippines Health Sector Reform Agenda, Philippines Chalks Up Modest Health Sector Reform Achievement But Needs to Address Risks, http://www.doh.gov.ph/hsra/tsk/index.htm (last visited May 10, 2005). 202. NEDA Medium Term Development Plan, supra note 184, at x. 203. NEDPA PowerPoint presentation, supra note 183. 204. See National Objectives for Health, Philippines 1999–2004, supra note 201, at i (“…correlation of poor health and lower socioeconomic status…no means of paying …”). 205. 2002 Philippine Statistical Yearbook, at 2-24 tbl.2.11 (2002). In 2000, 39.4% of the

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population had an annual per capita income that falls below the annual per capita poverty threshold, which is defined as the annual per capita income required to satisfy nutritional requirements and other basic needs. Id. 206. National Objectives for Health, Philippines 1999–2004, supra note 201, at i–ii. 207. Id. at 25. 208. Id. at 83. 209. Id. at 88. 210. Id. at 90–93. 211. Id. at 95. 212. Id. at 99. 213. Id. at 100–101. 214. Id. at 102–105. 215. Id. at 106–115. 216. Id. at 122–123. 217. Id. at 122. 218. Id. at 171–172. 219. Id. at 189–190. 220. Id. at 18. 221. Id. at 19. 222. Id. at 20. 223. Id. at 20. 224. Id. at 21. 225. Health Sector Reform Agenda, supra note 201, at iii–iv (1999); Commission on Population, Philippine Management Program Directional Plan, 2001–2004, at 31–32 (2001). 226. Exec. Order No. 102, Redirecting the Functions and Operations of the Department of Health § 2(a) (1999) (Phil.). 227. Id. § 1. Assistance refers to technical collaborations, logistical support, grant provisions or allocations, and other partnership mechanisms. Id. § 2(j). 228. Id. § 2(b). 229. Id. §§ 2(g), 3(d). 230. National Statistical Coordination Board, Philippine Statistical System, Databases, Philippine Standard Geographic Codes, List of regions, (figures as of June 2005) http://www.nscb.gov.ph/activestats/psgc/listreg.asp (last visited Sept. 22, 2005); National Objectives for Health, Philippines 1999–2004, supra note 201,at 12 (1999). 231. 2002 Philippine Statistical Yearbook, supra note 205, 9-29. 232. Id. 9-31 (numbers from 1999 & 1997 respectively). 233. National Objectives for Health, Philippines 1999–2004, supra note 201,at 12. 234. Id. at 14. 235. Id. at 13. 236. Local Government Code of 1991, Republic Act No. 7160, § 17 (1991) (Phil.); National Objectives for Health, Philippines 1999–2004, supra note 201, at 12. 237. Department of Health, Republic of the Philippines & Plaridel Communications Cooperative, Primer on Devolution of Health Services 3. 238. Local government units are the political subdivisions of the Philippines, that is, provinces, cities, municipalities, and barangays (villages). During the writing of this report, there were 79 provinces, 114 cities, 1,496 municipalities, and over 40,000 barangays in the Philippines. National Objectives for Health, Philippines 1999–2004, supra note 201, at 4; 2002 Philippine Statistical Yearbook, supra note 205, 15–16. 239. Primer on Devolution of Health Services, supra note 237, at 2. 240. U.S. Agency for International Development, Mission in the Philippines, Local Government Unit Performance Program (LPP), http://www.usaid-ph.gov/ health%20lpp_usaid.htm (last modified August 2001) [hereinafter USAID Local Government Program]. 241. U.S. Agency for International Development, Mission in the Philippines, Final Assessment Report: USAID/Philippines Support to Local Governments for Family Planning and Health (2002), http://www.usaid-ph.gov/Documents/ MGP%20assessment.doc (April 20, 2002). 242. USAID Local Government Program, supra note 240. 243. See Department of Health, Republic of the Philippines, Sentrong Sigla 2003– 2007, Phase II, at 2, http://www.doh.gov.ph/sigla (last visited May 27, 2005). Email from Dr. Junice L. Demeterio-Melgar, Likhaan, to Nile Park, Center for Reproductive Rights (May 23, 2005, 04:45:00 EST) (on file with the Center for Reproductive Rights). 244. Department of Health, Republic of the Philippines, ICHSP: DOH Response to Devolution, http://www.doh.gov.ph/ichsp/html/response.htm (last visited May 10, 2005). 245. 2002 Philippine Statistical Yearbook, supra note 205, 9-29. 246. See id.(figure extrapolated from the a total of 1708 hospitals). 247. USAID, Mission in the Philippines, USAID/Philippines Strategy Fiscal Year 2005–2009, at 10 (2004), http://www.usaid-ph.gov/Documents/USAID%20Phils.%20S trategy%20(Public)2005-2009.doc (Mar. 14, 2005). 248. National Statistical Coordination Board, 2002 Philippine National Health Accounts, Sources of Funds for Health, http://www.nscb.gov.ph/stats/ pnha/default.asp (last visited Apr. 8, 2005) [hereinafter NSCB Sources of Funds for Health]. 249. National Statistical Coordination Board, 2002 Philippine National Health Accounts, Executive Summary, http://www.nscb.gov.ph/stats/pnha/exsum.asp (posted July 13, 2003). 250. NSCB Sources of Funds for Health, supra note 248.

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251. Id. 252. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 35. 253. Id. 254. Department of Health, Republic of the Philippines, Annual Report 2001, Setting the Momentum for Health Reforms 22 (2001), http://www.doh.gov.ph/ library/references/doh_ar_2001.pdf (last visited May 19, 2005). 255. National Statistical Coordination Board, 2002 Philippine National Health Accounts, Government Expenditures, http://www.nscb.gov.ph/stats/pnha/government.asp (posted July 13, 2003). 256. Orville Solon, et. Al. Insurance and Price Discrimination in the Market for Hospital Services in the Philippines, in Health Sector Reform in Asia: Proceedings of the Regional Conference 22-25 May 1995, 138. 257. National Objectives for Health, Philippines 1999–2004, supra note 201, at 13. 258. NSCB Sources of Funds for Health, supra note 248. 259. National Health Insurance Act of 1995, Republic Act No. 7875, art. III, § 5 (1995) (Phil.). 260. Id. art. IV, § 16(a). 261. Id. art. I, § 2(b), (l). 262. National Statistics Office & ORC Marco, National Demographic and Health Survey 2003, at xxi (2004). 263. Id. 264. Paul Gertler & Orville Solon,Who Benefits from Social Health Insurance? Evidence from the Philippines 18 (2002), http://faculty.haas.berkeley.edu/gertler/ working_papers/Gertler-Solon%20Philippines%20Hopsital%20Paper%203-1-02.pdf (Mar. 1, 2002). 265. Id. at 26. The data was gathered in 1991, before the national insurance program was instituted. 266. In 1997, the John Snow Research and Training Institute, through a program called “Technical Assistance for the Conduct of Integrated Family Planning and Maternal Health Activities by Philippine Non-Governmental Organizations (TANGO),” funded by the United States Agency for International Development, established a network of clinics called Well Family Midwife Clinics (WFMCs). Well-Family Midwife Clinic, About WFMC, http://www.wfmc.com.ph/wfmc.htm (last visited May 10, 2005). These WFMCs are owned and operated by licensed midwives and provide family planning, maternal and child health services as well as other services such as basic life support and referrals. Id. WFMCs receive subsidies in supplies and administrative and technical assistance from external funding. Id. WFMCs cater to low- and middle-income families. Id. 267. Emily Christi A.Cabegin et al.,Willingness to Pay for Well-Family Midwife Services in the Philippines 12 (2001), http://www.dec.org/pdf_docs/PNACN612.pdf (Dec. 2001). 268. Also known as the food and drug administration. Food, Drug, and Cosmetic Act, Republic Act No. 3720, § 3 (1963) (Phil.), amended by Exec. Order No. 175, Further Amending Republic Act No. 3750, § 4 (1987) (Phil.). 269. Id. §§ 4(e), 11, 21-B, amended by Exec. Order No. 175, Further Amending Republic Act No. 3750, §§ 7–8, 15 (1987) (Phil.). 270. Id. § 21(b)(1)–(2), amended by Exec. Order No. 175, Further Amending Republic Act No. 3750, § 14 (1987) (Phil.). 271. Id. § 26(a), amended by Exec. Order No. 175, Further Amending Republic Act No. 3750, § 19 (1987) (Phil.). 272. Bureau of Health Devices and Technology, Department of Health, Republic of the Philippines, Brief Description, http://www.doh.gov.ph/bhdt/overview.htm (last visited May 11, 2005). 273. Phil. Const., art. XIII, § 12. 274. Creating The Professional Regulation Commission and Prescribing Its Powers and Functions, Presidential Decree No. 223, § 5 (1973) (Phil.). 275. Id. § 6(g). For example, the Board of Medicine requires that an applicant must not have been convicted by a court of any offense involving moral turpitude, must be a holder of the degree of Doctor of Medicine or its equivalent from a government-recognized college of medicine, and twenty-one years of age. The Medical Act of 1959, Republic Act No. 2382, art. 3, § 9 (1959) (Phil.). The Board of Nursing requires that an applicant must have a bachelor’s degree in nursing from a duly-recognized institution and must be at least eighteen years old. Philippine Nursing Act of 1991, Republic Act No. 7164, § 13(b), (d) (1991). The Board of Pharmacy requires an applicant to have a bachelor’s degree in pharmacy and to complete an internship program. An Act Regulating the Practice of Pharmacy and Setting Standards of Pharmaceutical Education in the Philippines and for Other Purposes, Republic Act No. 5921, § 18(c)–(d) (1969). 276. For example, the Code of Ethics of the Medical Profession in the Philippines, promulgated as Republic Act No. 4224, outlines different duties of Filipino physicians to their patients, community, colleagues and the profession. Jose Maria Enriquez Ferrer, Code of Ethics of the Medical Profession in the Philippines, Pinoy.MD, http://pinoy. md/modules/news/article.php?storyid=101 (June 13, 2003). 277. The Medical Act of 1959 art. 3, § 24(5). 278. The Code of Conduct and Ethical Standards for Public Officials and Employees, Republic Act No. 6713, §§ 2, 3(b) (1989) (Phil.). 279. Magna Carta of Public Health Workers, Republic Act No. 7305, § 1 (1992) (Phil.) (corresponds to Magna Carta of Public Health Workers, Republic Act No. 7305, Revised Implementing Rules and Regulations (1999) (Phil.)). 280. Magna Carta of Public Health Workers, Republic Act No. 7305, Revised Imple-

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menting Rules and Regulations, R. XIII (1999) (Phil.). 281. Traditional and Alternative Medicine Act of 1997, Republic Act No. 8423, § 5 (1997) (Phil.). 282. Revised Rules and Regulations Governing the Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines, Administrative Order No. 70-A s. 2002, § 5 (2002) (Phil.). 283. Id. § 9.4. 284. Id. § 11. 285. Id. § 17. 286. Philippine Health Insurance Corporation, Accreditation (2000), http://www. philhealth.gov.ph/accreditation.htm (last visited May 11, 2005). 287. Id. 288. Anti-Medical Malpractice Act of 2004, Senate Bill No. 1720, 13th Cong., 1st Reg. Sess. § 4 (2004) (Phil.). 289. Id.. § 3(2)–(3). 290. Philippine Medical Association, Position Paper of the Philippine Medical Association on S.B. 743- An Act Punishing the Malpractice of Any Medical Practitioner in the Philippines and for Other Purposes, Introduced by Senator Manuel B. Villar 14–15, http:// www.pma.com.ph/PositionPaperOnSenateBill743.doc (last visited May 19, 2005). 291. See Revised Penal Code, No. 3815 (1930) (Phil.); Civil Code of the Philippines, Republic Act No. 386 (1949). 292. See e.g., Revised Penal Code art. 365; Civil Code of the Philippines arts. 1172–1174, 2177–2179. 293. Magna Carta of Public Health Workers, Republic Act No. 7305, § 13(c) (1992) (Phil.) (corresponds to Magna Carta of Public Health Workers, Republic Act No. 7305, Revised Implementing Rules and Regulations (1999) (Phil.)). 294. Philippine Medical Association, Code of Ethics of the Medical Profession, art. 2, § 4 (1960) (amended 1965 and 1993), http://www.pma.com.ph/01%20PMA_ back_6CodeofEthics.asp (May 25, 1993). 295. Id. 296. Pending at the House of Representatives are House Bill Number (HBN) 666 (14 patient’s rights) and HBN 2524 (13 patient’s rights), both titled “An Act Declaring the Rights of Patients and Prescribing Penalties for Violations Thereof.” Pending at the Senate are Senate Bill Number (SBN) 2235, SBN 868, and SBN 588, all titled “An Act Declaring the Rights of Patients and Prescribing Penalties for Violations Thereof ”; and SBN 1720, “An Act to Protect against medical malpractice, punishing the malpractice of any medical practitioner and requiring them to secure malpractice insurance and for other purposes (Anti-Medical Malpractice Act of 2004).” 297. HBN 2524 was presented at the 12th Congress. At the 13th Congress, the revised version of the bill was presented as SBN 588, with 15 patient’s rights. Magna Carta of Patient’s Rights, SBN 588; An Act Declaring The Rights And Obligations Of Patients And Establishing a Grievance Mechanism For Violations Thereof And For Other Purposes, House Bill No. 261 (2004) (Phil.). 298. Magna Carta of Patient’s Rights, HBN 2524; Magna Carta of Patient’s Rights, SBN 588. 299. An Act Penalizing the Refusal of Hospitals and Medical Clinics to Administer Appropriate Initial Medical Treatment and Support in Emergency or Serious Cases, Amending for the Purpose Batas Pambansa Bilang 702, Otherwise Known as “An Act Prohibiting the Demand of Deposits or Advance Payments for the Confinement or Treatment of Patients in Hospitals and Medical Clinics in Certain Cases,” Republic Act No. 8344, §§ 1, 4 (1996) (Phil.). 300. Phil. Const. art. VX, § 3(a). Responsible parenthood is defined as the “will and ability to respond to the needs and aspirations of the family and the children” such as “making decisions on the timing, spacing and number of children within the context of gender equity and sensitivity in accordance with their culture and religions beliefs.” Philippine Management Program Directional Plan, 2001–2004, supra note 225 at 9–10, 30. 301. NEDA Medium Term Development Plan, supra note 184, at 161. 302. 3 Population Division, United Nations, Abortion Policies: A Global Review 36 (2002). Administrative Order No. 1-A, January 15, 1998 (as cited in PPMP Directional Plan at 30); UNFPA & International Planned Parenthood Federation (IPPF), Face to Face: Field Visits, Philippines: Sexual and Reproductive Health (1999), http:// www.fieldvisits.org/plc_21.html (June 1999). 303. Department of Health, Office of the Secretary, Administrative Order No. 1-A s, 1998, Creation of a Philippine Reproductive Health Program; UNFPA & International Planned Parenthood Federation (IPPF), supra note 302. 304. The Reproductive Health Care Act of 2002, House Bill No. 4110, 12th Cong., 1st Reg. Sess. (2002) (Phil.). The counterpart to this bill, SBN 2325 has been filed by Senator Rodolfo Biazon. Its first reading was on September 5, 2002, and it was then referred to the Committee(s) on Health And Demography and Youth, Women and Family Relations. It was also referred to the Committee on Finance on motion of the Chair. 305. The Reproductive Health Care Act of 2002, HBN 4110§ 2 . 306.Id. § 6(a). 307. Id. § 8. 308. Id. § 7(a)–(d). 309. Id. § 10. 310. Responsible Parenthood and Population Management Act of 2005, House Bill No. 3773, 13th Cong., 1st Reg. Sess., §§ 3(j)–(k), 4(b), (g)(3), 6(e)(4), 12 (2005) (Phil.); Email from Dr. Junice L. Demeterio-Melgar, Likhaan, to Nile Park, Center for Reproductive Rights, supra note 243.

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311. Email from Clara Rita Padilla, Executive Director, EnGendeRights, to Nile Park, Center for Reproductive Rights (Nov. 3, 2004, 13:50:00 EST) (on file with the Center for Reproductive Rights). 312. United Nations Educational, Scientific and Cultural Organization (UNESCO), National Legislation Concerning Human Reproductive and Therapeutic Cloning 12 (2004), http://unesdoc.unesco.org/images/0013/001342/134277e. pdf (June 2004). 313. Department of Health, Office of the Secretary, Administrative Order No. 125 S. 2002 National NFP Strategic Plan Year 2002-2006. 314. National Family Planning Policy, Administrative Order No. 50-A s. 2001, § IV(E)(1)–(2) (2001) (Phil.); Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 38. 315. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 39. 316. National Family Planning Policy § V, at 5–9; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 39–41 (2001). 317. Philippines National Statistics Office, 2002 Family Planning Survey, Final Report 14 tbl.4 (2003) [hereinafter 2002 Family Planning Survey]. 318. National Demographic and Health Survey 2003, supra note 262, at 58 tbl.5.4 (2004). The survey reports the percentage of currently married women age 15-49 using modern and traditional family planning methods. 319. Id. 320. Id. 321. Id. 322. Id. 323. 2002 Family Planning Survey, supra note 317, at 23 tbl.9. 324. National Demographic and Health Survey 2003, supra note 262, at 100. 325. Id. at 101 tbl.7.10. 326. Id. at 101 tbl.7.9. 327. Revised Population Act of the Philippines, Presidential Decree No. 79, § 4(f), (i) (1972). 328. Id. § 5(a), (d); Presidential Decree No. 1204, § 1 (1977) (Phil.). 329. Republic Act No. 4729, An Act to Regulate the Sale, Dispensation, and/or Distribution of Contraceptive Drugs and Devices (1966). 330. An Act Regulating the Practice of Pharmacy and Setting Standards of Pharmaceutical Education in the Philippines and for other Purposes, Republic Act No. 5921 (1969). 331. Pinky C. Serafica, Government’s creeping conservatism in family planning, Filnurse–Online Philippine Nursing Community, Aug. 12, 2002, http://www.filnurse. com/greymatter/archives/00000045.shtml (Aug. 12, 2002). 332. Delisting of Levonorgestrel 750mcg. (Postinor) from Bureau of Food and Drugs Registry of Drug Products, Bureau Circular No. 18 s. 2001 (2001) (Phil.). 333. Presidential Decree No. 1013 (1976) (Phil.). 334. Commission on Population, Republic of the Philippines, Philippines Country Report, Fifth Asian and Pacific Population Conference, 11–17 December 2002, Bangkok 42 (2002) [hereinafter Philippines Report to Asian and Pacific Population Conference 2002]. 335. National Family Planning Policy, Administrative Order No. 50-A s. 2001, § V(C)(6), at 7 (2001) (Phil.). 336. Id. 337. See Code of Ethics of the Medical Profession, supra note 294, art. 2, § 4. 338. Philippines Report to Asian and Pacific Population Conference 2002, supra note 334, at 21; Working draft of Women of the World: East and Southeast Asia, Philippines, sec. II.B. at 20 (peer reviewed by Dr. Junice L. Demeterio-Melgar, Likhaan, rec’vd May 10, 2005) (on file with the Center for Reproductive Rights). 339. Working draft of Women of the World: East and Southeast Asia, Philippines, sec. II.B. at 18 (peer reviewed by Dr. Junice L. Demeterio-Melgar, Likhaan, rec’vd May 10, 2005) (on file with the Center for Reproductive Rights). 340. Guidelines on Advertisement and Promotions of Prescription Pharmaceutical Products, Bureau of Food and Drugs Regulation No. 5 s. 1987, § 3 (1987) (Phil.). 341. Id. 342. 16 Human Rights Watch,The Philippines–Unprotected: Sex, Condoms and the Human Right To Health 34 (2004). 343. Id; “The Advertising Board of the Philippines or Adboard is a governing body composed of representatives of national organizations involved in advertising practice who have banded together to promote the development of the advertising industry through self-regulation, in harmony with industry goals. The Adboard is the umbrella organization of the advertising industry.” Philippine Culture and Information, Official website on Philippine Culture and Information, Advertising in the Philippines, http://www.pia.gov.ph/philinfo/phadv.htm (last visited Sept. 21, 2005). 344. The Family Planning Organization of the Philippines was created in 1969 upon the merger of the Family Planning Association of the Philippines and Planned Parenthood Movement of the Philippines. Family Planning Organization of the Philippines, Our Story, http://www.fpop.org.ph/fpop/ourstory.htm (last visited May 12, 2005). 345. Christine A.Varga & Imelda Zosa-Feranil , Adolescent Reproductive Health in Philippines: Status, Issues, Policies, and Programs 19 (2003), http://policyproject. com/pubs/countryreports/ARH_Philippines.pdf (Jan. 2003). 346. 2002 Family Planning Survey, supra note 317, at 31; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 5. 347. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 28.

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348. Id. 349. National Family Planning Policy, Administrative Order No. 50-A s. 2001, at 2 (2001) (Phil.). 350. Department of Health, Office of the Secretary, Department Circular No. 43 S. 1993, Sustainability of the Family Planning Program. 351. Philippine Health Insurance Corporation, Services and Benefits, http:// www.philhealth.gov.ph/ipp.htm (last visited May 12, 2005). 352. Implementing Guidelines for the Creation and Operationalization of Outreach/Itinerant Teams for Voluntary Sterilization Services, Administrative Order No. 153 s. 2002, § III(A) (2002) (Phil.). 353. Id. § IV(B)(a). 354. Family Planning Service, Department of Health, Republic of the Philippines, Contraceptive Supplies: A manual on how to obtain contraceptives from the Philippine Family Planning Program 4 (1998). 355. Philippines Report to Asian and Pacific Population Conference 2002, supra note 334, at 39. 356. Id. 357. Local Government Code of 1991, Republic Act No. 7160, § 17(b)(2)(iv) (1991) (Phil.); Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 34. 358. Local Government Code of 1991 § 17(b)(2)(iv). 359. Exec. Order No. 307, Implementing a Family Planning Program at the Local Government Level (1996) (Phil.). 360. Clara Rita A. Padilla, Local Policies Deny Women’s Rights to Health, 1 Rights Now! 18, 18–19 (2002); Florence Macagba Tadiar, Reproductive Health Programmes Under Health Reform:The Philippine Case, http://www.icomp.org.my/ Country/inno7b.html (last visited May 13, 2005). 361. 16 Human Rights Watch, supra note 342, at 28–31. 362. Email from Clara Rita Padilla, Executive Director, EnGendeRights, to Nile Park, Center for Reproductive Rights, supra note 311. 363. Health Sector Reform Agenda, supra note 201, at iii–iv; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 32. 364. 2002 Family Planning Survey, supra note 317, at 31. 365. USAID, Mission in the Philippines, USAID/Philippines Strategy Fiscal Year 2005–2009, supra note 247, at 10 (2004), http://www.usaid-ph.gov/Documents/USAID %20Phils.%20Strategy%20(Public)2005-2009.doc (Mar. 14, 2005). 366. Philippine NGO Council on Population, Health and Welfare, Inc. (PNGOC), Program Thrusts (2005), http://www.pngoc.com/about_03.htm (last visited May 13, 2005). 367. Id. 368. Safe Motherhood Policy, Administrative Order No. 79 s. 2000, § 1 (2000) (Phil.). 369. National Statistics Office & Department of Health, Republic of the Philippines, National Demographic and Health Survey 1998, § 8.6, at 128 (1999). The large sampling error associated with these estimates does not provide conclusive evidence that MMR has declined. Commission on Population & UNFPA, ICDP at 10: Philippines Country Report–Putting People First 24 (2004) [hereinafter Commission on Population & UNFPA, Putting People First]. The UNICEF, WHO, and UNFPA evaluated the data in 2000 and made adjustments to account for the well-documented problems of underreporting and misclassification of maternal deaths. The adjusted MMR is 200 per 100,000 live births. UNICEF, At a Glance: Philippines, http:// www.unicef.org/infobycountry/philippines_statistics.html (last visited May 13, 2005). 370. This figure was adjusted to 4100 based on the UNICEF, WHO & UNFPA data analysis. UNICEF, WHO and UNFPA evaluated the data in 2000 and made adjustments to account for the well-documented problems of underreporting and misclassification of maternal deaths. The adjusted MMR is 200 per 100,000 live births. UNICEF, At a Glance: Philippines, supra note 369. 371. National Statistics Office,Vital Statistics,Time Series Data, Registered Maternal Deaths by Region, Province, and City of Residence: 1990–1998, http:// www.census.gov.ph/data/sectordata/tsmd90s.htm (last modified Jan. 13, 2005). 372. National Statistics Office, Deaths in the Philippines 2000, Explanatory Notes, http://www.census.gov.ph/data/sectordata/sr0366tx.html (last modified Feb. 27, 2004). 373. National Demographic and Health Survey 2003, supra note 262, § 9.1.1, at 117–119. However, only 72% of women in poverty receive prenatal care compared with 97% of wealthy women. Id. The majority of prenatal care was delivered through health professionals, usually nurses or midwives (49.5%), followed by doctors (38.1%). Id. 374. Id. § 9.2.1, at 125. 375. Id. § 9.2.2, at 126–127. The figure is derived from the sum of doctors (33.6%), nurses (1.1%) and midwives (25.1%) that assist delivery. Id. at 122 tbl.8.6. 376. Id. at 131 tbl.9.12. 377. Government of the Philippines & UNFPA, Country Programme Action Plan between the Government of the Philippines and United Nations Population Fund, 2005–2009, § 18 (2005), http://www.unfpa.org.ph/6thCPCPAP/CountryProgra mmeActionPlan%20(CPAP).pdf (Mar. 21, 2005). 378. Safe Motherhood Policy, Administrative Order No. 79 s. 2000, § 4 (2000) (Phil.). 379. Id. § 3. 380. Id. § 5(I). 381. Id § 5(I)(A). 382. Id. § 5(I)(B). 383. Id. § 5(I)(C).

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384. USAID, Mission in the Philippines, USAID/Philippines Strategy Fiscal Year 2005–2009, supra note 247, at 10 (2004), http://www.usaid-ph.gov/Documents/USAID %20Phils.%20Strategy%20(Public)2005-2009.doc (Mar. 14, 2005). 385. National Family Planning Policy, Administrative Order No. 50-A s. 2001, § IV(E)(1)–(2), at 3–4 (2001) (Phil); Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 38. 386. Barangay-Level Total Development and Protection of Children Act, Republic Act No. 6972, § 3(f) (1990). 387. Food and Agriculture Organization of the United Nations, Nutrition Country Profiles–Philippines 19 (2001). This is the 1998 Nutrition Survey conducted by the Food and Nutrition Research Institute of the Department of Science and Technology of Philippines, on 41 UNICEF-assisted provinces and cities. 388. Id. 389. Philippine Food Fortification Act of 2000, Republic Act No. 8976 (2000). 390. Foods under mandatory food fortification consist of rice, wheat flour, refined sugar, cooking oil, and other staple foods selected by the National Nutrition Council. Philippine Food Fortification Act of 2000 § 6. 391. Id. §§ 4–6, 10. 392. Id. § 3(c). 393. Id. § 11. 394. Food and Nutrition Research Institute, Medium-Term Philippine Food and Nutrition Plan, 1999-2004, http://www.fnri.dost.gov.ph/htm/ppan.htm (last modified May 2005). 395. Country Programme Action Plan between the Government of the Philippines and United Nations Population Fund, 2005–2009, supra note 377, § 18. 396. Phil. Const. art. 2, § 12. 397. Joaquin G. Bernas, S. J., The Constitution of the Republic of the Philippines With Annotations based on Committee Deliberations 8 (1987). Another annotation states that the intent of this provision was to “prevent the State from adopting the doctrine in the US Supreme Court decision of Roe v. Wade …. [t]he understanding is that life begins at conception, although the definition of conception can be a matter for science.” 398. United Nations, Abortion Policies: A Global Review, supra note 302, at 34. 399. Revised Penal Code, No. 3815, arts. 76, 258 (1930) (Phil.). 400. Id. arts. 76, 256(3). 401. The Medical Act of 1959, Republic Act No. 2382, art. III, § 24 (1959) (Phil.); The Philippine Midwifery Act of 1992, Republic Act No. 7392, art. III, § 25 (1992) (Phil.); An Act Regulating the Practice of Pharmacy and Setting Standards of Pharmaceutical Education in the Philippines and of Other Purposes, Republic Act No. 5921, act. III, § 13 (1969) (Phil.). 402. Delisting of Levonorgestrel 750mcg. (Postinor) from Bureau of Food and Drugs Registry of Drug Products, Bureau Circular No. 18 s. 2001 (2001) (Phil.); Email from Carolina S. Ruiz Austria, Program Development Consultant, Womenlead Foundation, Inc., to Melissa Upreti, Center for Reproductive Rights (Sept. 16, 2005, 15:30:00 EST) (on file with the Center for Reproductive Rights). 403. Id. § I. 404. Prevention and Management of Abortion and its Complications (PMAC) Policy, Administrative Order No. 45–B s. 2000 (2000) (Phil.). 405. Id. § III. 406. Id. § V. 407. Id. § V(1). 408. Id. § V(2). 409. Id. § V(3). 410. Id. tbl.1. 411. Id. 412. Id. 413. Id. 414. Id. 415. EngenderHealth, Changing Policies and Attitudes: Postabortion Care in the Philippines, Compass, 2003, at 1. 416. Id. at 1–4; Engender Health, Postabortion Care with Compassion in the Philippines (2003), http://www.engenderhealth.org/itf/philippines.html (last visited May 16, 2005). 417. National Epidemiology Center, Republic of the Philippines, HIV/AIDS Registry– Monthly Update, February 2005. 418. Id. 419. The Philippine AIDS Prevention and Control Act of 1998, Republic Act No. 8504 (1998). 420. Id. § 2(a). 421. Id. § 2(b)(1)–(4). 422. Id. § 2(c). 423. Id. § 2(d). 424. Id. § 2(e). 425. Id. § 14. 426. Id. § 43. The council was created by Executive Order No. 39. 427. Id. § 44. 428. Id. § 44(b). 429. Id. § 44(c). 430. Id. § 44(f). 431. Id. § 45. 432. Rules and Regulations Implementing the Philippine AIDS Prevention and Control

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Act of 1998, Republic Act No. 8504, resol. 1, R. 4, § 26 (1999). 433. Id. R. 4, §§ 31, 43(b). 434. Id. R. 4, § 27(a)–(g). 435. Id. R. 4, § 28. 436. Id. R. 7, § 41. 437. Id. R. 7, §§ 43, 47. 438. Id. R. 7, § 45. 439. Id. R. 8, § 36. 440. Id. R. 8, § 47. 441. Id. § 48. 442. Id. R. 8, §§ 50–52. 443. Id. R. 8, § 53. 444. Id. 445. The Anti-Rape Law of 1997, Republic Act. No. 8353, § 2 (1997) (Phil.); Revised Penal Code, No. 3815, art. 266-B(6) (1930) (Phil.). 446. Working draft of Women of the World: East and Southeast Asia, Philippines, sec. II.B. at 36 (peer reviewed by Dr. Junice L. Demeterio-Melgar, Likhaan, rec’vd May 10, 2005) (on file with the Center for Reproductive Rights). 447. Philippine National AIDS Council, Seizing the Opportunity: The 2000–2004 Medium Term Plan for Accelerating the Philippine Response to HIV/AIDS, ch. 3, § A(2) (2000). 448. Id. ch. 3, § A(4). 449. Id. ch. 3, § A(6). 450. Id. ch. 3, § A(5). 451. Id. ch. 3, § A(8). 452. Id. ch. 3, § A(9). 453. Department of Health, Office of the Secretary, Administrative Order No. 16-A Series 1997 Guidelines for the Management of Asymptomatic Women with RTIs and STD 1. 454. Id. at 2-3. 455. The Philippine AIDS Prevention and Control Act of 1998, Republic Act No. 8504, art. 1, §§ 4–9 (1998). 456. Id. art. 1, § 4. 457. Id. art. 1, § 10. 458. Department of Health, Republic of the Philippines, et al.,The 2001 Technical Report of the National HIV/AIDS Sentinel Surveillance System 3 (2001). 459. Id. at 2–3. 460. Id. at 3. 461. Id. at 9. 462. Id. at 2, 4. 463. Philippine Council for Health Research and Development, Department of Science and Technology, National Guidelines for Biomedical/Behavioral Research 18 (2000), http://www.nus.edu.sg/irb/Articles/PCHRD_DOST_ NEC%20Guidelines.pdf (last visited May 17, 2005). 464. Id. 465. Id. 466. Id. 467. 2002 Philippine Statistical Yearbook, supra note 205, 1-19. Under WHO guidelines, adolescents are people aged 10–19. 468. National Demographic and Health Survey 1998, supra note 369, at 45 tbl.3.10. The 2003 National Demographic and Health Survey shows that among young women aged 15–24, 23.3% in urban areas and 31.3% in rural areas have begun childbearing. National Demographic and Health Survey 2003, supra note 262, at 51 tbl.4.9. 469. National Statistics Office, Vital Statistics Report 1998 (2002), page 24. Of the 1,579 reported cases of maternal death in 1998, 99 (6.3%) were girls aged 15-19. 470. Press Release, 2002 Young Adult Fertility and Sexuality Study (YAFS 3), The Youth are Not Alright (Dec. 12, 2002), http://www.yafs.com/downloads/youth.pdf (last visited May 17, 2005). The Young Adult Fertility and Sexuality Survey refers to those between 15–24 years old as young adults. 471. Press Release, 2002 Young Adult Fertility and Sexuality Study (YAFS 3), 4.9 million young adults have engaged in premarital sex (Feb. 12, 2003), http://www.yafs.com/ downloads/pms.pdf (last visited May 17, 2005). 472. Press Release, 2002 Young Adult Fertility and Sexuality Study (YAFS 3), Filipino youth think they have immunity from HIV/AIDS (Nov. 26, 2004), http://www.yafs. com/downloads/aids.pdf (last visited May 17, 2005). 473. HIV/AIDS Registry– Monthly Update, February 2005, supra note 417, 2 fig.2. 474. Figures extrapolated from total HIV infections under age 29 (739) and number of females in that group. Id. 475. Working draft of Women of the World: East and Southeast Asia, Philippines, sec. II.B. at 39 (peer reviewed by Dr. Junice L. Demeterio-Melgar, Likhaan, rec’vd May 10, 2005) (on file with the Center for Reproductive Rights). 476. Working draft of Women of the World: East and Southeast Asia, Philippines, sec. II.B. at 39 (peer reviewed by Dr. Junice L. Demeterio-Melgar, Likhaan, rec’vd May 10, 2005) (on file with the Center for Reproductive Rights). 477. Phil. Const., art. II, § 13. 478. Id. art. XV, § 3(2). 479. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, § 2 (1992) (Phil.). 480. Id. § 19. 481. Id. § 20(1).

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482. Id. § 20(2); Revised Penal Code, No. 3815, art. 70 (1930) (Phil.) (duration of arresto mayor). 483. Adolescent and Youth Health (AYH) Policy, Administrative Order No. 34-A s. 2000, §§ I–II (2000) (Phil.). The Department of Health adopts the World Health Organization definitions of adolescent (10–19), youth (15–24), and young people (10–24). Id. § III(1). 484. Id. 485. Id. § II. 486. Id. § III(3). 487. Id. § III(7). 488. Id. § III(10). 489. Amendment to the Sub-sections 2,3,4,5 under Section III Providing for the Specific Guidelines of AO # 34-A s. 2000, Adolescent and Youth Health Policy, Administrative Order No. 138-A s. 2000, No. 4 (2000) (Phil.). 490. Adolescent and Youth Health (AYH) Policy, Administrative Order No. 34-A s. 2000, § III(9) (2000) (Phil.). 491. Department of Health, Republic of the Philippines, A Guidebook on Adolescent and Youth Health and Development Program 7; Id. Annex X Work Plan 2001-2010, at 86-87. 492. The baseline for this target is 7.2% in 1998, according to the National Demographic Health Survey. No other baselines were established for the remaining targets. Id. at 7. 493. Id. 494. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 58. 495. Id. at 60–62. 496. Commission on Population & UNFPA, Putting People First, supra note 369, at 37; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 56. 497. Commission on Population & UNFPA, Putting People First, supra note 369, at 50; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 53; Republic of the Philippines, Department of Education, Historical Perspective of the Philippine Educational System, http://www.deped.gov.ph/about_deped/history.asp (last visited Sept. 21, 2005). 498. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 53. 499. The project is the collaboration of the Philippine Center for Population and Development and the Bureau of Secondary Education. Commission on Population & UNFPA, Putting People First, supra note 369, at 50; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 53–54. 500. This program is produced in partnership with Johnson and Johnson and the ASEA Consumer Group of Companies. Commission on Population & UNFPA, Putting People First, supra note 369, at 51. 501. This program is implemented through the Department of Education and Kimberly Clarke Philippines. Id. at 51. 502. Id. at 50. 503. Varga & Zosa-Feranil, supra note 345, at 19. 504. International Council on Management of Population Programs, Catalogue of Practices, Development and Family Life Education for Youths in Davao, http://www.icomp.org.my/SSouth/Inven/NewInven/Devfledu-Davao.htm (last visited May 19, 2005). See also Family Planning Organization of Philippines, Services and Programs, http://www.fpop.org.ph/fpop/programs.htm (last visited May 19, 2005). 505. International Council on Management of Population Programs, Catalogue of Practices, Development and Family Life Education for Youths in Davao, supra note 504. See also Family Planning Organization of Philippines, supra note 504. 506. Foundation for Adolescent Development, All About FAD, http://www.teenfad.ph/about/fadinc/about.htm (last visited May 19, 2005); Commission on Population & UNFPA, Putting People First, supra note 369, at 50. 507. Foundation for Adolescent Development, supra note 506; Commission on Population & UNFPA, Putting People First, supra note 369, at 50. 508. Commission on Population & UNFPA, Putting People First, supra note 369, at 50. 509. Philippine NGO Council on Population, Health and Welfare, Inc. (PNGOC), PNGOC Membership Directory, http://www.pngoc.com/member.htm (last visited May 19, 2005). 510. Commission on Population & UNFPA, Putting People First, supra note 369, at 50. 511. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 66 tbl.4. 512. National Statistics Office, Government of the Philippines, 2000 Census of Population and Housing, http://www.census.gov.ph/census2000/c2khighlights_ final.html (last visited May 19, 2005); Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 66 tbl.4. 513. National Demographic and Health Survey 2003, supra note 262, at 41 tbl.4.1. 514. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 4. 515. Id. at 4–5. 516. Id. at 5. 517. Id. at 6. 518. Id. at 7. 519. Commission on Population & UNFPA, Putting People First, supra note 369, at 15; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 10.

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520. Commission on Population & UNFPA, Putting People First, supra note 369, at 16; Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 10. 521. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 10. 522. Id. at 11. 523. Exec. Order No. 188, Transferring the Commission on Population From the National Economic Development Authority to the Office of the President and then Placing it Under the Control and Supervision of the Department of Health (2003) (Phil.). 524. Population Act of the Philippines, Republic Act No. 6365, § 3 (1971). 525. Revised Population Act of the Philippines, Presidential Decree No. 79, § 2 (1972); Amending the Revised Population Act of 1971, Presidential Decree No. 166 (1973); Further Amending Certain Sections of Presidential Decree No. 79 As Amended, Otherwise Known as Revised Population Act of the Philippines, Presidential Decree No. 803, §§ 1–3 (1975); Amending Certain Sections of Presidential Decree No. 79, As Amended, Otherwise Known as the Revised Population Act of the Philippines, Presidential Decree No. 1204, §§ 1–6 (1977). 526. Commission on Population, Republic of the Philippines, Organizational Structure, http://www.popcom.gov.ph/about_us/org_structure.html (last visited May 19, 2005). 527. Id. 528. Exec. Order No. 123, Reorganizing the Ministry of Transportation and Communications Defining its Powers and Functions and for Other Purpose (1987) (Phil.); Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 5. 529. The department’s leadership was heavily influenced by the Roman Catholic Church and did not believe that family planning was a priority program. Government funding for family planning service delivery was thus effectively frozen from 1986 to 1988. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 5. 530. Id. at 5, 28. 531. Exec. Order No. 408, Placing the Commission of Population Under the Control and Supervisions of the Office of the President (1990) (Phil.). 532. Executive Order No.476, August 14, 1991. 533. Exec. Order No. 188, Transferring the Commission on Population From the National Economic Development Authority to the Office of the President and then Placing it Under the Control and Supervision of the Department of Health § I (2003) (Phil.). 534. Id. 535. Commission on Population, Board Resolution No. 02 S. 1993 Operational Guidelines for a Decentralized Implementation of the Population Program. 536. Commission on Population, Republic of the Philippines, Mission,Vision & Goals, http://www.popcom.gov.ph/about_us/mission.html (last visited May 19, 2005). 537. Id. 538. Phil. Const. art. III, § 1. 539. Id. art. II, § 11. 540. Id. art. II, § 14. 541. The Women in Development and Nation Building Act, Republic Act No. 7192, § 2 (1992) (Phil.). 542. Id. § 2(1). 543. Id. § 2(2). 544. Id. § 2(3). 545. Id. § 5. 546. Id. § 6. 547. Id. § 7. 548. Id. § 8. 549. The act pertains to Indigenous Cultural Communities and Indigenous Peoples. The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371, § 26 (1997) (Phil.). 550. Id. 551. Id. § 26, para. 2. 552. Creation of Inter-Agency Committee on Gender Statistics, National Statistical Coordination Board Memorandum Order No. 003 s. 2002 (2002), http://www.nscb.gov. ph/aboutus/board/memoOrders/2002/3.asp (Jan. 4, 2002). 553. Id. 554. Commission on Population & UNFPA, Putting People First, supra note 369, at 4, 42–43. 555. Id. at 42. 556. International Labour Organization, Equal Employment Opportunities for Women and Men, National Guidelines in Philippines- Project Development, http://www.ilo.org/public/english/employment/gems/eeo/guide/philip/aware.htm (last modified June 20, 2002). 557. Exec. Order No. 273, Approving and Adopting the Philippine Plan for GenderResponsive Development, 1995 to 2025, § 1 (1995). 558. National Commission on the Role of Filipino Women, Framework Plan for Women 2 (2003) [hereinafter Commission on the Role of Filipino Women, Framework Plan]. 559. Id. at iv, 3, 8; Email from Elizabeth Pangalangan, to Nile Park, Center for Reproductive Rights (May 23, 2005, 23:18:00 EST) (on file with the Center for Reproductive Rights). 560. National Economic and Development Authority (NEDA) Board Resolution No.35 s.1992, Approving the Implementing Rules and Regulations of R.A. 7192 (Women in Development and Nation Building Act), Rule II, b(2). 561. General Appropriations Act of 1998, Republic Act No. 8522, § 28 (1998) (Phil.).

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562. Exec. Order No. 208, Further Defining the Composition, Powers and Functions of the National Commission on the Role of Filipino Women §§ 2–3 (1994) (Phil.); Presidential Decree No. 633. 563. Exec. Order No. 273, Approving and Adopting the Philippine Plan for GenderResponsive Development, 1995 to 2025, § 2.1 (1995). 564. Id. § 2.2. 565. Id. § 3. 566. Exec. Order No. 208 § 5.1. 567. Aurora Javate-De Dios, National Commission on the Role of Filipino Women (NCRFW): Making Government Work for Gender Equality (2003), http://www. moge.go.kr/board/eng_kwdi_report/data/Phlippines%20report.doc (Nov. 12, 2003) (presented at the Regional Meeting of National Machineries for Gender Equality in the Asian and Pacific Region: Towards a Forward Looking Agenda (Nov. 12–14, 2003)). 568. The Coordinating Committee on Human Rights is chaired by the Department of Foreign Affairs and is divided into two working groups: one on Civil and Political Rights and the other on Economic, Social and Cultural Rights. 569. Phil. Const. art. XIII; Exec. Order No. 163, Declaring the Effectivity of the Creation of the Commission on Human Rights as Provided for in the 1987 Constitution, Providing Guidelines for the Operation Thereof, and for Other Purposes (1987) (Phil.). 570. Phil. Const. art. XIII, § 18(7); Exec. Order No. 163 § 3(7). 571. Creating the Inter-Agency Coordinating Committee on Human Rights, Administrative Order No. 370, § 1 (1997) (Phil.). 572. Id. § 2. 573. The Women in Development and Nation Building Act, Republic Act No. 7192, § 4(4) (1992) (Phil.). 574. Enjoining Different Agencies to Promote Gender Concerns in the Generation of Statistics, National Statistical Coordination Board Resolution No. 8 s. 1994 (1994) (Phil.), http://www.nscb.gov.ph/resolutions/1994/8.asp (Oct. 12, 1994). 575. House Bill 2051, 12th Congress, 1st Session. 576. Id. 577. Anti-Discrimination Act, House Bill No. 6416 (2004) (Phil.). 578. Anti-Discrimination Act, House Bill No. 2784 (2004) (Phil.). 579. There is no similar provision for children of Filipino fathers. Phil. Const., art. IV, § 1. 580. Id. art. XV, § 1. 581. Id. art. XV, § 2. 582. Id. art. XV, § 3(1). 583. The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 13(1) (1977). 584. Id. art. 13(1)–(2). 585. The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371, § 15 (1997) (Phil.). 586. Exec. Order No. 209, The Family Code of the Philippines, art. 33 (1987). 587. Id. art. 1. 588. Id. art. 2. 589. An authorized official refers to members of the judiciary, religious leaders (priest, rabbi, etc.), military commanders, and consular officials. Id. arts. 7, 10. 590. Id. art. 3. 591. Id. art. 4. 592. Id. art. 5. 593. Id. art. 14. 594. Id. art. 45(1). 595. Id. art. 15. 596. Even if only one party of the intended marriage requires parental consent, both parties must undergo marriage counseling. Id. art. 16. The Mandatory Marriage Counseling Act is currently undergoing deliberations at the House of Representatives which would mandate counseling for all couples intending to marry. An Act Amending Article 16 Of Executive Order No. 209 As Amended By Executive Order No. 227, Otherwise Known As The Family Code Of The Philippines, Making It Mandatory For Couples To Undergo Counseling Prior To The Issuance Of A Marriage License, House Bill No. 216 (2004) (Phil.). 597. Exec. Order No. 209, The Family Code of the Philippines, art. 16 (1987). 598. Id. art. 34. 599. Id. art. 68. 600. Id. art. 195. Support comprises everything necessary for sustenance, dwelling, clothing, medical attendance, education, and transportation, keeping with the financial capacity of the family. Id. art. 194. 601. The Civil Code of the Philippines, Republic Act No. 386, arts. 19–21 (1949). 602. Exec. Order No. 209, The Family Code of the Philippines, art. 69 (1987). 603. Id. art. 70. 604. Id. art. 71. 605. Id. art. 73. 606. Id. art. 35(4). Revised Penal Code, No. 3815, art. 349 (1930) (Phil.). 607. Exec. Order No. 209, arts. 37–38. 608. Revised Penal Code art. 333. 609. Id. arts. 76, 333, para. 2. 610. Id. art. 334. 611. Id. arts. 76, 334. 612. An Act Repealing Articles 333 and 334 and Amending Article 344 Of Act 3815, As Amended, Otherwise Known As The Revised Penal Code, And Defining The Crime

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Of Marital Infidelity, House Bill No. 334 (2004). This bill is currently pending in the House of Representatives which seeks to correct the disparity between treatment of husbands and wives in the matter of marital infidelities. 613. Exec. Order No. 209, The Family Code of the Philippines, arts. 1–2 (1987). 614. The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 15 (1977). 615. Id. art. 16(1). 616. Shari’a District Court is a Court of Muslim Law. Id. art. 16(2). 617. Id. art. 16(3)(1977). 618. Id. art. 34(1). 619. Id. art. 35. 620. The wife “may purchase things…and the husband shall be bound to reimburse the expenses, if he has not delivered the proper sum.” Id. art. 36(1). 621. Id. art. 67(1). 622. Id. art. 36. 623. Id. art. 27. 624. The prohibition on marriage by reason of fosterage applies to nursemaids and their charges, and persons related by fosterage within the third degree. Id. art. 23–26. 625. Pending bill introduces divorce as an option for couples and lists five grounds for divorce. An Act Introducing Divorce in the Philippines, Amending for the Purpose Title II, Articles 55 to 66 Inclusive and Article 26 of Executive Order No. 209, as Amended, Otherwise Known as The Family Code of the Philippines, and Repealing Article 36 of the Same Code, and For Other Purposes, House Bill No. 4016 (2005) (Phil.). 626. Exec. Order No. 209, The Family Code of the Philippines, art. 35(3) (1987). 627. Id. art. 37. 628. Exec. Order No. 209, The Family Code of the Philippines, art. 36 (1987), amended by Exec. Order No. 227, Amending Executive Order No. 209, Otherwise Known as the “Family Code of the Philippines § 2 (1987) (Phil.). 629. Exec. Order No. 209, The Family Code of the Philippines, art. 35(1) (1987). 630. Martial consent through violence, intimidation or fraud is also punishable by imprisonment. Revised Penal Code, No. 3815, arts. 71, 350 (1930) (Phil.). 631. Exec. Order No. 209, The Family Code of the Philippines, art. 45 (1987). Grounds for annulment in the Family Code are similar to those in Article 85 of the Civil Code. 632. Id. art. 45(3). 633. Id. art. 46(4). However, misrepresentation of character, health, rank, fortune or chastity does not constitute fraud for the purpose of annulling a marriage. Id. art. 46. 634. Id. arts. 52–53. The absolute nullity of a previous marriage may be invoked for purposes of remarriage; proof of the nullity of the prior marriage can only be based on a final judgment declaring the previous marriage void. Id. art. 40. 635. Exec. Order No. 209, The Family Code of the Philippines, art. 26 (1987), amended by Exec. Order No. 227, Amending Executive Order No. 209, Otherwise Known as the “Family Code of the Philippines § 1 (1987). 636. Since the Family Code does not provide for divorce, a divorced woman refers to any woman whose marriage has been annulled or dissolved, who is legally separated from her spouse or where one spouse is a foreign citizen, and has obtained a divorce in a foreign court. Revised Penal Code, No. 3815, art. 351 (1930) (Phil.). 637. Id. 638. Id. 639. An Act Abolishing the 301 Days Criminal Prohibition to Remarry and Allowing the Remarriage of a Widow or a Separated Woman Forty Days After the Death of Her Husband or the Annulment or Dissolution of Her Previous Marriage, Amending for the Purpose Article 351 of Act No. 3815, as Amended, Otherwise Known as the “Revised Penal Code,” House Bill No. 3473 (2004) (Phil.). 640. Exec. Order No. 209, The Family Code of the Philippines, art. 55 (1987). 641. Id. art. 63(1). 642. Absolute community property consists of all property owned by the spouses at the time of marriage and acquired thereafter. Id. art. 91. Exclusions to community property include those “acquired during the marriage by gratuitous title…unless expressly provided by the donor…,” “for personal and exclusive use,” individually acquired prior to the marriage, or the fruits or income therefrom. Id. art. 92. 643. Id. art. 198. 644. Id. 645. Id. 646. Id. arts. 201–202. 647. The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 45 (1977). 648. Id. 649. Id. art. 46. The repudiation must be during her non-menstrual period (tuhr), during which time he has abstained from any carnal relation with her. 650. Idda is the waiting period prescribed for a widowed or divorced woman which will enable her to remarry. Id. art. 56. The Idda is three months for divorced women, four months and ten days for widowed women and upon delivery if she is pregnant. Id. art. 57(1). 651. In such cases, there is no need for a new contract of marriage. Id. arts. 46, 56. 652. Id. art. 46. 653. Id. art. 47. 654. Id. art. 48. 655. The acts of redemption, or “prescribed expiation” involve the freeing of a slave, fasting during the daytime of two consecutive lunar months or feedings sixty needy people if he is unable to free a slave or fast. Hussein Al-Hussein, Marital Relations in Islam

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(2001), http://www.stanford.edu/group/ISSU/about_islam/articles_hussein/node21. html#SECTION000210000000000000000 (Nov. 13, 2001); The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 48 (1977). 656. The Code of Muslim Personal Laws of the Philippines art. 48. 657. Id. 658. Id. art. 49. The “prescribed acts of imprecation” are procedures husbands and wives must follow in a divorce by li’an. It involves vowing four times to the truth of one’s testimony and at the fifth vowing invokes the curse of Allah. Hussein Al-Hussein, supra note 655. 659. The Code of Muslim Personal Laws of the Philippines art. 50. 660. Id. art. 51. 661. Id. 662. Id. art. 52. 663. Id. art. 53. 664. Id. art. 54(a). 665. Id. arts. 28–29(1). Where it is indisputable that the marriage was not consummated when the divorce was effectuated, no idda is required. Id. arts. 29(3), 56–57. 666. Id. arts. 28–29(1), 57(1)(c). 667. Id. art. 182. 668. Id. art. 67. 669. Id. 670. Id. 671. Id. art. 70. 672. Id. art. 54. 673. Exec. Order No. 209, The Family Code of the Philippines, art. 221 (1987). 674. The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 71 (1977). 675. Exec. Order No. 209 art. 213. The law does not specify whether the separation has to be a legal separation and parents who are in fact separated are covered within its provisions. Nerissa Z. Perez v. The Court of Appeals and Ray C. Perez, G.R. No. 118870 (1996) (Phil.). 676. Exec. Order No. 209 art. 63. 677. The Civil Code of the Philippines, Republic Act No. 386, art. 363 (1949) (Phil.) (repealed by the Family Code of 1987); Rules of Court of the Philippines, Special Proceedings, R. 99, § 6 (Phil.). Custody of children with disabilities or under the age of 7 is automatically given to the mother, unless there are compelling reasons to do otherwise. Anti-Violence Against Women and Their Children Act of 2004, Republic Act No. 9262, § 28 (2004) (Phil.). 678. Nerissa Z. Perez v. The Court of Appeals and Ray C. Perez, G.R. No. 118870 (1996) (Phil.) (citing Medina v. Makabali, G.R. No. L-26953 (1969) (Phil.)). 679. Id. (citing Sy v. Funa, CA G.R. No.122117 (Phil.)). 680. Id. (citing Cervantes v. Fajardo, G.R. No. 79955 (1989) (Phil.)). 681. Id. (citing I.A.Tolentino, Commentaries and Jurisprudence on the Civil Code of the Philippines 609 (1990)). 682. Id. (citing Sy v. Funa, CA G.R. No.122117 (Phil.)). 683. Id. 684. Nerissa Z. Perez v. The Court of Appeals and Ray C. Perez, G.R. No. 118870 (1996) (Phil.). 685. This law covers physical, sexual, psychological violence and economic abuse by any person against his wife, former wife, women with which the accused is in a sexual relationship, or the mother of his child/children. Anti-Violence Against Women and Their Children Act of 2004, Republic Act No. 9262, § 28 (2004) (Phil.). 686. In the mother’s absence, custody is awarded to the maternal grandmother, paternal grandmother, sisters and aunts and only in their absence is custody granted to fathers and other paternal relatives. The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 78(1) (1977). 687. Id.. 688. Id. art. 78(2). 689. Phil. Const., art. III, § 1. 690. Id. art. XIII, § 1. 691. Id. art. XIII, § 1, para. 2. 692. The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371, § 2(b) (1997) (Phil.). 693. Id. §§ 25–27. 694. Exec. Order No. 209, The Family Code of the Philippines, art. 74 (1987). 695. Id. art. 75. 696. Id. arts. 75, 91. See art. 92 for property not included as “community property.” 697. Id. art. 105. 698. Id. art. 109. 699. Id. art. 117. 700. Id. arts. 96, 124. 701. Id. arts. 96, 124. 702. Id. art. 147, para. 1. 703. Id. art. 147. 704. Id. 705. Id. art. 147, para. 2. 706. Id. art. 147, para. 4. 707. Id. art. 148. 708. Id. arts. 225–226. Parental authority (including guardianship over the minor’s property) is granted to the mother (or appointed legal guardian). Id. art. 176. The Family

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Code provides that the age of majority commences at the age of 18. Id. art. 234. 709. The Civil Code of the Philippines, Republic Act No. 386, bk. III, tit. IV (1949) (Phil.). 710. The Code of Muslim Personal Laws of the Philippines, Presidential Decree No. 1083, art. 38 (1977). 711. Id. arts. 36(4), 40. 712. Id. art. 42. 713. Id. art. 36(2). 714. Id. arts. 111–112. Inheritance includes all properties movable and immovable, ancestral, onerous or acquired through gratuitous title, and all transmittable rights and obligations at the time of death. Id. art. 90. 715. Id. art. 117(1). 716. Mutual rights of inheritance between divorced husbands and wives remain during the idda, while the wife’s right of inheritance to her husband’s estate extends beyond the idda if the husband sought the divorce while suffering from a terminal illness. Id. art. 96(1)–(2). 717. Comprehensive Agrarian Reform Law of 1988, Republic Act No. 6657, § 40(5) (1988) (Phil.). 718. 2002 Philippine Statistical Yearbook, supra note 205, 11-11. 719. Id. 11-9. 720. Id. 11-11. 721. Id. 11-17. 722. Maria Cynthia Rose Banzon Bautista, Migrant Workers and Their Environments: Insights from the Filipino Diaspora (2002), http://www.unu.edu/hq/japanese/gs-j/gs2002j/shonan18/Bautista4abstE.pdf (last visited May 21, 2005). 723. Philippine Overseas Employment Administration, Republic of the Philippines, Stock Estimates of Overseas Filipinos (as of Dec. 2003), http://www.poea.gov. ph/docs/ofwStock2003.doc (last visited May 21, 2005). 724. Philippine Overseas Employment Administration, Republic of the Philippines, Annual Report 2004, at 9 (2005), http://www.poea.gov.ph/AR2004/AnnualReports/ AR2004.pdf (last visited May 21, 2005). 725. Service sector includes domestic helpers, household workers, caretakers, waiters and bartenders etc. A significant number of females hired in professional/technical positions are health care workers. Id. at 9. 726. Phil. Const., art. XIII, § 3, para. 1. 727. Id. art. XIII, § 3, para. 2. 728. Id. 729. Id. art. XIII, § 14. 730. The Labor Code of the Philippines, Presidential Decree No. 442, arts. 135–136, 138–139 (1974), amended by An Act Strengthening the Prohibition on Discrimination Against Women with Respect to Terms and Conditions of Employment, Amending for the Purposes Article 135 of the Labor Code, as Amended, Republic Act No. 6725, § 1 (1989) (Phil.). 731. Id. art. 135(a). 732. Id. art. 135(b). 733. The Labor Code of the Philippines, Presidential Decree No. 442, art. 136 (1974). 734. Id. art. 137. 735. Philippine Telegraph and Telephone Company v. National Labor Relations Commission and Grace de Guzman, G.R. 118978, § 3 (1997) (Phil.). 736. Id. § 5. 737. Night work generally refers to work between 10 p.m. and 6 a.m. The Labor Code of the Philippines, Presidential Decree No. 442, art. 130 (1974); Rules to Implement the Labor Code, R. XII, §5 (1989) (Phil.). 738. The Labor Code of the Philippines, Presidential Decree No. 442, art. 131 (1974); Rules to Implement the Labor Code, R. XII, § 5 (1989) (Phil.). 739. Social Security Act of 1997, Republic Act No. 8282 (1997) (Phil.). 740. Id. § 14-A, 14-A(d). The provisions are only valid if the female employee has paid at least three monthly contributions to the social security system within the last year. Id. Maternity Leave may be granted for deliveries, miscarriages, and/or complete abortions. Rules to Implement the Labor Code, R. XII, §§ 7, 10 (1989) (Phil.). 741. Social Security Act of 1997 § 14-A. Employers that fail to provide maternity benefits as stipulated in the Social Security Act are subject to criminal investigation initiated by the Social Security Commission, fines of P5000 to P20,000, and/or imprisonment of up to 12 years. Id. § 28(e), (i). 742. Civil Service Commission, Omnibus Rules Implementing Book V of the Administrative Code of 1987, R. XVI (1992) (Phil.). 743. Civil Service Commission, Amendment to the Maternity Leave Rules under Rule XVI of the Omnibus Rules Implementing Book V of the Administrative Code of 1987, Resolution No. 021420, (Executive Order No. 292) (2002) (Phil.). 744. Delivery can either mean childbirth or miscarriage. The Paternity Leave Act of 1996, Republic Act No. 8187, § 2 (1996) (Phil.). The Act was incorporated into the Omnibus Rules for Civil Service, Rules XVI, sec. 19 and sec. 20 on December 14, 1998. The provisions specifically stated that married male employees with more than one wife are limited to four paternity leaves regardless of whichever wife gives birth. Id. § 19. 745. The Labor Code of the Philippines, Presidential Decree No. 442, art. 132 (1974); Rules to Implement the Labor Code, R. XII, § 14 (1989) (Phil.). 746. The Labor Code of the Philippines, Presidential Decree No. 442, art. 134 (1974); Rules to Implement the Labor Code, R. XII, § 11. 747. Barangay-Level Total Development and Protection of Children Act, Republic Act No. 6972, § 3 (1990) (Phil.).

WOMEN OF THE WORLD:

748. The Women in Development and Nation Building Act, Republic Act No. 7192, § 5 (1992) (Phil.). 749. Id. § 5(1)–(2). 750. An Act Providing Assistance to Women Engaging in Micro and Cottage Business Enterprises, and for Other Purposes, Republic Act No. 7882, §§ 3–4 (1995) (Phil.). 751. Women with an existing business are eligible for loans only if they have a good track record in sales. Id. § 2. 752. Id. § 7. 753. Asian Development Bank, Sociolegal Status of Women in Indonesia, Malaysia, Philippines, and Thailand 75 (2002). 754. National Commission on the Role of Filipino Women, Making Financing Projects Work for Women 18 (2001). 755. Figures reflect simple literacy rates of the population over 10 years of age in 1994. 2002 Philippine Statistical Yearbook, supra note 205, 10-16 tbl.10.11. 756. National Statistical Coordination Board,Women and Men Factsheet, http://www.nscb.gov.ph/stats/gender/statwatch03March05.asp (last modified Mar. 4, 2005). 757. 2002 Philippine Statistical Yearbook, supra note 205, 10-16 tbl.10.11; Abdulgani A. Salapuddin, Enhancing Participation in Promoting Access and Equity to Higher Education for Muslim Filipinos (on file with the Center for Reproductive Rights). 758. Gender differentials extrapolated from statistics on enrollment by discipline group, sector and gender. Commission on Higher Education, Republic of the Philippines, Higher Education Statistical Bulletin 11 tbl.5 (2002). 759. Commission on the Role of Filipino Women, Framework Plan, supra note 558, at 15 (2003). 760. Phil. Const. art. XIV, § 1. 761. Id. art. XIV, § 2(2). 762. Id. art. XIV, § 2(3)–(5). 763. The Free Public Secondary Education Act of 1988, Republic Act No. 6655, § 2 (1988). 764. Education Act of 1982, No. 232, §§ 2, 6, 8–18 (1982) (Phil.). 765. Id. §§ 33, 45. 766. An Act Providing Assistance to Women Engaging in Micro and Cottage Business Enterprises, and for Other Purposes, Republic Act No. 7882, § 5 (1995) (Phil.). 767. Despite the constitutional guarantee, access to higher education has been particularly difficult for Muslim Filipinos and indigenous peoples, many of whom live in poverty. See Salapuddin, supra note 757, para. 3. 768. Salapuddin, supra note 757. Republic Act No. 1387 provides scholarships and grants to Muslim Filipino students. 769. The Indigenous Peoples Rights Act of 1997, Republic Act No. 8371, § 25 (1997) (Phil.). 770. Education Act of 1982, No. 232, § 3 (1982) (Phil.). 771. Commission on Population & UNFPA, Putting People First, supra note 369, at 27, 39. The DECS was formerly known as the Ministry of Education and Culture. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 53. 772. See Department of Education, Republic of the Philippines, Population Education Curriculum (1996). 773. Id. at 1. 774. Id. at 1–14. 775. Id. at 15–19. 776. Id. at 20–22. 777. Philippine Management Program Directional Plan, 2001–2004, supra note 225. 778. Id. at 127. 779. The program was authorized under Administrative Order No. 950. Philippine Management Program Directional Plan, 2001–2004, supra note 225, at 53. See also Varga & Zosa-Feranil, supra note 345, at 19. 780. Revised Penal Code, No. 3815, art. 266-A(1) (1930) (Phil.), amended by The AntiRape Law of 1997, Republic Act No. 8353 (1997). 781. Rape is deemed to have occurred when the penis enters the labia of the vagina, or touches the external genitalia. Women’s Legal Bureau, Inc., Addressing Rape in the Legal System: A Multidisciplinary Training Manual 108 (2001) (referencing People v. Quiñanola, 306 SCRA 710 (1999), People v. Cabebe, 290 SCRA 543 (1998), and People v. De la Peña, 233 SCRA 753 (1994), as cited in People vs. Castromero, 280 SCRA 421 (1997)). 782. Revised Penal Code, No. 3815, art. 266-A(2) (1930) (Phil.), amended by The AntiRape Law of 1997, Republic Act No. 8353 (1997). 783. Communication with Institute for Social Studies and Action (ISSA), Women of the World Report—Philippines (draft) (May 8, 2003) (on file with the Center for Reproductive Rights). 784. Revised Penal Code, No. 3815, art. 266-C (1930) (Phil.), amended by The Anti-Rape Law of 1997, Republic Act No. 8353 (1997). 785. Id. art. 266-C. 786. Id. arts. 25, 70, 266-B. 787. Id. art. 266-B, para. 4. 788. Id. art. 266-B(2), (5)–(10). 789. Id. art. 266-B(1). 790. Revised Penal Code, No. 3815, art. 336 (1930) (Phil.). 791. Anti-Violence Against Women and Their Children Act of 2004, Republic Act No. 9262, § 6(a)–(f) (2004) (Phil.). 792. Id. § 6. Perpetrators are subject to the death penalty if the act(s) constitute attempt-

PHILIPPINES

ed, frustrated or consummated parricide, murder or homicide. Id. § 6(a). Other penalties, ranging from imprisonment of one month to 12 years, depending on severity of the injury inflicted or the acts committed. Id. § 6(a)–(f). 793. An Act Strengthening Further the Right of Daughters Against Incestuous Rape by Penalizing Mothers Who Refrain From Proceeding Against the Father-Rapists or Tolerate Its Commission, House Bill No. 1715 (2001) (Phil.). 794. The Family Courts Act of 1997, Republic Act No. 8369, § 5(k)(1) (1997) (Phil.). 795. Id. § 5(k)(2). 796. Id. § 5(k). 797. Id. § 7. 798. Intimate partners refer to a person with whom the perpetrator has or had an extended sexual, dating, or romantic relationship. Anti-Violence Against Women and Their Children Act of 2004, Republic Act No. 9262, § 3(a), (e) (2004) (Phil.). 799. Id. § 3(a). 800. Id. § 5(a)–(i). Being under the influence of alcohol, any illicit drug, or any other mind-altering substance is not a defense under the Act. Id. § 27. 801. Id. §§ 8–23. 802. Id. §§ 3, 26. 803. Id. § 28. 804. Id. § 35(a)–(e). 805. Id. § 40. 806. Rape Victim Assistance and Protection Act of 1998, Republic Act No. 8505, § 3 (1998) (Phil.). 807. Revised Penal Code, No. 3815, arts. 246–249, 262–266 (1930) (Phil.). 808. Exec. Order No. 209, The Family Code of the Philippines, art. 55(1) (1987). 809. The Anti-Sexual Harassment Act of 1995, Republic Act No. 7877, § 2 (1995) (Phil.). 810. Sexual harassment is also committed when the demanded sexual favor is a condition for employment, education or training decisions, and where sexual advances create an intimidating, hostile or offensive environment for the victim. Id. § 3. 811. Id. § 7. 812. Id. § 6. 813. Id. § 5. 814. Civil Service Commission, Republic of Philippines, Administrative Disciplinary Rules on Sexual Harassment Cases, Resolution No. 01-940 (2001). 815. Id. § 3. 816. Id. § 54. 817. Id. § 56. 818. Saligan Women’s Unit, Sexual Harassment 3, http://www.salidumay.org/discussions/articles/sexual-harassment.doc (last visited May 21, 2005). See Floride Dawa v. Judge Armando C. De Asa, A.M. No. MTJ-98-1144 (1998) (Phil.). 819. Most of the cases have resulted in dismissals or downgraded to a lower offense (i.e., a charge under the Revised Penal Code, art. 336 for an act of lasciviousness). Saligan Women’s Unit, supra note 818, at 3. 820. Revised Penal Code, No. 3815, arts. 76, 341 (1930) (Phil.), amended by An Act Increasing the Penalty for White Slave Trade, Amending for the Purpose Article 341 of the Revised Penal Code, No. 186 (1982) (Phil.). 821. Anti-Violence Against Women and Their Children Act of 2004, Republic Act No. 9262, §§ 3(a), (c), 6 (2004) (Phil.). 822. Laws and Regulations Governing the Fight Against Prostitution in All Forms, House Resolution No. 00546 (2002) (approved on Second Reading on May 29, 2002 with Committee Report No. 00516 and referred to Committee on Rules). 823. The Anti-Prostitution Act, House Bill No. 03051 (2004) (Phil.). 824. The Anti-Prostitution Act of 2004, House Bill No. 02419 (2004) (Phil.); The AntiProstitution Act, House Bill No. 00520 (2004) (Phil.); The Anti-Prostitution Act of 2004, House Bill No. 02857 (2004) (Phil.). 825. Varga & Zosa-Feranil, supra note 345, at 14. 826. Id. 827. Id. 828. Anti-Trafficking in Persons Act of 2003, Republic Act No. 9208, §§ 3(a), 4–5 (2003) (Phil.). 829. Id. § 3(a). 830. Id. 831. Id. § 3(a), para. 2. “Children” refers to persons below 18 years of age or those over 18 but who are unable to fully take care of or protect themselves from abuse, neglect, cruelty, exploitation or discrimination because of a physical or mental disability or conditions.” Id. § 3(b). 832. Id. § 10(a). 833. Id. § 10(b). 834. Id. § 17. 835. The penalty for a first offense is 6 months of community service and a fine of 50,000 pesos while the penalty for second and subsequent offenses is imprisonment of 1 year and a fine of 100,000 pesos. Id. § 11(a)–(b). 836. Id. § 20. 837. Id. §§ 16, 23–24. 838. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, §§ 2, 3(b)(1) (1992) (Phil.), amended by Republic Act No. 9231, An Act Providing for the Elimination of the Worst Forms of Child Labor and Affording Stronger Protection for the Working Child, Amending for this Purpose Republic Act No. 7610, as Amended, Otherwise Known as the “ Special Protection of Children Against Abuse, Exploitation and Discrimination Act” (2003) (Phil.). Under the Act, sexual abuse

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encompasses child prostitution and the action of any adult to coerce, influence, facilitate a child into prostitution and those who profit from such. Id. §§ 2, 5(a), (c). 839. Penalty for acts of lasciviousness is greater than the norm when the victim is under 12. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, § 5(b) (1992) (Phil.); Revised Penal Code, arts. 27, 335 (1930) (Phil.). 840. Special Protection of Children against Child Abuse, Exploitation and Discrimination Act, § 5(b) (1992) (Phil.); Revised Penal Code, No. 3815, arts. 76, 336 (1930) (Phil.). 841. Revised Penal Code, No. 3815, arts. 337–338 (1930) (Phil.). 842. Id. art. 337. 843. Id. arts. 76, 337. 844. Special Protection of Children against Child Abuse, Exploitation and Discrimination Act, § 10(6) (1992) (Phil.); Revised Penal Code, No. 3815 (1930) (Phil.). 845. Revised Penal Code, No. 3815, art. 338 (1930) (Phil.). Deceit is usually interpreted as a promise of marriage, although a promise made after sexual intercourse or one made by a married man whom the victim knows to be married, is not considered deceitful. Rex Editorial Board. The Revised Penal Code of the Philippines, 133 (1986). 846. Revised Penal Code, No. 3815, art. 338 (1930) (Phil.). 847. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, § 5(a) (1992) (Phil.); Revised Penal Code, No. 3815, arts. 27, 76 (1930) (Phil.). 848. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, § 5(b) (1992) (Phil.). 849. Id. § 5(c). 850. Attempts to commit child prostitution include an unrelated person found alone with a prostituted child in a room where it is reasonable to infer that the child is about to be prostituted or sexually abused; or where a person is receiving services from a child in a sauna parlor and other similar establishments. Id. § 6. 851. “A penalty lower by two (2) degrees than …the consummated felony …shall be imposed.” Id. § 6, para. 2. See also Revised Penal Code, No. 3815, art. 52 (1930) (Phil.). According to the Revised Penal Code’s graduated scales, two degrees below reclusion perpetua is prison mayor. Id. arts. 61, 71, 76. 852. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, § 10(6) (1992) (Phil.). See also Revised Penal Code, No. 3815, arts. 340–341 (1930) (Phil.). 853. Special Protection of Children Against Abuse, Exploitation and Discrimination Act, Republic Act No. 7610, § 7 (1992) (Phil.). 854. Attempts at child trafficking are punishable by penalties 2 degrees less than actual commitment of child trafficking, therefore, the penalty is prision correccional. Id. § 8. 855. Id. § 8(a). 856. Id. § 8(d). 857. Id. § 8(c), (e).

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WOMEN OF THE WORLD:

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

4. Thailand Statistics GENERAL

Population Total population (millions): 64.2.1 ■ Population by sex (thousands): 32,333.0 (female) and 31,132.0 (male).2 ■ Percentage of population aged 0–14: 23.2.3 ■ Percentage of population aged 15–24: 17.8.4 ■ Percentage of population in rural areas: 68.5 Economy ■ Annual percentage growth of gross domestic product (GDP): 3.7.6 ■ Gross national income per capita: USD 2,190.7 ■ Government expenditure on health: 3.1% of GDP.8 ■ Government expenditure on education: 3.6% of GDP.9 ■ Percentage of population below the poverty line: Information unavailable. ■

WOMEN’S STATUS ■ ■ ■ ■ ■ ■ ■ ■ ■

Life expectancy: 74.3 (female) and 67.3 (male).10 Average age at marriage: 23.5 (female) and 26.0 (male).11 Labor force participation: 65.0 (female) and 81.4 (male).12 Percentage of employed women in agricultural labor force: Information unavailable. Percentage of women among administrative and managerial workers: 26.13 Literacy rate among population aged 15 and older: 95% (female) and 98% (male).14 Percentage of female-headed households: Information unavailable. Percentage of seats held by women in national government: 9.15 Percentage of parliamentary seats occupied by women: 9.16

CONTRACEPTION ■ ■ ■ ■

Total fertility rate: 1.90.17 Contraceptive prevalence rate among married women aged 15–49: 72% (any method) and 70% (modern method).18 Prevalence of sterilization among couples: 22.6% (total); 19.8% (female); 2.8% (male).19 Sterilization as a percentage of overall contraceptive prevalence: 30.6.20

MATERNAL HEALTH ■ ■ ■ ■

Lifetime risk of maternal death: 1 in 1,100 women.21 Maternal mortality ratio per 100,000 live births: 44.22 Percentage of pregnant women with anemia: 57.23 Percentage of births monitored by trained attendants: 99.24

ABORTION ■ ■

Total number of abortions per year: Information unavailable. Annual number of hospitalizations for abortion-related complications: Information unavailable.

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■ ■ ■

WOMEN OF THE WORLD:

Rate of abortion per 1,000 women aged 15–44: Information unavailable. Breakdown by age of women obtaining abortions: Information unavailable. Percentage of abortions that are obtained by married women: Information unavailable.

SEXUALLY TRANSMISSIBLE INFECTIONS (STIS) AND HIV/AIDS ■ ■ ■ ■

Number of people living with sexually transmissible infections: Information unavailable. Number of people living with HIV/AIDS: 570,000.25 Percentage of people aged 15–49 living with HIV/AIDS: 1.1 (female) and 2.0 (male).26 Estimated number of deaths due to AIDS: 58,000.27

CHILDREN AND ADOLESCENTS ■ ■ ■ ■ ■ ■

■ ■

Infant mortality rate per 1,000 live births: 18.28 Under five mortality rate per 1,000 live births: 19 (female) and 31 (male).29 Gross primary school enrollment ratio: 95% (female) and 99% (male).30 Primary school completion rate: Information unavailable. Number of births per 1,000 women aged 15–19: 48.31 Contraceptive prevalence rates among married female adolescents: 40.5% (modern methods); 2.6% (traditional methods); 43.0% (any method).32 Percentage of abortions that are obtained by women younger than age 20: Information unavailable. Number of children under the age of 15 living with HIV/AIDS: 12,000.33

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

ENDNOTES 1. See United Nations Population Fund (UNFPA),The State of World Population 2005, at 112 (estimates for 2005). 2. See United Nations Population Fund (UNFPA), Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003 (2003), http://www.unfpa.org/profile/default.cfm. [hereinafter UNFPA, Country Profiles]. 3. See The World Bank,World Development Indicators 2004, at 40 (2004), http:// www.worldbank.org/data/ (estimates for 2002). [hereinafter The World Bank]. 4. See UNFPA, Country Profiles, supra note 2. 5. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimates for 2003). 6. See The World Bank, supra note 3, at 184 (estimates for 1990-2002). 7. See The World Bank,World Development Indicators 2004: Data Query (2004), http://devdata.worldbank.org/data-query/ (statistical figure obtained through the Atlas method) (estimates for 2003). 8. See UNFPA,The State of World Population 2005, supra note 1, at 112. 9. See United Nations CyberSchoolBus, InfoNation: Government Education Expenditure (2004), http://www.un.org/Pubs/CyberSchoolBus/infonation/e_ infonation.htm (estimates for 1997). 10. See UNFPA,The State of World Population 2005, supra note 1, at 108. 11. See UNFPA, Country Profiles, supra note 2. 12. See Id. 13. See Social and Demographic Statistics Branch, United Nations Statistics Division,The World’s Women 2000:Trends and Statistics (2000) (estimate for 2003). 14. See UNFPA, Country Profiles, supra note 2. 15. See Save the Children, State of World’s Mothers 2004, at 38 (2004), http:// www.savethechildren.org/mothers/report_2004/images/pdf/SOWM_2004_final.pdf (estimate for 2004). 16. See United Nations Statistics Division, Millennium Indicators Database (2005), http://unstats.un.org/unsd/mi/mi_series_results.asp?rowId=557 (last updated Mar. 16, 2005) (estimate for 2005). 17. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimates for 2000-2005). 18. See Id. at 108. 19. See Engenderhealth, Contraceptive Sterilization: Global Issues and Trends, tbl. 2.2, at 47 (2002) (estimates for 1993). 20. See Id. at tbl. Supp. 2.5, at 56. (estimate for 1993). 21. See World Health Organization (WHO) et al., Maternal Mortality in 1995: Estimates Developed by WHO, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), 46 (2000) (estimate for 1995). 22. See UNFPA,The State of World Population 2005, supra note 1, at 108. 23. See Save the Children, supra note 15, at 38 (estimate for 1989-2000). 24. See UNFPA,The State of World Population 2005, supra note 1, at 112. 25. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., UNAIDS/World Health Organization (WHO) Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 Update:Thailand 3 (2004), http://www.who.int/GlobalAtlas/PDFFactory/HIV/EFS_PDFs/EFS2004_ TH.pdf (estimate for 2003). 26. See UNFPA,The State of World Population 2005, supra note 1, at 108. 27. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., supra note 25. 28. See UNFPA,The State of World Population 2005, supra note 1, at 108. 29. See UNFPA, Country Profiles, supra note 2. 30. See UNFPA,The State of World Population 2005, supra note 1, at 112. The ratio may be more than 100 because the figures remain uncorrected for individuals who are older than the level-appropriate age due to late starts, interrupted schooling or grade repetition. 31. See Id. 32. See Saroj Pachauri & K.G. Santhya, Reproductive Choices for Asian Adolescents: A Focus on Contraceptive Behavior, 28 Int’l Fam. Planning Persp. 186–195 (2002), http://www. agi-usa.org/pubs/journals/2818602.html (estimates for 1987). 33. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., supra note 25.

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T

he Kingdom of Thailand is situated in Southeast Asia and borders Myanmar, Cambodia, Laos, Malaysia, the Andaman Sea, and the Gulf of Thailand.1 The unified kingdom of Thailand, known as Siam until 1939, was established in the mid-fourteenth century. Subsequently, starting in the sixteenth century, Thailand engaged in a series of wars with its northeast neighbor, Burma (currently known as Myanmar), and in the nineteenth century, it began to fend off European powers. Though Thailand lost territory in the east to France and in the south to Britain, Thailand succeeded in maintaining its independence and is the only Southeast Asian country that was not colonized by European powers.2 Until 1932, Thailand was governed by a system of absolute monarchy, but it became a constitutional monarchy that year after a “bloodless revolution” that was organized by a group of civil servants and army officers with the support of army units in the Bangkok area.3 During World War II, Thailand was occupied by Japan after the Thai prime minister signed a mutual defense pact with Japan.4 However, in 1944, the prime minister was forced out of office and replaced by a civilian government.5 In 1992, after a series of military governments, civilian authorities replaced the military. Subsequently, there have been five national multiparty elections, which have transferred power to successive governments through peaceful, democratic processes.6 In 2002, the total population was 62 million,7 with approximately 50.8% being female.8 The ethnic composition of Thailand consists of 75% Thai, 14% Chinese, and 11% other.9 According to 1991 statistics on religious affiliation, 95% of Thais are Buddhist, 3.8% Muslim, 0.5% Christian, 0.1% Hindu, and 0.6% other.10 The official language is Thai, but English is also widely taught,11 and there are numerous ethnic and regional dialects.12 Thailand has been a member of the United Nations since 1946.13 It is an active member of the Association of Southeast Asian Nations (ASEAN).14

I. Setting the Stage: The Legal and Political Framework of Thailand Fundamental rights are rooted in a nation’s legal and political framework, as established by its constitution. The principles and goals enshrined in a constitution, along with the processes it prescribes for advancing them, determine the extent to which these basic rights are enjoyed and protected. A con-

WOMEN OF THE WORLD:

stitution that upholds equality, liberty, and social justice can provide a sound basis for the realization of women’s human rights, including their reproductive rights. Likewise, a political system committed to democracy and the rule of law is critical to establishing an environment for advancing these rights. The following section outlines important aspects of the Thailand’s legal and political framework. A. THE STRUCTURE OF NATIONAL GOVERNMENT

The Constitution of Thailand came into force on October 11, 1997.15 It establishes a democratically governed constitutional monarchy and declares itself to be the supreme law of the state16 from which the power of the three branches of government—executive, legislative, and judicial—is derived. Thailand is divided into 76 provinces.17 The constitution establishes sovereignty in the people.18 Executive branch The executive branch consists of the king, the prime minister, the Council of Ministers, and the Privy Council.19 The king serves as the head of state and the head of the Thai armed forces.20 The king exercises power in accordance with constitutional provisions.21 He exerts powerful informal influence, but has not yet used his constitutionally mandated power to veto legislation or adjourn the legislative branch.22 The king may appoint a regent in the event of his absence or incapacity to perform his functions.23 The prime minister is the head of government and is appointed from among the members of the House of Representatives by the king.24 The appointment of the prime minister must be approved by a vote of more than one-half the total membership of the House of Representatives.25 The king may appoint no more than 35 ministers who constitute the Council of Ministers26 and are in charge of the administration of state affairs.27 Each minister reports individually to the House of Representatives28 and collectively to the National Assembly.29 The king has the prerogative to remove a minister from office upon the advice of the prime minister.30 The constitution provides for the establishment of a Privy Council.31 The Privy Council submits advice to the king on matters pertaining to his functions, such as matters that require the king’s signature or sanction, including drafts of legislation, royal decrees, and appointments of high officials; petitions for clemency for convicted prisoners; and petitions regarding grievances submitted to the king by private citizens.32 The king can issue an emergency decree, which has the force of an act, to maintain national or public safety or national economic security, or avert public calamity.33 He also has the power to issue a royal decree that is not contrary to existing laws; declare and lift martial law; declare war with

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the approval of the National Assembly; enter into a treaty with another country or international organization; and grant pardons.34 The king selects and appoints both the president of the Privy Council and no more than 18 of the councilors who sit on it.35 The Privy Council has a duty to report to the king on all matters.36 Legislative branch Legislative power rests with a bicameral parliament, known as the National Assembly, consisting of the House of Representatives and the Senate.37 The House of Representatives is composed of 500 members38 who serve four-year terms.39 One hundred representatives are elected on a party-list basis and 400 are elected on a constituency basis.40 The Senate is composed of 200 members who are elected by the people41 and serve six-year terms.42 In 1999, only 6.6% of the seats in the National Assembly were filled by women.43 The king has the prerogative to dissolve the House of Representatives for a new election of its members.44 Bills may be proposed by the Council of Ministers, members of the House of Representatives,45 or a petition signed by a minimum of 50,000 eligible voters,46 but only members of the House of Representatives may introduce money bills with the endorsement of the prime minister.47 A member of the House of Representatives may introduce a bill that his or her political party has approved and that has been endorsed by no fewer than 20 members of the House of Representatives.48 After the National Assembly approves the bill, the prime minister presents it to the king for signature within 20 days.49 If the king returns the bill to the National Assembly or refuses to assent within 90 days, then the National Assembly may reaffirm the bill with votes of no fewer than twothirds the total number of members of both houses.50 Afterwards, the prime minister may present the bill to the king for his signature and, if the king does not sign and return the bill within 30 days, the prime minister causes the bill to be promulgated as an act in the Government Gazette as if the king had signed it.51 Judicial branch The constitution establishes a hierarchy of Courts of Justice, with the Supreme Court at the apex of the hierarchy, followed by the Court of Appeal and the Courts of First Instance.52 The Sarn Dikaar (Supreme Court) is the court of last resort and the ultimate court of appeal.53 It hears appeals from the Court of Appeal and from Courts of First Instance.54 There are nine judges on the Supreme Court55 who are appointed by the king.56 There is also a Criminal Division for Persons Holding Political Positions under the Supreme Court, which hears cases against politicians.57 The Court of Appeal

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consists of three regional and one Bangkok appellate court. The Courts of First Instance handle both civil and criminal cases. The appointment and removal from office of a judge of a Court of Justice, including the Supreme Court, must be approved by the Judicial Commission of the Courts of Justice before being tendered to the king.58 The constitution also establishes an independent Constitutional Court,59 a military court,60 and administrative courts. The Constitutional Court is headed by the president and 14 judges who are appointed by the king upon the advice of the Senate.61 The president and judges of the Constitutional Court serve nine-year terms.62 The Constitutional Court determines the constitutionality of bills and laws63 and settles disputes on the powers of constitutional organs.64 The constitution also provides for a maximum of three ombudspersons, who are appointed by the king with the advice of the Senate; these officials serve six-year terms and act on complaints against government officials.65 Administrative courts hear cases between a state party (e.g., state agency or entity, local government organization, or state official) and a private individual, or between state parties.66 Other courts include juvenile and family courts at the central and provincial levels, and fiscal tribunals.67 The quorums in juvenile and family courts consist of two career and two associate judges, with a quota for one female judge.68 Appeals to the judgments and orders of these courts go to the Courts of Appeal.69 There is no law in Thailand that deals with legal aid services, but legal aid is provided in both civil and criminal cases under the Civil and Criminal Procedure Codes.70 A range of nongovernmental organizations (NGOs) also fill some of the need for free legal work. The Women Lawyers Association of Thailand provides legal aid services to protect the rights of children and youth, and to provide assistance to low-income women.71 A Legal Aid Center, which offers legal counseling and assistance, is affiliated with Chulalongkorn University.72 Customary forms of alternative dispute resolution Thailand’s long-standing tradition of conciliation under the Civil Procedure Code since 1935 was extended under the Civil Procedure Amendment Act (1999); the act expands dispute resolution procedures by allowing conciliation to be conducted behind closed doors with all or any of the parties, and by allowing the court to appoint a sole conciliator or panel of conciliators.73 Conciliation is mandatory in small claims disputes.74 The proceedings occur without a formal procedure, and may take place with or without an attorney.75 Secrecy and confidentiality are enforced by barring the public and the press from the conciliation proceedings.76

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B. THE STRUCTURE OF LOCAL GOVERNMENTS

The local assembly constitutes an important part of local government, which is founded on the principles of self-government, autonomy, and decentralization.77 Local assembly members are elected by local residents, who also have the right to vote for the removal of any member of a local assembly.78 Members, who hold office for four years, may also appoint some members of the local administrative committee.79 Women were barred from running for local office under the Local Administration Act (1914) until the act was amended in 1982.80 Women now make up 2% of village subdistrict heads.81 Local residents have the right to vote for the removal of any member of the local assembly or the local administrative committee of the local government,82 and also have the right to draft local ordinances and request their issuance.83 Local governing bodies may adopt their own policies dealing with their governance, administration, personnel administration, and finance.84 C. THE ROLE OF CIVIL SOCIETY AND NONGOVERNMENTAL ORGANIZATIONS

There are hundreds of active NGOs in Thailand that work in development, environmental protection, and philanthropy.85 NGOs play an important role in the provision of social welfare services, especially to low-income women. Approximately 43% of local NGOs are dependent on foreign sources for most of their funding.86 D. SOURCES OF LAW AND POLICY

Domestic sources Domestic sources of law include the constitution, enactments by the National Assembly, and royal decrees.87 Other forms of legislation, such as decrees, regulations, and administrative directives made under legislative or constitutional authority are also important sources of Thai law.88 The legal system is based on civil law with common law influences.89 The 1997 Thai Constitution provides protection for “the human dignity, right and liberty of the people.”90 Under the section on the rights and liberties of the Thai people, the constitution specifies that “[a] person can invoke human dignity, or exercise his or her rights and liberties in so far as it is not in violation of rights and liberties of other persons or contrary to this Constitution or good morals. A person whose rights and liberties recognized by this Constitution are violated can invoke the provisions of this Constitution to bring a lawsuit, or to defend himself or herself in the court.”91 The constitution guarantees equal rights to men and women,92 and equal protection under the law.93 It prohibits discrimination on the grounds of difference in origin, race, language, sex, age, physi-

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cal or health condition, personal status, economic or social standing, religious belief, education, and political view.94 The constitution also guarantees the right to life and prohibits torture, cruel or inhumane punishment,95 and forced labor.96 It guarantees important freedoms, including the freedoms of speech, expression,97 and assembly;98 and the freedoms to form an association, unionize,99 and practice religion;100 the document also guarantees family rights and the right to privacy.101 The constitution asserts the right of traditional communities to their customs and culture.102 It also guarantees the right to receive basic public health services, including free medical treatment for the indigent;103 the provision of thorough and efficient public health services;104 and the prevention and eradication of harmful contagious diseases, without charge.105 The constitution guarantees the right of children, youth, and family members to be protected from violence and unfair treatment,106 and in its Directive Principles of Fundamental State Policies, the document reinforces family integrity and the strength of communities.107 The constitution promotes employment; labor protections, especially of women and children; and provides for an official system governing labor relations, social security, and fair wages.108 The constitution provides for a National Human Rights Commission consisting of a president and ten other members appointed by the king with the advice of the Senate,109 which has the power to examine and report on human rights violations.110 The domestic legal framework is also established by several codifications of law, including the penal code of 1956 and the Civil and Commercial Code.111 The Act on the Application of Islamic Law in the Territorial Jurisdictions of Pattani, Narathiwat, Yala, and Satun (1946) applies to Muslims in these four provinces.112 Successive five-year development plans provide comprehensive national policy frameworks for the country’s socioeconomic and development goals. The Ninth National Economic and Social Development Plan (2002–2006) is currently operative.113 International sources The constitution authorizes the king to conclude a treaty or international agreement. Treaties that change the makeup of Thai territories or the jurisdiction of the state, or that require the enactment of a law, must be approved by the National Assembly.114 Thailand has ratified the following international legal instruments: the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) (with reservations on article 16 and article 29, paragraph 1),115 the Optional Protocol to CEDAW,116 the Convention on the Rights of the Child,117 the International Covenant on Economic, Social and Cultural Rights,118 the International

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Convention on the Elimination of All Forms of Racial Discrimination,119 and the International Covenant on Civil and Political Rights.120 Thailand has also adopted international consensus documents including the 1993 Vienna Declaration and Programme of Action; the 1994 International Conference on Population and Development (ICPD) Programme of Action; the 1995 Beijing Declaration and Platform for Action; and the 2000 United Nations Millennium Declaration and the Millennium Development Goals.121

II. Examining Reproductive Health and Rights In general, reproductive health matters are addressed through a variety of complementary, and sometimes contradictory, laws and policies. The scope and nature of such laws and policies reflect a government’s commitment to advancing the reproductive health status and rights of its citizens. The following sections highlight key legal and policy provisions that together determine the reproductive rights and choices of women and girls in Thailand. A. GENERAL HEALTH LAWS AND POLICIES

The constitution guarantees the equal rights of all persons to basic public health services, and the right of low-income individuals to free medical treatment from public health facilities, as provided by law.122 It obligates the state to provide public health services thoroughly and efficiently; promote the participation of local government and the private sector in service delivery as much as possible; and prevent and eradicate harmful contagious diseases for the public free of charge, as provided by law.123 In addition, the constitution’s prohibition of unjust discrimination specifically includes the grounds of physical or health conditions.124 Secondary to these fundamental rights, the constitution’s Directive Principles of Fundamental State Policies call on the state to provide and promote basic and efficient public health services.125 Along with the constitution, the National Health Development Plan under the Ninth National Economic and Social Development Plan (2002–2006), known as the Ninth National Health Development Plan, forms the basic national legal and policy framework for the implementation of health activities and services.126 The plan focuses on extending health-care coverage with the goal of “building healthy conditions for all Thai citizens” rather than merely treating ill heath.127 Objectives The main objective of the Ninth National Health Devel-

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opment Plan is the “Health for All” scheme, which aims to mobilize the whole society to participate in health development, inculcate health awareness in every part of society, and open opportunities for all sectors of society to play a role and use their own potential in developing a healthy society.128 The plan’s main strategies are the following: ■ use an assertive approach in health development; ■ establish guarantees for universal access to health services; ■ reform the health management system, structures, and mechanisms; ■ strengthen civil society; ■ effectively manage knowledge and information on health; and ■ develop and upgrade health service providers to prepare them for the reform of the health system.129 The plan identifies 30 critical health issues; these include, among others, meeting the challenges of the guarantee of health for all, health system reform, improving nutrition and health, and conducting research on health issues.130 Reproductive health is not specifically mentioned as one of these issues. The plan recognizes economic inequality and the resulting injustices in the present health service system.131 Specific policies introduced by the permanent secretary of the Ministry of Public Health also shape health-care priorities and services, and these are implemented through the ministry’s own action plans. A number of health-sector reforms have been set in motion in Thailand in recent years in an effort to establish universal health-care coverage.132 These reform measures find strong support in the constitution and subsequent laws that have stressed the decentralization of planning processes and have prompted the Ministry of Public Health to reform the public health system through decentralization, health financing reform, expansion of health insurance coverage, increased community participation, and greater transparency and accountability.133 The government is now implementing these changes. By the year 2006, health system reforms will be put into action in their entirety with the enforcement of the National Health Act,134 which is currently under the consideration by the cabinet, and will subsequently be submitted to the National Assembly for approval.135 Infrastructure of health-care services Government facilities The Ministry of Public Health is the principle agency responsible for the promotion, support, control, and coordination of all physical and mental health activities; the well-being of the Thai people; and the provision of health services.136 Other ministries that play a role in supporting

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and implementing health activities include the Ministry of University Affairs, the Ministry of the Interior, the Ministry of Defense, and the Ministry of Education.137 In addition to ministries, several discrete government bodies provide a range of support for the efficient implementation of health programs, including support in the areas of policy planning, budgetary allocations, human resources, international assistance, statistical information, and research.138 These bodies include the National Economic and Social Development Board, the Bureau of Budgets, the Civil Service Commission, the Department of Technical and Economic Cooperation, the National Statistical Office, the Thailand Research Foundation, and the Health System Research Institute.139 Government agencies with oversight of health services for specific groups are the Social Security Office and the Insurance Department of the Ministry of Commerce.140 The Ministry of Public Health classifies health care into five groups, according to the type and level of care.141 The most basic group of health care is self-care at the family level, where services include the enhancement of the individual’s capacity to provide self-care and make decisions about health.142 The next group is identified as community care at the primary care level, where services are organized by the community and relate to health promotion, disease prevention, simple curative care, and rehabilitative care.143 Service providers include village health volunteers and volunteers from NGOs.144 The next group is government health facilities at the primary care level.145 The services provided by health personnel and general practitioners include health promotion, disease prevention, and simple curative care. Government health facilities providing primary care include community health posts and health centers;146 these facilities also provide family planning and maternal and child health services.147 Community health posts are village-level health service units, established specifically in remote areas, that cover a population of 500–1,000 persons and are staffed by one community health worker, who is a Ministry of Public Health permanent employee.148 Health centers are subdistrict- or village-level health service units that cover a population of about 1,000–5,000 persons, and have a health worker, a midwife, and a technical nurse on staff.149 Health center staff run health programs according to standard Ministry of Public Health procedures under the technical supervision and support of the community hospital.150 (Primary care is also provided by the outpatient departments of public hospitals at all levels of care.) The fourth group is specialized care provided through government health facilities at the secondary care level; these facilities include community, general, and regional hospitals,

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and other large public hospitals.151 These hospitals also provide extensive reproductive health services.152 A community hospital is located in a district or subdistrict and has 10–150 beds, covering a population of 10,000 or more.153 Generally, they provide mostly curative care, compared with the mainly preventive care offered at primary care facilities.154 General hospitals have 200–500 beds, while regional hospitals have over 500 beds and medical specialists in all fields.155 The fifth group is tertiary level specialized care, which is provided by medical and health professionals with expertise in various specializations.156 Tertiary care government facilities include regional, general, and university hospitals.157 Approximately 112.4 million patients received outpatient care at government facilities in 2000; this total has increased steadily from 11.9 million in 1977.158 Among these patients, the types of providers most commonly visited were health centers and community health posts (46.1%), followed by community and extended hospitals (35.7%), and, lastly, regional and general hospitals (18.2%).159 According to a 2001 Ministry of Public Health survey on the health situation in the provinces only (i.e., excluding Bangkok),160 when surveyed about where they sought care for severe illnesses, a solid majority (86.4%) relied on the public sector (80.2% chose to go to public hospitals, another 6.1 % went to health centers, and 0.1 % used village primary care centers).161 In cases of minor illness, a majority said they went to public facilities. 162 Individuals living in rural areas are much more likely than those in urban areas to seek services for minor illnesses at health centers and community health posts (54% vs. 15.7%), and they are less likely than their urban counterparts to seek services at community or general hospitals (14% vs. 25%).163 The ratio of primary health-care providers to the total population has steadily improved in every region over the past few decades; at the national level, those ratios rose from 1 to 2,421 in 1987 to 1 to 1,324 in 2000.164 The overall doctor-to-population ratio in 2000 was 1 to 3,427; the ratio was 1 to 793 in the province of the metropolis Bangkok, and 1 to 5,161 in the other 75 provinces.165 The overall nurse-topopulation ratio in 2000 was 1 to 870; the ratio was 1 to 309 in Bangkok, and 1 to 1,066 in the rest of the country.166 The number of hospital beds has also recently increased in every region across the country. However, as with the distribution of doctors and nurses, hospital beds are mostly concentrated in Bangkok and the central region, with the fewest numbers in the northeast region.167 Pursuant to the Act on Operationalization of Decentralization (1999), the Ministry of Public Health must plan for the devolution of its functions, facilities, and personnel to local

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administrative units, namely to tambon administrative organizations and municipalities by 2010.168 This will result in the shifting of approximately 80% of the ministry’s annual budget, and about 90% of its staff will move to local administrative units.169 The draft National Health Act, which is currently under review by the cabinet, proposes broad reforms in the national health system. The draft act provides for the establishment of several new mechanisms to improve the implementation of the system, such as a National Health Committee to coordinate all government policies relating to health; a health service accreditation process to support quality improvement and accreditation of facilities at all levels; a consumers’ protection mechanism; a national health manpower development committee charged with the planning and regulation of service provision by health personnel; alternative medicine provision; and a health research system.170 Privately run facilities In the private as in the public sector, health care is provided through facilities at the primary, secondary, and tertiary care levels.171 Private clinics, the outpatient departments of private hospitals, and drugstores all offer primary care services, while private hospitals provide secondary and tertiary medical treatment.172 Between 1987 and 1997, the country saw a period of rapid economic growth during which the private health sector also expanded.173 In 2000, there were 13,099 drugstores, 10,875 clinics, and 461 private hospitals, with a ratio of privateto-government hospital beds of one to three.174 However, as a result of the economic crisis in 2001, some private facilities have adjusted their operations, for example, by reducing the number of hospital beds and staff.175 According to a 2001 Ministry of Public Health survey conducted in the provinces only (i.e., excluding Bangkok), in cases of severe illness, 13.4% of respondents relied on the private sector (i.e., 6.1% used private hospitals, 5.4% went to private clinics, 0.5% saw local traditional practitioners or monks, and 1.4% frequented other nongovernment establishments).176 A minority of respondents sought relief from minor ailments in the private sector (i.e., 8.5% bought medicines from grocery stores, 10.5% bought remedies from drugstores, and 1.7% went to private hospitals.)177 Residents of urban areas tend to seek treatment for minor illnesses at private clinics more often than do residents outside of such areas (24.7% vs. 10.9%).178 In addition to for-profit health facilities, there are about 375 nonprofit health-related organizations throughout the country, including foundations and associations.179 These organizations have contributed to a number of health programs in areas such as family planning, sanitation, mater-

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nal and child health, and general health services.180 Financing and cost of health-care services Government financing Health-care financing is relatively complex in Thailand, with large resources devoted to health and relatively high administrative costs stemming from having multiple sources of funding.181 The total national health expenditure has increased significantly over the past few decades, from 3.8% of the country’s GDP in 1980 to 6.1% of GDP in 2000, with per capita health spending rising from 545 baht (USD 13) to 4,832 baht (USD 118) during that period.182 Most of the national expenditure on health is for curative care.183 As of 2001, government health expenditure accounted for 57% of the total national health expenditure, and 11% of the government’s total budget. Although the private and public sectors spend roughly the same amount for care received in health-care facilities, the private sector total includes payments for private drug purchases.184 One of the aims of the Ninth National Health Development Plan is to increase the government’s budget for activities relating to health promotion and the prevention of diseases by at least 10% over the course of the plan. By its end point in 2006, an estimated 126 billion baht (approximately USD 3 billion), or about 40% of the total health budget, will be allocated for these activities.185 Private and international financing In 2000, private spending accounted for 66.7% of the national health expenditure.186 Out-of-pocket expenses represented the majority of private spending on health (85% of the total) in 1998.187 International financial support to Thailand in the area of health has been declining recently, from 1.44% of total expenditure on health in 1980 to 0.15% in 1990.188 In 2000, international financing dropped to 0.14% of the country’s total health expenditure.189 Thailand is now seen as one of the donor countries providing assistance to other Southeast Asian countries.190 One significant donor-funded project is the South-South Cooperation on Population, Family Planning, and Reproductive Health; this project, established in 1995, involves a network of developing countries that cooperate and exchange information and technology on related issues, including follow-up and support of the implementation of the ICPD Programme of Action.191 The project receives funding and technical support from the United Nations Population Fund, the Rockefeller Foundation, and the World Bank. Thailand was one of the founding countries of the project, and in 1995, it established the Center for the South-South Initiative under the Reproductive Health Division of the Department of Health to implement assigned activities, coordinate with

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member organizations, and direct technical cooperation in the field of population and reproductive health for both local and international agencies.192 Cost Thailand has several health insurance and social security schemes covering various segments of the population.193 Existing schemes include the following:194 ■ medical care plans for low-income persons; ■ medical care plans for civil servants and state employees; ■ social security and workmen’s compensation funds; ■ voluntary health insurance supplied by the Ministry of Public Health; ■ voluntary health insurance supplied by private health insurance institutions; and ■ other types of insurance plans (e.g., compulsory and voluntary insurance for car accidents). There are some differences between schemes in the per capita costs; for example, the health plans provided for civil servants and state employees are more heavily subsidized by the state than are the plans for low-income individuals. There are also some discrepancies in the health benefits provided under each health insurance system.195 Health insurance coverage in Thailand has been expanding.196 A 2001 government survey found that approximately 71% of the population is covered by at least one of the existing health insurance schemes, with greater coverage among people living in rural areas.197 Overall 31.5% of Thais are covered by the plan for low-income individuals, 8.5% by the plan for civil servants and state employees, 7.2% by social security and the workmen’s compensation fund, 20.8% by voluntary health insurance plans under the Ministry of Public Health, 1.3% by voluntary private health insurance plans, and 0.9% by the recently introduced 30 Baht Scheme Policy (described below).198 About 29.0% have no health insurance at all. These uncovered individuals must pay for public or private health care and services out of pocket, which amounts to as much as 18.6% of the annual income of a household.199 Thailand established the Social Security Fund in 1990, through the Social Security Act (1990), which requires the government, employers, and insured persons to make equal contributions to the Social Security Fund at a prescribed rate. The fund provides insurance for injury or sickness, disability, death, maternity, old age, and, as of 1999, child and unemployment benefits. As of May 2003, 7,158,068 persons were insured by the Social Security Fund.200 As of April 2003, 16,709 insured persons had applied for maternity benefits, the benefit type with the highest number of applicants.201 Medical services not covered by the Social Security Act, as pre-

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scribed by the Office of Social Security’s Regulations (1991), are infertility treatment, tissue typing for organ transplants, artificial insemination, rehabilitation services, and any medical services that are deemed unnecessary for the treatment of individual injuries and illnesses.202 As part of the Ninth National Economic and Social Development Plan, the government calls for health-care system reform and the further development of the health insurance system to make it more efficient, more equitable, and more available to people of all disadvantaged groups. Accordingly, the government added to the previously mentioned plans by introducing universal health-care coverage in Thailand by enacting the National Health Security Act in November 2002.203 Pursuant to the act, the government announced the 30 Baht Health Plan, which is designed to provide health services for people aged 13–50 years who lack health insurance of any kind. The plan covers services necessary for the enjoyment of good health and living, including those relating to medical treatment, rehabilitation, health promotion and prevention of diseases, and a range of reproductive health–care services. The cost of uncovered services and those deemed unnecessary must be borne by the individuals. Specific reproductive health services provided free of charge under the plan include family planning services, including sterilization services, but not infertility treatment or artificial insemination; maternal health care; the provision of medication to prevent mother-to-child transmission of HIV; delivery care (for the insured’s first two live births); and physical examinations for the prevention and early treatment of reproductive tract cancers, such as cervical cancer.204 Regulation of health-care providers Health services rendered by health-care providers in Thailand are regulated by the Practice of the Art of Healing Act (1999).205 According to the act, the “practice of the art of healing” is defined as the practice of a profession that is carried out or aims to be carried out on human beings and concerns the examination, diagnosis, treatment, and prevention of disease. The Act also includes health promotion and rehabilitation and obstetric care, but excludes all other medical and public health practices governed by other laws.206 The act prescribes several eligibility requirements regarding the registration and licensing of individuals applying to work in their respective professions; these requirements cover the applicants’ age, knowledge of the profession, professional conduct, and physical and mental health status.207 In addition to the Practice of the Art of Healing Act, other laws concerning the medical and health professions include the Medical Treatment Profession Act (1982),208 the Nursing and Midwifery Profession Act (1985, amended in 1997),209 the

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Pharmaceutic Profession Act (1994),210 the Dental Treatment Profession Act (1994),211 and the Protection and Promotion of Traditional Thai Medicine Act (1999).212 The Medical Treatment Profession Act provides for the establishment of the Medical Council, which is a professional organization charged with the oversight of various aspects of the medical profession.213 Among other functions, the council regulates physicians’ conduct according to medical ethics standards, provides technical support, provides advice or recommendations to the government, and represents physicians of all fields in Thailand.214 The council is directly responsible for registering and issuing licenses to physicians applying to work in medical professions, suspending or revoking licenses, and verifying that medical institutions meet academic standards.215 The council also has the statutory authority to issue announcements, which are regarded as regulations, with which medical practitioners must comply.216 Nurses and birth attendants are under the supervision of the Nursing Council, which was established by the Nursing and Midwifery Profession Act.217 The main objectives of the council are to supervise the professional conduct of nurses and birth attendants according to prescribed ethical standards, provide technical support, issue recommendations to the government, and represent nurses and birth attendants in Thailand.218 Important duties of the council include the registration and issuance of work licenses to persons applying to work as nurses and birth attendants, and the suspension and revocation of licenses.219 The Pharmaceutic Profession Act220 and the Dental Treatment Profession Act also provide for the establishment of regulatory Pharmaceutical and Dental Councils, respectively. Thai traditional medical practitioners are considered to be practitioners of the art of healing, and are supervised and controlled by the Practice of the Art of Healing Act.221 According to the act, Thai traditional medicine is defined as “the practice of the art of healing according to the Thai traditional knowledge or texts, which has been transferred and developed over the years, or has been learned from the institutions which are accredited by the Executive Committee of the Medical Council.”222 Thai traditional medicine encompasses traditional medical treatments, remedies, midwifery, and other traditional practices, as determined by the minister of public health in accordance with the recommendations of the Executive Committee of the Medical Council.223 The Protection and Promotion of Traditional Thai Medicine Act, which was passed in 1999 and implemented in 2002, was followed by the establishment of the Department for the Development of Thai Traditional and Alternative Medicine under the Ministry of Public Health in 2002.224 The newly

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established department’s duties, which are prescribed by the act and will serve to implement it, include the development, support, and protection of knowledge about Thai traditional medicine, including herbal medicine.225 Patients’ rights The Medical Treatment Profession Act (1982) contains provisions that directly relate to the protection of patients’ rights.226 The act provides that a person wronged by the conduct of a medical worker who violates professional codes of conduct has the right to lodge a complaint with the Medical Council.227 Complaints must be submitted in writing.228 The council then appoints a subcommittee to investigate the complaint and the accused practitioner229 before recommending that the executive committee of the council take certain actions, including dismissing the complaint or issuing a warning to the practitioner, prescribing probation, suspending the practitioner’s license for up to two years, or revoking his or her license.230 The council’s judgment is considered to be complete and final.231 In cases where a practitioner’s license has been revoked for wrongdoing, he or she may reapply for a license.232 However, the executive committee of the council also has discretion to permanently cancel a practitioner’s license.233 In addition to the provisions for malpractice outlined in the Medical Treatment Profession Act, persons harmed by a practitioner may also initiate legal action for medical malpractice under provisions in the penal code that recognize criminal liability for negligent or unintentional acts.234 Other code provisions that may be applied in cases of medical malpractice relate to false certification235 and the disclosure of private secrets.236 The Medical Council, the Nursing Council, the Pharmaceutical Council, the Dental Council, and the Medical Registration Committee jointly issued a Declaration on Patients’ Rights in 1998; this declaration includes ten fundamental rights, such as the right to receive health services without discrimination of any kind, and the right of parents or legal guardians to exercise rights on behalf of children younger than 18, and persons with physical or mental disabilities.237 The declaration raises awareness about patients’ rights, but does not include mechanisms for their protection in cases of violations. B. REPRODUCTIVE HEALTH LAWS AND POLICIES

The Ministry of Public Health announced the National Reproductive Health Policy in 1997 stating that “[a]ll Thai citizens, at all ages, must have good reproductive life.”238 The policy specifies the following objectives: ■ promote an appropriate family size for the capacity of

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each family; promote proper pre- and postnatal care; ■ control, prevent, and provide treatment for HIV/ AIDS; ■ promote the prevention and treatment of reproductive tract infections; ■ control malignancies of the reproductive organs; ■ promote counseling on reproductive health issues and the dissemination of sex education; ■ decrease the incidence of abortion and its complications; ■ improve reproductive health-care services and their availability among youth and adolescents; and ■ promote and provide services for peri- and postmenopausal women and the elderly.239 The policy’s implementing strategies, which aim to achieve the policy’s objectives, are as follows: ■ provide fully integrated and coordinated services, so all implementing agencies concerned may jointly plan their operational plans; ■ safeguard the human rights of all groups in society, especially women’s human rights, and encourage men to take more responsibility; ■ encourage the full participation of people, communities, and NGOs at all levels, in order to find appropriate solutions to specific problems encountered by each community; ■ aim to provide higher quality services, not simply higher quantities of services; and ■ disseminate information on the core elements of reproductive health to all age-groups and levels of society, in order to raise awareness of the importance of reproductive health.240 Reproductive health care provided through the government health delivery system includes services in the following ten areas: ■ family planning (including counseling; services; and information, education, and communication activities); ■ maternal and child health (including prenatal education and services, safe delivery and postnatal care, breast-feeding support, and infant care); ■ HIV/AIDS (including prevention and reduction efforts); ■ reproductive tract infections (including information, education, and treatment); ■ malignancies of the reproductive tract (including diagnosis, treatment, and education); ■ sex education, sexuality, reproductive health and ■

responsible parenthood; adolescent reproductive health (including information, education, counseling, and services); ■ abortion (including prevention of unsafe abortion and management of its complications and consequences); ■ infertility (including prevention and appropriate treatment); and ■ sexual health issues among those who are past reproductive age and the elderly (including information, education, and care).241 At present, reproductive health services are not integrated, and the various components of reproductive health care are carried out by different departments of the Ministry of Public Health, Ministry of Education, Department of Communicable Diseases, Department of Medical Services, and Department of Medical Sciences 242 Moreover, these departments provide reproductive health services in different sectors, as demonstrated in the following table:243 ■

Department or Ministry Responsible for Implementation

Reproductive Health Area

Department of Health

Family planning, and maternal and child health

Department of Health and Department of Disease Control

HIV/AIDS (including motherto-child transmission and reproductive tract infections)

Department of Health and Department of Medical Services

Malignancies of the reproductive tract, abortion and abortion complications, infertility, and reproductive health care for peri- and postmenopausal women and the elderly

Department of Health, Department of Mental Health, and Ministry of Education

Sex education

Department of Health and Department of Mental Health

Adolescent reproductive health

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The Reproductive Health Division of the Department of Health under the Ministry of Public Health is responsible for the overall supervision of reproductive health services. The division’s specific functions include the following: ■ study, research, analyze, and develop a body of knowledge and technology concerning reproductive health; ■ develop and establish reproductive health standards to promote and support operational mechanisms in accordance with laws on public health and other related laws; and ■ provide technical assistance on reproductive health.244 In 2002, the Thai National Assembly organized a national seminar on Reproductive Rights and Women’s Health, in order to develop understanding and raise awareness of women’s health and reproductive rights among National Assembly members, as well as to brainstorm ideas on the appropriate changes needed in laws and regulations concerning women’s health and reproductive rights. After extensive discussions, seminar participants recommended a comprehensive reproductive health law to guard the reproductive health and rights of all Thais and furthermore, steps have already been taken to draft a protective bill.245 Regulation of reproductive health technologies Thailand has no specific law on assisted reproductive technologies. However, in 1997, the Executive Committee of the Medical Council approved regulations affecting these technologies, which include the following prescriptions:246 ■ each center offering assisted reproductive technologies must have an ethics committee made up of at least three staff members; ■ each center must provide a form for the husband and wife’s written consent for all procedures; and ■ the Royal Thai College of Obstetricians and Gynecologists will supervise and manage the administration of assisted reproductive technologies and produce annual reports on their use.247 The World Health Organization (WHO) and Chulalongkorn University in Bangkok have worked together to create the WHO Collaborating Centre for Research in Human Reproduction.248 Over the past five years, the enter has been involved in an assisted reproductive technology project, including an in vitro fertilization and embryo exchange program using cryopreservation of embryos and sperm banks for research and treatment purposes.249 Research topics have included measuring reproductive hormones, monitoring short- and long-term effects of injectable contraceptive use, developing male methods of fertility regulation, studying sperm–zona pellucida interactions, and creating aging and menopausal profiles.250

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Family planning General policy framework Within the Ministry of Public Health, the Family Planning and Population Division of the Department of Health is responsible for implementing the National Family Planning Program.251 The government’s objectives relating to family planning include the following: ■ accelerate family planning efforts in areas where the total fertility rate is still high and the contraceptive prevalence rate is low; ■ provide services for married and unmarried male and female youth, with the specific aim of reducing adolescent pregnancy; ■ promote three-year birthspacing intervals; ■ monitor the quality of services; ■ promote male involvement in family planning; and ■ better meet the needs of specific populations, including ethnic and religious minorities and underserved populations.252 Since 1976, Thailand has implemented a targeted family planning program concentrating on four groups—remote rural villages, the southern Muslim religious communities, ethnic minority hill tribe groups, and unmarried adolescents.253 Contraception The contraceptive prevalence rate in 2001 was 79.2%. A government survey found regional disparities in prevalence among married women aged 15–44, with the highest rate in the northern region (83.8%) and the lowest in the southern region (73.0%).254 The southern Muslim population has an especially low rate of contraceptive use due to cultural and religious reasons.255 The pill was the most commonly used method (by 26.8% of married women), followed by female sterilization (22.6%) and the injectable (22.0%).256 The least used methods among Thai couples were vasectomy (1.2%), the implant (1.5%), and condoms (1.7%).257 Methods that have increased in popularity over the past few decades include the injectable, the pill, and the implant.258 Conversely, methods that have lost ground are the IUD, vasectomy, and female sterilization.259 While overall condom use has also declined slightly, its use among sex workers has risen.260 According to official data, 127,937 persons received sterilization services in 2000.261 The overwhelming majority were women (95%).262 The percentage of men seeking sterilization in every region was less than 1%, except in Bangkok, where it reached 3.4%.263 Such proportions remain relatively unchanged since 1997.264 According to community-based research in 2001 that

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examined the pregnancy records of 1,180 women aged 15–59, 45% of pregnancies were unplanned.265 There is no available information on contraceptive prevalence rates among unmarried individuals, since they are not included in government family planning surveys.266 Contraception laws and policies Generally, the government does not prohibit the use of contraception, except for methods with potentially harmful effects, such as pills containing over 50 micrograms of estrogen, which are known to raise the risk of hemorrhage.267 The only law dealing specifically with contraceptive methods is a law on condoms.268 The law defines condoms as “medical devices” and, as such, producers and importers of these products must seek approval from the secretary general of the Food and Drug Administration pursuant to the Medical Device Act (1988). Other requirements are imposed to ensure the quality and safety of condoms.269 The Food and Drug Administration is the main agency responsible for overseeing and making recommendations to the public health minister on matters relating to contraceptives.270 The government does not prohibit the use of emergency contraception, which has been widely used in Thailand for over a decade.271 There is relatively easy access to the product, which is available in any drugstore. In 2000, the Ministry of Public Health ordered manufacturers as well as importers of emergency contraception to change its indications for use.272 The new indications state that the product may be used “[t]o prevent pregnancy in case of rape, incorrect use of normal contraceptives, or emergency cases….” Previously, the indications were “[t]o prevent pregnancy after sexual intercourse, in case other methods have not been used.” Pursuant to the ministry’s order, the recommended dosage and instructions for use were also modified. The instructions currently call for one tablet to be taken within 24 hours but not more than 72 hours after unprotected sexual intercourse, with a second tablet to be taken 12 hours after the first dose. The previous instructions called for one tablet to be taken immediately or within an hour of having unprotected sexual intercourse.273 The order also changes the product label from “Birth control pills after sexual intercourse” to “Emergency birth control pills.” The changes were partly attributable to advocacy by women’s health organizations for more accurate indications, since inaccurate labeling had led to improper use among some Thai women. Regulation of information on contraception There are no known legal restrictions in Thailand on advertising contraception. Indeed, public awareness of contraceptive options is a top government priority, in keeping with its overall population plan, as well as its efforts to combat the spread of AIDS.

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All hormonal contraceptives marketed in Thailand are required to give two standard precautions on their use; one advises patients to see medical doctors in case of “irregularities,” and the other warns patients with blood vessel blockage or hepatitis not to use hormonal methods.274 Sterilization is legal in Thailand. However, there is no specific law on the procedure or its eligibility requirements. The only requirement is that the service provider be a nurse or midwife trained in sterilization in accordance with Ministry of Public Health regulations.275 In addition, persons seeking sterilization are required to give written informed consent before the procedure is performed.276 The Labour Protection Act (1998) includes a provision relating to employee leave for sterilization.277 The law entitles an employee to paid leave for such time as prescribed by an authorized medical practitioner.278 Although there is no specific law on the eligibility criteria for sterilization, in practice medical doctors provide the service to women with at least two children with spousal consent.279 Men who seek sterilization may apply for the service without spousal consent.280 Government delivery of family planning services Thailand’s current family planning program aims to make family planning services available at all private and public facilities, including 9,661 public health centers nationwide.281 Family planning services and contraceptive methods are also provided at the village level and in remote rural communities through village health volunteers and an extensive network of mobile family planning units.282 Contraceptive methods, such as the pill and the condom, are readily available at public health facilities and are provided largely free of charge.283 Contraceptive services offered in public health facilities include female sterilization, vasectomy, IUD and implant insertions, and contraceptive injections.284 The National Health Security Act fully covers the costs of family planning methods, including sterilization services, but it does not pay the costs of infertility treatment or artificial insemination.285 Holders of a social security card may also be reimbursed for the medical fees associated with sterilization, at a maximum of 500 baht for men (approximately USD 12) and 1,000 baht for women (approximately USD 25).286 Clients covered by the universal health coverage program, “Health for All” are also entitled to sterilization services free of cost.287 Family planning services provided by NGOs and the private sector Family planning services are provided by a variety of sources outside of the government sector, including traditional healers, community-based organizations, NGOs, and private hospitals. Many of these providers partner with each other or the government to improve access to contraception.

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Approximately 9% of women aged 15–44 use family planning services provided by private health institutions.288 The nongovernmental sector plays an important role in the provision of family planning counseling, services, and information; it also conducts related education and communication campaigns, with an emphasis on helping couples achieve their desired family size.289 In addition to centers run by the Planned Parenthood Association of Thailand, which target the underserved hill tribes in the northern provinces,290 a network of community-based village health volunteers provides family planning services in 17,000 villages in 157 districts.291 Maternal health Thailand’s maternal mortality ratio has declined from 43.9 maternal deaths per 100,000 live births in 1996 to 23.9 deaths per 100,000 in 2002.292 There are wide variations between regions, with the highest ratio in the northern region (47.95 per 100,000), followed by the southern region (23.48 per 100,000), the northeast region (16.78 per 100,000) and the central region (16.45 per 100,000).293 The very high maternal mortality ratios in the northern region reflect the negative health consequences of early marriage and limited access to health care among the several ethnic groups in that area. The two most common causes of maternal mortality overall are hemorrhaging (42.11% of maternal deaths) and toxemia in pregnancy (15.04% of maternal deaths).294 Poverty and lack of health insurance have been cited by experts as major obstacles to women’s access to prenatal care in Thailand.295 Ever since malaria has become a problem of epidemic proportions in some border areas,296 Thai women of childbearing age in these areas are increasingly affected by malarial infections, which can compromise maternal health.297 Laws and policies Maternal health has been a stated priority of the Thai government since the National Health Development Plan of the Third National Economic and Social Development Plan (1972–1976). The current (ninth) plan again lists maternal health, including the reduction of maternal mortality, as one of its priorities.298 The plan has adopted the following maternal health targets: ■ reduce the proportion of women having their first child before the age of 20 to under 10%; ■ reduce the maternal mortality ratio to under 18 maternal deaths per 100,000 live births; ■ reduce HIV prevalence among pregnant women to under 1%; and ■ reduce the prevalence of iron deficiency anemia among pregnant women to under 10%.299 A component of Thailand’s current Reproductive Health

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Policy is education on maternal health and the provision of adequate pre- and postnatal care.300 A number of government projects and programs on maternal and child health have been initiated over the past few decades. In 1988, the Bureau of Health Promotion of the Department of Health launched the Increase of the Capability of Maternal and Child Health Project in collaboration with the WHO and the Ministry of University Affairs.301 The project’s first phase focused on increasing awareness, collecting information, analyzing problems, and strategizing. In 1998, the Safe Birth Hospital project was also initiated under the responsibility of the bureau, but with the additional participation of the Regional Public Health Division and the Office of the Permanent Secretary (Ministry of Foreign Affairs). Hospitals joining the project must meet prescribed service and quality standards. Specifically, they must have the capacity to provide basic prenatal care (i.e., at least four prenatal checkups and a voluntary HIV test); basic birth and delivery services, including having staff on hand for emergency resuscitation, cesarean sections and prompt transferals; and basic postpartum services (e.g., family planning and breast-feeding promotion in accordance with the criteria of the Child-Mother Relationships Hospital Program).302 The Child-Mother Relationships Hospital Program, which is formally known as the Baby-Friendly Hospitals Initiative, was started in 1991 and promotes breast-feeding in hospitals.303 Currently, 788 public and private hospitals and 8,650 public health centers are participating in the project.304 In 2001, the Department of Health initiated the national Pregnant Women’s Health Surveillance Project, which aims to enhance birth weight and promotes a target weight of at least 2,500 grams. This project has produced educational materials to increase knowledge and promote good health practices among pregnant women.305 By law, pregnant women against whom criminal proceedings have been initiated or who are incarcerated are protected in several ways. The Criminal Procedure Code gives courts discretion to defer imprisonment in cases where the defendant is over seven months’ pregnant or has a newborn less than one month old.306 In cases where a defendant is sentenced to death while she is pregnant, the code allows the execution to be postponed until after the delivery.307 In addition, the Corrections Act (1936), which was amended in 1980, categorizes a pregnant inmate or an inmate with a newborn as an “ill person.”308 Nutrition Thailand has been largely successful in implementing policies and programs addressing problems relating to nutrition over the past several decades.309 The government has addressed nutrition concerns in successive National Economic and Social Development Plans, as well as in a specific national policy on nutrition.310

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Presently, moderate malnutrition is no longer a significant problem as a general matter, although it remains a problem in specific geographic areas.311 However, iron deficiency anemia remains a common problem among school children and pregnant women.312 The government has adopted a comprehensive strategy that includes iron supplementation offered through health clinics and schools, fortification of food products, and dietary diversification.313 The Ministry of Public Health recently identified overnutrition as an emerging health problem among adults and children. The government has not yet identified specific strategies to deal with the problem, however.314 Safe abortion Official statistics on the incidence of abortion are limited. While maternal health in general has improved in the past few decades, unsafe abortion and its complications are still widespread, particularly in rural areas,315 according to several discrete government studies. In 1999, for example, the Ministry of Public Health conducted a survey on abortion in Thailand by examining the records of women who were hospitalized for the treatment of complications from miscarriages and induced abortions in 787 state hospitals nationwide.316 Of the 45,990 records examined, 28.5% were of women who sought an induced abortion. Among women who sought an induced abortion, 48.6% were age 24 or younger, and had been pregnant, on average, for 13 weeks—a stage at which the woman is at especially high risk of infection and may suffer from a perforated uterus. More than one-quarter (28.8%) of the patients who had sought an induced abortion developed a severe infection from a perforated uterus, and 0.11% of these women died from the resulting complications.317 According to community-based research in 2001 that examined the pregnancy records of 1,180 women aged 15–59, 8% of pregnancies resulted in abortion.318 According to some studies, a majority of women who obtained an abortion in rural areas cited limiting family size as their main reason for seeking an abortion.319 A significant proportion also cited the need for child spacing.320 Despite the ready availability of contraceptives, several studies have shown that a significant proportion of women who sought an abortion were not using any method prior to the procedure.321 Abortion laws and policies Abortion is generally prohibited by the penal code, and both women who seek abortions and providers who perform them are liable to penalties.322 The law allows abortion only when the pregnancy endangers the woman’s health and in cases of rape, and only if the procedure is performed by a medical practitioner.323 In practice, the application of the legal

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health exception has often been restricted to cases where the pregnancy endangers the woman’s life, rather than to a broader range of health conditions.324 The penal code stipulates the penalties for illegal abortion, which vary in severity depending on the individual performing the abortion, whether the woman consented to the procedure, and whether the woman suffered additional physical harm because of it.325 A woman who induces her own abortion or allows another person to do so is liable to imprisonment of up to three years or a fine of up to 6,000 baht (USD 146), or both;326 the penalty is more severe for the 3rd party involved in performing the abortion. If the abortion is performed with the woman’s consent, whoever carries out the procedure is liable to imprisonment of up to five years or a fine of up to 10,000 baht (approximately USD 244), or both.327 If the woman did not consent, the punishment increases to imprisonment of up to seven years or a fine of 14,000 baht (USD 342) or both.328 The penalty is more severe in both instances if the abortion also results in grievous bodily harm to the woman or her death.329 An attempt to commit the offense of abortion is not considered a crime.330 Thus far, specific government regulations for requesting or providing abortion services have not been issued, and the resulting confusion serves as a major obstacle for women who seek abortions. For health service providers, the lack of clear and practical regulations has created problems in the interpretation of the law. To protect themselves from accusations of illegal activity, most physicians usually refuse to perform abortions. In cases where they agree to perform the procedure, they interpret the law as narrowly as possible to safeguard themselves as much as possible.331 Currently, efforts are being made to expand the Medical Council’s guidelines on abortion by expanding the health exception and drafting regulations. Despite the general illegality of abortion, there are varying legal and religious interpretations in Thailand regarding when life begins. The criminal code does not explicitly define abortion or state when life begins. The Civil and Commercial Code, however, stipulates that a person comes into being after being born alive.332 Buddhist conventional wisdom (Tripitaka) contends that life starts at conception and that abortion is an act of killing and a sin.333 However, Buddhism tolerates given sinful acts when taking into account their social and legal context.334 Consequently, under Buddhism as practiced in Thailand, abortion is considered morally wrong but socially excusable.335 In 1979, the Council of the Catholic Bishops in Thailand issued a statement on abortion that defines human life as beginning “…at the time that the parents’ seeds of life have been mixed. At such time, it is to be held that there is

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already a conception, or a pregnancy has already occurred.”336 An abortion is thus “a murder allowed by the parents to happen”337 and considered “the most hideous crime.”338 The Ninth National Health Promotion Plan issued by the Ministry of Public Health includes an objective to lower the incidence of maternal mortality and morbidity resulting from unsafe abortions. Under the plan, a target for government medical facilities is to keep the maternal mortality ratio from exceeding 18 maternal deaths per 100,000 live births.339 In addition, the Medical Council has specific directives relating to abortion in its Guidelines on the Provision of Obstetric and Gynecological Services.340 The guidelines advise doctors to discuss all possible options with patients who present with unplanned pregnancies, including legal abortion. The guidelines also stipulate that patients should be informed of the possible health effects associated with abortion, and that they should be discouraged from seeking an illegal abortion.341 In cases where a doctor learns that a patient has had an abortion, the doctor is bound to a strict duty of confidentiality and must not disclose the fact to any other person or the police. A breach of this duty is considered an offense under the penal code.342 There is currently no comprehensive government policy regarding postabortion care. Regulation of information on abortion Commercial drug advertisements are controlled by the Drug Act (1967), which restricts advertisements that “lead to an understanding that [the product] can induce miscarriages, or menstruation.”343 However, advertisements intended for medical doctors may mention that a drug could cause miscarriages.344 Government delivery of abortion services Abortions, to the extent permitted by law, are available in public health facilities.345 Legal abortions may be performed only by a medical doctor.346 Only authorized government doctors can perform abortions; private doctors need to register their certificate with the Medical Council before they can offer the procedure. Although there is currently no policy on postabortion care in Thailand, the Reproductive Health Division is undertaking a three-year training project on postabortion care for interested physicians. Abortion services are not included in the list of health-care services covered by the national health insurance system.347 Abortion services provided by NGOs and the private sector Since abortion is illegal in most circumstances in Thailand, NGOs and private clinics have no data on such services. HIV/AIDS and other sexually transmissible infections (STIs) Between 1984 and 2003, there were 305,848 reported cases

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of HIV infection, of which 223,476 had progressed to AIDS, and 69,233 resulted in death.348 Most people living with AIDS are of reproductive age (15–44). Although men account for most AIDS cases, the rate of HIV infection is higher among women aged 10–19 than among men aged 10–19. It is projected that an estimated 1,109,000 people, including 53,400 children, will be living with AIDS by 2006. Projections also estimate that the annual number of new cases of AIDS will be 17,000 in 2006, and that the cumulative total of AIDSrelated deaths will have reached 601,000 by that year.349 The most common mode of HIV transmission is through sexual relations (83.80%), followed by intravenous drug use (4.72%),350 mother-to-child transmission (4.31%), and blood transfusions (0.03%).351 HIV/AIDS remains a major problem among intravenous drug users and sex workers; these subgroups have especially high HIV prevalence rates of 41.7% and 12.3%, respectively.352 Gaps exist in the treatment and coverage of many HIV-infected mothers in need of antiretroviral treatments to prevent vertical transmission.353 As a result of AIDS control and prevention campaigns, including efforts to promote the use of condoms, the overall STI situation has improved in Thailand over the past few decades. For example, the incidence of STIs was 7.85 infections per 1,000 persons in 2001.354 Laws and policies There is no specific legislation relating to HIV/AIDS or laws that make screening of blood products mandatory. Neither are there specific laws for the protection of the rights of infected persons, although the constitution and other laws may be invoked in cases where such persons have suffered rights violations. The constitution specifically prohibits discrimination or unfair treatment on the basis of health differences.355 An appeal to the Medical Council may also be made in such cases.356 The issue of how to balance protecting the human rights of both the general public and of people living with HIV/AIDS has been under debate and discussion, but no resolution has yet been reached.357 Legal discrimination based on HIV/AIDS status has been upheld in some cases. The Regulation on the Administration of Welfare Benefits for HIV-infected Workers and Families, of the Ministry of Labour and Social Welfare, requires infected persons to disclose their HIV/AIDS status in order to request financial assistance for education and occupational training and support.358 Specifically, such individuals must provide health certificates that include identifying personal information and that indicate their HIV-positive status.359 The Venereal Diseases Division of the Department of Disease Control is the main Ministry of Public Health agency

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that makes policy relating to STIs. Because the incidence of STIs in Thailand has decreased over the past few decades in response to HIV/AIDS prevention policies, the division has not recently issued any special measures for STI control. However, a specific target relating to the control of STIs aims to keep the prevalence of STIs among the general population from exceeding 0.5 infections per 1,000 population.360 The current government policy addressing HIV/AIDS is the National Plan for the Prevention and Alleviation of HIV/ AIDS, 2002–2006, which envisages a strong and healthy society where individuals, families, and communities “possess wisdom and knowledge, have a mutual sense of concern, and work together to prevent and alleviate the HIV/AIDS problem.”361 The plan has the following broad targets: ■ reduce the incidence of HIV/AIDS among the population of reproductive age (15–49) to less than 1% by the end of the plan period; ■ increase to at least 80% the proportion of people living with HIV/AIDS and affected individuals who will have access to and be receiving appropriate care and support from public, private, and community providers of social, economic, educational, and primary health-care services; and ■ have local administrations and community organizations throughout the country efficiently and continuously plan and carry out HIV/AIDS prevention and alleviation.362 It also has five broad strategies, which include the following: ■ developing the potential of individuals, families, communities, and the broader social environment to prevent and treat HIV/AIDS and alleviate problems associated with HIV/AIDS; ■ establishing health and social welfare services for the prevention and treatment of HIV/AIDS; ■ expanding knowledge and developing research for the prevention and treatment of HIV/AIDS; ■ fostering international cooperation for the prevention and treatment of HIV/AIDS; and ■ developing a collective program management system to integrate the tasks of HIV/AIDS prevention and treatment.363 Each strategy contains its own specific objectives, target groups, and measures. Specific objectives and aims relating to the rights of people living with HIV/AIDS are to ensure that basic health-care services are provided to infected individuals without discrimination, and to establish mechanisms to protect the rights of such individuals and others affected by the disease.364 The plan also calls for the mandatory provision

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of medical treatment for HIV/AIDS patients, in all hospital facilities, that meets the standards of the national health insurance system, as well as support for the provision of alternative health-care services at facilities both inside and outside the formal health-care system.365 The government also has a policy on infected persons’ rights to voluntary testing.366 The policy respects the decisions of infected persons who cannot be forced to undergo blood tests in most situations.367 However, there is a significant gap between law and practice.368 There are several government projects focusing on HIV/ AIDS prevention and treatment. One specific project aims to prevent mother-to-child transmission of HIV through the provision of AZT drugs to pregnant women. Other government prevention efforts include a successful campaign to promote the use of condoms. The government also plans to implement a special project for the treatment of infected persons using generic GPO-VIR drugs (a combination of three antiretrovirals) in certain hospitals with appropriate equipment and specially trained staff.369 Adolescent reproductive health Adolescents 18 years and under comprise 27.6% (13.5% girls and 14.2% boys) of the total population of Thailand.370 About 22% of adolescents who are enrolled in school report having had sexual intercourse. The proportion of adolescent boys who have had sex is higher than the proportion of adolescent girls (30.5% vs. 12.8% of the adolescents who have had sexual intercourse).371 Most adolescents are aged 15–17 when they have their first sexual experience, with boys generally starting a year earlier than girls.372 The most commonly mentioned person with whom adolescents first had sex was a girlfriend or boyfriend (77%), followed by friends, and sex workers.373 In addition, 31.0% of male adolescents had their first sexual experience involuntarily, compared with 52.7% of female adolescents.374 Studies indicate that most Thai adolescents are aware of contraceptive methods,375 although knowledge does not necessarily correlate with use.376 Among married adolescent girls aged 15–19, for example, approximately 89% are aware of condoms, but 43% currently use contraceptives.377 Furthermore, a study among young people aged 15–24 from the rural areas of north and northeast Thailand found that 82% knew about different contraceptive methods, particularly the pill, with females being more knowledgeable than males about most methods (except for the condom).378 However, almost 30% of males and 50% of females did not use any contraceptive method during their first experience of sexual intercourse.379 Among unmarried adolescents, withdrawal is the most popular method of family planning, followed by periodic

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abstinence, or the rhythm method.380 A study conducted among Thai secondary school students with a mean age of 14.9 years found that 23% of male students had had intercourse with a girlfriend or sex worker, and only 42% of them had used condoms.381 Condom use appears to be much more frequent in sexual encounters with sex workers than with girlfriends and boyfriends.382 In 2001, the birthrate among very young adolescents was 0.2 births per 1,000 girls under the age of 15. The corresponding rates that year were 33.7 births per 1,000 girls aged 15–19, and 75.6 per 1,000 girls aged 20–24.383 Of all maternal deaths in Thailand in 2001, girls under the age of 20 accounted for 7.8% of the total.384 Girls younger than age 20 also accounted for 30% of the total number of women who were hospitalized due to complications resulting from miscarriage and induced abortion in 1999.385 Young men and women under the age of 25 constitute 29% of the total number of cases of patients who contract STIs.386 In 2002, this age-group accounted for 12.5% of the total number of persons with active HIV infections.387 Although most HIV-infected persons overall are male, among 10–19-year-olds, more women are infected than men.388 There are no available data concerning adolescents’ access to reproductive health services. However, the Ministry of Public Health has recognized that poor accessibility to reproductive health services among adolescents is one of the main causes of unwanted pregnancy and complications due to unsafe abortion.389 The constitution provides that children and youth without guardians shall have the right “to receive care and education from the state, as provided by law.”390 It also calls upon the state to “protect and develop children and the youth” in its Directive Principles of Fundamental State Policies.391 Adolescent reproductive health is one component of the 1997 Reproductive Health Policy, which emphasizes information, education, counseling, and services.392 The Medical Council Guidelines on the Provision of Obstetric and Gynecological Services state that physicians should recognize that most adolescent pregnancies are unplanned; the guidelines recommend that physicians provide knowledge and information; recommend necessary social services agencies; and discuss in depth the best options for the pregnant adolescent, including whether to carry the pregnancy to term and raise the child or place the child for adoption.393 Physicians are also advised to discuss the resolution of an unplanned pregnancy with the patient’s partner or husband or, if the patient is an unmarried minor, with her parents.394 Monitoring mechanisms are absent from the guidelines. In 2001, the Family Planning and Population Division

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of the Department of Health under the Ministry of Public Health launched a program called the Wai Roon Sod Sai (Vibrant Youth) Project,395 which is being implemented with support from the Department of Health, regional health promotion centers, and provincial public health offices. The project involves establishing “Friends Corners” to provide reproductive health services and information for adolescents. This government effort to provide adolescent-specific reproductive health services is the first of its kind in Thailand.396 The project was included in the Department of Health’s implementation plan for 2003.397 It is now integrated with a project addressing adolescents’ use of drugs. Apart from the reproductive health information and services for adolescents just mentioned, the Health Promotion Office of the Department of Health has organized campaigns on general health promotion for adolescents under the program Health for School-Age Children and Youth, which covers those aged 6–21.398 C. POPULATION

Thailand’s first national population policy was declared in March 1970.399 That policy established government support for voluntary family planning to address the then very high rate of population growth, which was perceived as an obstacle to the economic and social development of Thailand.400 Although the population policy advocated voluntary family planning, the National Family Planning Program under the Ministry of Public Health set operational targets annually in quantitative terms. Such targets were set beginning with the Third National Social and Economic Development Plan (1972–1976) and continued through the Seventh National Social and Economic Development Plan (1992–1996); by the end point year of that plan, Thailand’s annual population growth rate had fallen to 1.2%.401 The Eighth National Social and Economic Development Plan (1997–2001) marked the introduction of qualitative targets that advocated for couples’ achieving their “appropriate family size” in line with a “people-centered development” approach.402 With the announcement of its Reproductive Health Policy in 1997, the Ministry of Public Health integrated population and family planning activities into reproductive health services.403 Currently, Thailand has a total population of 62 million404, which is growing at a rate of 1.19% per year.405 In the near future, the total fertility rate of the Thai population is expected to decrease to a level that is lower than replacement.406 The efforts of national development plans to curb population growth, in addition to the National Family Planning Program’s significant gains in increasing the accessibility and acceptability of contraceptives, have contributed to the cur-

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rent low population growth rate.407 In addition, modernization has changed family structures and educational needs so that having a large number of children has become a burden rather than a benefit.408 To encourage small family norms, the government directly supports contraceptive use, and about 79% of married women were using a modern method of contraception in 2000.409 Objectives Currently, Thailand’s Ninth National Social and Economic Development Plan has maintained the “people-centered development” concept from the previous national plan.410 The ninth plan’s development policies on population contain the following strategies: ■ enhancing the quality of life, and achieving a balanced population structure and appropriate family size norms; ■ maintaining replacement level fertility; ■ ensuring that Thais are in good health and capable of keeping up with the rapidly changing economy, while maintaining high ethical standards and awareness of the common good in society; ■ providing no fewer than nine years of education to the school-age population and ensuring that at least 50% of Thai laborers have completed a secondary school education by 2006; ■ extending equal health insurance coverage to the entire population, including social security benefits for Thais of all age-groups; ■ strengthening civil society to enhance the livability of cities and communities; and ■ promoting a more efficient use of natural resources and management of the environment, as well as the greater participation of the general population in such efforts.411 Building on the Ninth National Social and Economic Development Plan, the Bureau of Health Promotion of the Department of Health under the Ministry of Public Health has established goals for promoting the health of women of reproductive age. They are the following: ■ ensuring that at least 15% of women aged 15–44 have access to basic reproductive health services; ■ keeping the pregnancy rate among women less than 20 years of age to no more than 10%; ■ keeping the birth control rate at at least 77%; ■ increasing the proportion of the working population who have proper nutrition to at least 60%; ■ raising the proportion of the working population who are physically fit by 20%; and ■ ensuring that at least 15% of women aged 45–59 have

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a basic knowledge of reproductive health issues.412 The hill tribe population is a group for whom the government has designed a special development policy, which is called the Master Plan for Community Development, Environment and Control of Narcotics in Highland Areas. Currently, the Third Master Plan (2002–2006) is operational. One of the main objectives of the present master plan is to control the rate of population growth in the highland areas;413 the plan aims to reduce the fertility rate among the highland population to 1.5% by the end of the plan period.414 The birthrate of the hill tribe population was reported to be almost twice that of the lowland population in 1997.415 Implementing agencies The Ministry of Public Health is the core ministry responsible for population and family planning nationwide.416 The Bureau of Social Development and Quality of Life is responsible for the formulation and coordination of population policy at the national and local levels.417 The facilities responsible at the implementation level are provincial hospitals, maternal and child health hospitals, community hospitals, health centers, university hospitals, and other hospitals under the Ministry of Public Health and other ministries, as well as village health volunteers, NGO volunteers, and private hospitals and clinics.418 The Center for Highlands Health Development of the Department of Health is the main Ministry of Public Health agency responsible for the implementation of reproductive health and population activities for the hill tribe population.419

III. Legal Status of Women and Girls The health and reproductive rights of women and girls cannot be fully understood without taking into account their legal and social status. Laws relating to their legal status not only reflect societal attitudes that shape the landscape of reproductive rights, they directly impact their ability to exercise these rights. A woman or adolescent girl’s marital status, her ability to own property and earn an independent income, her level of education, and her vulnerability to violence affect her ability to make decisions about her reproductive and sexual health and access to appropriate services. The following section describes the legal status of women and girls in Thailand. A. RIGHTS TO EQUALITY AND NONDISCRIMINATION

Equality and freedom from discrimination are fundamental rights under the constitution. The “supreme law of the State” provides that all persons are equal before the law and enjoy

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equal protection under the law, and that men and women enjoy equal rights. The constitution prohibits discrimination on several specific grounds, which are origin, race, language, sex, age, physical or health condition, personal status, economic or social standing, religious belief, education, and political views.420 However, affirmative state measures intended “to eliminate obstacles to or to promote persons’ ability to exercise their rights and liberties as other persons shall not be deemed an unjust discrimination.”421 In addition to these fundamental guarantees, the constitution’s Directive Principles of Fundamental State Policies call upon the state to promote equality between the sexes.422 In addition to being in the constitution, equality and nondiscrimination provisions are included in some national legislation, including the Labour Protection Act (1998) and the National Education Act (1999).423 (See “Labor and employment” and “Education” for more information on these acts.) However, the Civil and Commercial Code, which governs secular marriage, divorce, and property rights, among other matters, does not specifically guarantee the right to gender equality or prohibit gender-based discrimination.424 The constitution does not prohibit discrimination on the ground of sexual orientation. Homosexuality is not a crime under the penal code.425 Formal institutions and policies The National Commission on Women’s Affairs and Family Development, which was formerly known as the National Commission on Women’s Affairs and was restructured in 2003, is the central government body charged with promoting women’s status.426 The commission’s specific duties including the following: ■ propose to the cabinet policies and master plans that promote women’s empowerment, gender equality, and the institution of the family; ■ establish implementing guidelines for approved policies and master plans consistent with the current National Economic and Social Development Plan; ■ coordinate, follow up, and evaluate implementation of the policies, master plans, and guidelines, and report to the cabinet at least once a year; ■ advise the cabinet on the implementation of laws, regulations, policies, programs, and projects on the promotion of women’s potential, gender equality, and the institution of the family; ■ recommend appropriate mechanisms and measures, and propose new laws or amendments, to the cabinet and the prime minister and advise them on the government’s positions in the national and international arenas with regard to promoting women’s potential,

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gender equality, and the institution of the family; promote, support, and assist related activities of government organizations and NGOs; and ■ solicit necessary relevant information and materials from government officers, employees, and other relevant persons in government agencies.427 The prime minister or the appointed deputy prime minister is the commission’s chairperson, the minister of social development and human security is its vice-chairperson, and the director of the Office of Women’s Affairs and Family Development under the Ministry of Social Development and Human Security is its secretary.428 The commission’s other membership consists of high-ranking representatives from various ministries and government agencies, and up to ten experts appointed by the prime minister, at least five of whom must be directly involved in women- and family-related issues.429 The commission reports to the prime minister.430 The Office of Women’s Affairs and Family Development, which is the commission’s implementing agency, works as an integrating institution of the work of the former Office of National Commission on Women’s Affairs and is charged with certain responsibilities relating to promoting women’s status. These include the following: ■ Develop and make recommendations to promote women’s potential, gender equality, and family unity for the security of lives; ■ strengthen and develop measures and mechanisms to promote women’s potential, gender equality, and the institution of the family; ■ provide academic support and resources to networks that work on promoting women’s potential, gender equality, and the institution of the family; and ■ promote and accelerate Thailand’s implementation of international obligations and agreements.431 In 2001, the government passed a resolution to promote the mainstreaming of gender issues in government agencies. Pursuant to the resolution, each ministry or government department must appoint a chief gender equality officer, establish a Gender Focal Point Unit, and formulate a master plan to promote gender equality principles and integrate them into plans and projects.432 In addition to government institutions that focus on women’s rights, there are other agencies that address related issues under a larger mandate to protect human rights. The Department of the Rights and Liberties Protection under the Ministry of Justice, which was established in 2002, is charged with, among other duties, promoting awareness about human rights.433 A specific division of the department is authorized to redress problems and complaints related to the violation ■

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of individual rights and liberties.434 The National Human Rights Commission,435 an independent agency established after the promulgation of the 1997 constitution, is empowered to examine and report on acts that violate human rights or the government’s obligations under international treaties.436 The commission has several subcommittees on specific issues, although none focus on women’s rights or gender equality.437 B. CITIZENSHIP

Citizenship is governed by the Nationality Act (1965). Pursuant to a 1992 amendment to the Nationality Act, Thai men and women may equally confer citizenship to children born in wedlock. The amendment applies retroactively and, at the time of its passage, granted citizenship to some 2,500 children who were born to Thai women married to foreign men and were denied citizenship under the former law.438 Children born out of wedlock to Thai mothers are citizens, regardless of their country of birth and whether their father is stateless or if the identity of their father is unknown.439 While a foreign woman married to a Thai man may apply for citizenship, a foreign man married to a Thai woman does not have the same right.440 Generally speaking, citizenship is not automatically conferred upon birth within the borders of Thailand under the Nationality Act. As a result, over one million Myanmar refugees and migrants born in Thailand are stateless, as are over one-half the population of the highlands (i.e., the hill tribe population of roughly 600,000–1,000,000); their stateless status is likely to continue because of corruption and abuse in the application process for citizenship.441 These groups are restricted in their movements and are subject to arrests and deportation, and they cannot own immovable property, obtain higher education, or run for public office.442 Women in these groups face particular hardships and barriers to obtaining citizenship, including being unable to pass the language requirement for Thai citizenship because of a general lack of education. Although refugee and migrant women are frequently subject to trafficking, sexual violence, and abuse at the hands of employers and police, they lack access to legal protection or remedies because of their status as noncitizens. They often “fall into debt and into situations of deception, coercion, and/or exploitation” owing to their noncitizen status.443 C. MARRIAGE

Marriage is regulated in the family laws of Thailand; Muslim family law applies specifically to Muslims residing in the southern provinces of Pattani, Narathiwat, Yala, and Satun; and general family law applies to all other Thais, non-Muslims and Muslims alike. For most Thais, the relevant marriage

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laws are contained in the Civil and Commercial Code (1934), which was amended in 1976.444 Muslims in the aforementioned southern provinces are governed by the Islamic Law on Family and Succession.445 The preeminence of this law in matters pertaining to marriage and other family affairs is established by the Act on the Application of Islamic Law in the Territorial Jurisdictions of Pattani, Narathiwat, Yala, and Satun Provinces (1946).446 Book Five of the Civil and Commercial Code establishes the legal requirements for a valid civil marriage. The code requires the consent of both parties to the marriage, which must be declared publicly before a registrar and legally recorded.447 Both parties must have completed their seventeenth year of age, although minors may marry with the consent of a parent or a guardian, or if the minors file an application with a court requesting permission for the marriage.448 The law forbids marriage between blood relatives, as well as between adoptive relatives.449 The code prohibits bigamy, but does not prescribe punishment for violating this prohibition.450 In practice, a person accused of bigamy may be charged with giving false information to an official under the penal code.451 The code includes provisions addressing the remarriage of widows and divorced women. In general, such women may remarry only after 310 days have passed since the termination of their previous marriage, with the following exceptions: ■ a child is born during those 310 days; ■ the divorced woman plans to remarry her ex-husband; ■ a lawful and qualified medical practitioner issues a certificate showing that the woman is not pregnant; or ■ a court issues an order allowing the woman to remarry.452 Although the code does not prohibit marriage between persons of the same sex, it provides validation for marriage between a man and a woman only.453 Laws governing Muslims in four provinces Marriages among Thai Muslims who reside in Pattani, Narathiwat, Yala, and Satun must be performed in accordance with the Islamic Law on Family and Succession.454 Although there is no clear indication of the minimum age for marriage, the law defines a person who is “of age” as someone who has reached his or her sixteenth birthday, or who will have had his or her tenth birthday within 15 days of marriage and have attained puberty.455 For persons who have not yet come of age but wish to marry, a male relative of the underage party must perform the marriage ceremony.456 The law permits a man to have up to four wives at one time.457

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The law stipulates clearly that marriage may only be between a man and a woman.458 D. DIVORCE

The Civil and Commercial Code and the Islamic Law on Family and Succession govern divorce among Thais in general and among Thai Muslims residing in Pattani, Narathiwat, Yala, and Satun, respectively. Under the Civil and Commercial Code, divorce may be effectuated only by mutual consent of the parties or court order.459 It is far easier for men to obtain a divorce than it is for women. A husband, for example, may request a divorce by demonstrating that his wife has committed adultery.460 A wife, however, must in addition prove that her husband has given maintenance to or honored another woman as his wife.461 Other grounds for divorce initiated by either spouse include: ■ infliction of serious harm or torture to the body or mind of the spouse, or of serious insult to the spouse or to his or her relatives; ■ desertion lasting more than one year; ■ imprisonment of more than one year for an offense committed without the participation, consent, or knowledge of the other spouse; ■ if a spouse has been adjudged to have disappeared, or has left his or her residence for more than three years and is not known to be dead or alive; ■ failure to provide maintenance and support to the other; ■ insanity for more than three consecutive years; ■ breaking of a bond of good behavior executed by him or her; ■ the suffering by one spouse of a communicable and dangerous disease that is incurable and may cause injury to the other; and ■ the physical disability of one spouse that makes permanent cohabitation impossible.462 Also, if the husband and wife voluntarily live separately for more than three years because of irreconcilable differences or by an order of a court, either spouse may enter a claim for divorce.463 In a divorce case, either party may petition the court for the amount of maintenance.464 After a divorce, if a party who is entitled to maintenance fails to receive such maintenance, or receives inadequate maintenance, the party may petition the court.465 The court will determine on a case-by-case basis whether and how much maintenance will be granted, taking into account the ability of the paying party, the receiving party’s condition in life, and the circumstances of the case.466 Laws governing Muslims in four provinces

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For Muslims residing in Pattani, Narathiwat, Yala, and Satun, the Islamic Law on Family and Succession specifies several ways of terminating a marriage, which are the following: ■ torla (repudiation of the wife by the husband);467 ■ pasaka (judicial dissolution of the marriage);468 ■ the husband’s sworn statement to the court that his wife has committed adultery;469 and ■ tadrpasaka (termination of the marriage because of gross misconduct of either party, including the renunciation of Islam by either party).470 The law obligates a husband to provide maintenance during iddah (the prescribed waiting period before a divorce becomes final) if the wife is pregnant. Such maintenance includes accommodation, food, and clothing.471 Parental rights For Thais who are subject to the Civil and Commercial Code in family matters, the code does not clearly specify which parent is entitled to custody of the couple’s children upon divorce. Rather, divorced parents are allowed to reach a mutual agreement independently on the custody and maintenance of their children.472 In cases where parents are unable to reach an agreement, they may petition a court for a judgment on the matter, which takes into account the financial status of both parties and the circumstances of the case.473 The code also contains many provisions concerning the legitimacy of children, stipulating that a child born to a woman is deemed her legitimate child, regardless of the woman’s marital status.474 However, if the parents of the child are unmarried, the presumed father must apply for registration of his status as the father before he can exercise parental rights.475 Under the code, he may also repudiate his paternity by filing a court action against the mother and child jointly.476 To succeed in such a court action, the man must prove that he did not cohabit with the mother during her pregnancy during the period from the 180th day of pregnancy to the 310th day of pregnancy.477 Laws governing Muslims Among Thai Muslims subject to Islamic law in Pattani, Narathiwat, Yala, and Satun, the father automatically receives guardianship, or legal decision-making power, over the couple’s children upon divorce, while the mother is entitled to their custody and care. The father is required to pay for the maintenance of his children and has the right to take them with him in case of a change in domicile.478 In cases where a woman is pregnant with a fetus her husband is certain is not his, Islamic law permits the husband to bring an action against his wife for adultery. The husband is required to make his claim under oath, but need not provide evidence for his accusation.479 A woman who does

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not repudiate the claim under oath is presumed by law to be guilty of adultery, and is required to pay compensation to her husband.480 The law also requires that the couple divorce and forbids them from ever remarrying.481 E. ECONOMIC AND SOCIAL RIGHTS

Ownership of property and inheritance The constitution protects the rights to property and succession, and provides for the scope of such rights to be determined by law.482 It also prohibits the expropriation of immovable property except for purposes that serve the public interest, and provides for the right to fair compensation in such cases.483 In addition to the constitution, the property rights of most Thais are governed by the Civil and Commercial Code, which contains legal provisions relating to property, including ownership of immovable property.484 These provisions use the gender-neutral term “spouse” in discussing property rights and do not discriminate according to sex.485 The code also covers matters of succession and inheritance, prescribing the general rule that a deceased’s property passes to his or her heirs.486 The surviving spouse of a deceased person who leaves no children is entitled to the whole inheritance.487 Where there are living children, the surviving spouse and children are entitled to equal parts of the inheritance, in accordance with the code.488 The code does not discriminate against daughters or sons in their right to inheritance. In cases where a deceased husband leaves more than one surviving wife, all wives whose marriages with the deceased were registered before the enactment of Book Five of the Civil and Commercial Code are jointly entitled to inherit the deceased’s property.489 However, each secondary wife is entitled to only one-half of the share of the principal wife.490 Under the Islamic law applicable to Muslims in Pattani, Narathiwat, Yala, and Satun, the husband and wife have the right to their own property without interference from the other spouse.491 Rights to agricultural land The constitution’s Directive Principles of Fundamental State Policies call upon the state to develop and appropriate a system of landholding and land use, provide sufficient water resources for farmers, and protect and promote their interests.492 Labor and employment In 2000, women comprised 46% of the Thai workforce.493 Almost half (48%) of the female labor force was employed in agriculture, 35% in the service sector, and 17% in industry.494 As of 2000, urban female workers were largely employed in the informal sector, and were underrepresented in professional and technical professions, as well as in administrative, mana-

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gerial, and executive positions. Women continue to earn less pay than men in all categories of employment, earning on average 72% of the wages of their male counterparts in nonagricultural employment and 64% of the wages of men in manufacturing.495 The constitution’s Directive Principles of Fundamental State Policies urge the state to “promote people of working age to obtain employment, protect labor, especially child and woman labour, and provide for the system of labour relations, social security and fair wages.”496 At the level of federal legislation, the Labour Protection Act (1998) is a key labor law. In addition, the Social Security Act (1990) includes provisions addressing employment benefits for insured persons. In general, Thai law provides for equal rights in the workplace. The Labour Protection Act guarantees gender equality in employment and payment of wages, requiring employers to “treat male and female employees equally in their employment, except where the nature or conditions of the work does or do not allow the employer to so do.”497 The law also specifically prohibits discrimination against pregnant workers, prohibiting employers from terminating a female worker because of her pregnancy.498 The law prescribes penalties for discriminating on the basis of gender in hiring and payment of wages, subjecting employers to a fine of up to 20,000 baht (approximately USD 485) for violations.499 An employer who terminates an employee on account of her pregnancy is subject to imprisonment of up to six months, a fine of up to 100,000 baht (approximately USD 2,428), or both.500 Pregnant employees are entitled to maternity benefits under the Labour Protection Act, as well as the Social Security Act. The Labour Protection Act affords pregnant employees maternity leave of up to 90 days for each pregnancy,501 out of which 45 days are paid leave.502 Under the Social Security Act, an insured pregnant employee is entitled to a lump sum payment in the amount of 50% of wages during a 90-day maternity leave in addition to what the employer pays.503 The Social Security Act also covers medical treatment and supplies provided during the course of prenatal care and childbirth; lodging and meals during the institution-based delivery; care and treatment for the newborn; transportation to and from the health-care institution; and other necessary services. Insured persons are entitled to maternity benefits for up to two pregnancies.504 The act also provides maternity benefits to the spouses of insured male workers who are married or in a consensual cohabiting union.505 The act also provides benefits for the children of insured workers,506 including coverage for their educational expenses, and medical care and treatment.507 Unmarried single mothers are entitled to the same benefits for their dependent children as are married female

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workers with children.508 Thai labor laws do not provide for the establishment of nurseries in the workplace or nursing breaks during working hours. The Labour Protection Act includes certain protective provisions for pregnant employees relating to working conditions. It prohibits employers from requiring that a pregnant employee work between 10 p.m. and 6 a.m., overtime, or on holidays, or that she perform certain physically demanding tasks specified in the act.509 A pregnant employee who presents a medical certificate stating that she is no longer able to perform her original duties is also entitled to request her employer to temporarily assign her to more suitable duties either before or after childbirth.510 Violations of the act’s protective provisions for pregnant employees are punishable with imprisonment of up to six months, a fine of up to 100,000 baht (approximately USD 2,436), or both.511 The act also contains provisions restricting certain types of work for all female workers, regardless of pregnancy status. These include mining, construction, erecting and dismantling scaffolding, producing and transporting explosives or inflammable materials, and any other work as prescribed by the regulations.512 Access to credit The Civil and Commercial Code contains provisions concerning access to credit, which do not discriminate by gender.513 A woman may apply independently for a loan from a financial institution. If either the husband or wife wishes to use financial properties as collateral against a loan, one spouse must obtain the other’s consent.514 In practice, officials usually request evidence of consent from the husband of a married woman, whereas a married man is usually not requested to show evidence of consent from his wife.515 The Asian Development Bank has been working in collaboration with the Thai government on projects to improve Thai women’s access to credit, such as targeted credit mechanisms, projects involving training in new labor force skills and self-employment skills, and small-enterprise training.516 Education According to a recent assessment by the National Commission on Women’s Affairs of the Women’s Development Plan under the Ninth National Economic and Social Development Plan, 63% of illiterate persons are women, mostly aged 40 and above.517 This gender gap in illiteracy among the middle-aged population reflects imbalances in educational opportunities in the past.518 There is greater equality in present times, particularly at the primary and secondary school levels.519 The 2000 population census indicated that the illiteracy rate was slightly higher among males aged 6–17 than among females in the same age-group, although the converse

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was true among those aged 18–24.520 According to recent government data, there are more female than male graduates at the secondary school level, as well as more females than males who earn occupational certificates and doctorates.521 At the secondary school and undergraduate levels, more female than male students are enrolled,522 although female students tend to be concentrated in fields that are traditionally thought to be suitable for women.523 There are almost equal numbers of girls and boys enrolled at both the primary and secondary school levels.524 The constitution guarantees equal rights to free and quality public education for the first 12 years of schooling.525 In addition, the constitution’s Directive Principles of Fundamental State Policies urge the state to promote education services provided by the private sector, as well as by local administrative units.526 In addition to the constitution, the National Education Act (1999) and the Compulsory Education Act (2002) are key laws addressing education. In accordance with the constitution, the National Education Act provides for the equal rights and opportunities of all individuals to receive basic public education for at least 12 years. The act specifies that such education, provided nationwide, shall be of quality and free of charge.527 The act creates mechanisms to ensure children’s rights to access their education. The Compulsory Education Act (2002), which replaces the 1921 act of the same name, obligates parents and other responsible parties, including “a person…for whom the child serves in domestic service,”528 to send children under their care to educational institutions that provide compulsory education.529 The act applies to children aged 7–16,530 and defines compulsory education as education from the first through the ninth year, which is considered to be fundamental education.531 Sex education According to a study of Bangkok college students, 94% of those surveyed had knowledge about AIDS, and 92% knew about the major modes of transmission.532 The majority of students also knew that HIV could not be transmitted in various casual ways or by mosquitoes, and that there were no vaccines to prevent infection.533 Secondary school students’ knowledge of STIs and contraception is more limited;534 their main sources of information in this area are books and magazines.535 Research among secondary school students and their teachers shows that combined knowledge about their sexuality was only at a “moderate” level.536 Eighty two percent of students in the research sample agreed that sex education programs should be provided at the secondary school level, and 42.6% agreed that sex education should be provided by the family.537

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Sex education is one component of the Thai Reproductive Health Policy.538 At present, the Departments of Health and Mental Health of the Ministry of Public Health have joined forces with the Ministry of Education to revise the sex education curriculum.539 The contents of the curriculum are to be taught according to the developmental level of the students, from the first grade through the secondary school level. The main topics of the curriculum include human sexual development; human relationships; sexual behavior; sexual hygiene; and necessary life, social, and cultural skills.540 In addition, the Department of Health and other government agencies are partnering with the private sector to prepare a handbook on life skills for adolescents, called Modern Teenagers and the Understanding of Life.541 F. PROTECTIONS AGAINST PHYSICAL AND SEXUAL VIOLENCE

Rape The penal code governs the crime of rape, defining the act as sexual intercourse initiated by a man with a woman who is not his wife under any of the following circumstances: ■ against her will; ■ by threatening by any means whatever; ■ through any act of violence; ■ by taking advantage of a woman who is unable to resist; or ■ by causing the woman to mistake him for another person.542 The punishment for rape under the code is imprisonment of one to ten years and a fine of 2,000–20,000 baht (approximately USD 49-487).543 If the victim is seriously injured or killed, the offender may be punished by 10–20 years’ imprisonment and a fine of 20,000–40,000 baht (approximately USD 487-974), or life imprisonment or death.544 There is not yet any legislation on marital rape. Sexual intercourse with a girl under 13 years of age, regardless of whether the act was consensual, is punishable by 2–12 years’ imprisonment and a fine of 4,000–20,000 baht (approximately USD 97-487).545 The code also addresses the issue of rape by a blood relative.546 The penalty is increased by one-third if the perpetrator is a relative.547 Domestic violence Domestic violence affects Thai women across all social classes and has been given increased attention in recent years. However, the problem is still widely underreported.548 According to available information from a 2000 survey, 23% of women in the capital and 34% of women in the other provinces reported having been the victim of physical violence

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by their intimate partner at least one time in their life.549 In addition, 4% of women who had ever been pregnant reported having experienced physical violence at the hands of their partner during pregnancy.550 Research also found that the majority of Thai women prefer to not press charges against their abusive partners, but would rather preserve the relationship while ending the violence.551 The constitution guarantees the right of “children, youth and family members” to be protected by the state against violence and unfair treatment.552 There is no specific national law on domestic or gender-based violence, or a law that provides protection to victims of violence through a protection order or a restraining order. However, the penal code may be invoked to charge perpetrators of domestic violence, specifically the sections of the code under the categories of Offences Relating to Sexuality and Offences against Life and Body.553 The Child Protection Act (2004) also protects against child abuse, as does the penal code in a provision imposing penalties for those who commit child abuse and offenses against minors.554 According to police procedures, when the police have been informed of a criminal offense, they have a duty to undertake an immediate investigation or interrogation, regardless of whether there is a complainant;555 there is also a specific police protocol in cases of domestic disputes.556 According to the protocol, in cases where a husband or wife accuses the other spouse of inflicting physical harm, the officer in charge should attempt reconciliation between the parties under certain circumstances (e.g., if a weapon was not used, if the injury was not serious, if the injury did not occur on a main road, or if the injury lacked evil intent and was “simply done as a means of admonishment”). If the attempt at reconciliation fails, the officer in charge must submit the results of the investigation for further consideration by the local police superintendent. However, if the dispute between the husband and wife involves a weapon or a serious injury, or if it is carried out on a main road, the officer in charge, if he deems it necessary, should submit the matter to his superintendent for consideration and orders for further action, “as the government has the duty to maintain peace and order, and family security as a matter of importance.”557 Perpetrators of domestic violence are subject to jail terms, but not to rehabilitation and program activities.558 To ameliorate some of the problems in enforcement and underreporting, over the past decade police units have recruited teams of female police officers in three Bangkok stations and several other parts of the country to encourage women to report domestic violence.559 In May 2002, the cabinet passed a resolution ordering

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the enactment of the Policy and Plan on the Elimination of Violence against Children and Women; the National Commission on Women’s Affairs had submitted this resolution to establish a national policy and plan addressing domestic violence.560 The policy serves as a guideline for the coordination of government agencies, NGOs, and community-based organizations involved in activities aimed at eliminating violence against women and children.561 The designated national-level coordinating agencies are the Office of the National Commission on Women’s Affairs, which is responsible for policy-level coordination on women’s affairs; the National Youth Bureau, which is responsible for policy-level coordination of children’s and youth’s affairs; and the National Institute for Child and Family Development of Mahidol University, which is responsible for coordination of technical issues.562 However, to date there is no report on the implementation of the policy. Passage of domestic violence legislation is one of the main objectives of the Women’s Development Plan under the Ninth National Economic and Social Development Plan.563 Sexual harassment There is no specific or comprehensive law on sexual harassment. The Labour Protection Act addresses sexual harassment in the workplace and prohibits “a person who is in overall charge of staff, a supervisor, or an inspector” from sexually harassing female or child employees.564 The act prescribes a fine of up to 20,000 baht (approximately USD 487) for sexual harassment of a female employee565 The act does not provide a definition of sexual harassment. The penal code also prescribes penalties for a person who commits an “indecent act” with another person, although such acts are not clearly defined.566 Sexual harassment in the schools has recently received attention by the Ministry of Education. In 2000, the ministry issued a regulation on the Promotion and Protection of the Rights of Children and Youth by Educational Institutions, which provides that educational personnel who know of an act of sexual harassment against a pupil have a duty to report the matter to the responsible authorities; further, the head of the educational institution concerned has to take action to protect and give assistance to the child as soon as possible.567 The ministry also issued several subsequent policies and measures, directed at educational institutions and personnel, that attempt to respond to widespread sexual harassment, prostitution by fraud, and commercial sex acts involving pupils and students, and establishes procedures for responding to reported incidents.568 In cases of sexual harassment committed by educational personnel against a student, the staff member’s employment is suspended and a committee must respond by investigating the incident or taking some other action within

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15 days. Every educational institution’s administrator must take concrete action against any staff member under his or her supervision who commits an offense. If the offender was assisted by others, or was exempted from discipline or other necessary action, the administrator and any other persons responsible will also be subject to punishment.569 Commercial sex work and sex-trafficking Commercial sex work is a major industry in Thailand involving hundreds of thousands of women and fueled, in part, by widespread sex tourism.570 Anecdotal information and survey data suggest that a large number of women are trafficked as prostitutes and as forced laborers in households, factories, and farms. Thailand is both a sending and receiving country of trafficking, and it transports women to countries and regions such as Japan, South Africa, Australia, Bahrain, Taiwan, Europe, and North America.571 There is also an internal flow of trafficking from the northern provinces to other regions. Comprehensive official data on the prevalence of commercial sex work and sex trafficking in the country are not readily available. The government has recently made the issue of trafficking of women and forced prostitution a national priority. Thailand criminalized prostitution with the Suppression of Prostitution Act (1960), which penalized both prostitutes and their procurers, but not their clients.572 While the Prevention and Suppression of Prostitution Act (1996), which repeals the 1960 act, keeps prostitution illegal and subjects prostitutes to a fine of 1,000 baht (approximately USD 24), the act’s aim is to punish procurers and, for the first time, their clients, rather than prostitutes or child victims of prostitution.573 Whereas authorities have used this law to some degree, enforcement remains low.574 Between 1996 and 1999, 355 people were arrested for violating the act, but only 14 were convicted and sentenced.575 Thailand also has a law dealing directly with trafficking for various purposes, including prostitution. The Measures in Prevention and Suppression of Trafficking in Women and Children Act (1997) amends the Traffic in Women and Girls Act (1928) by extending coverage to girls and boys under the age of 18 who are victims of trafficking; the measures penalize conspiracy to commit a trafficking-related offense and prescribe equal punishment for principal actors as well as for abettors of trafficking.576 The act also authorizes officials to give appropriate assistance to victimized women and children by providing them with food and shelter; officials are further authorized to repatriate victims who are foreign nationals.577 Other laws that can be used to prosecute traffickers of women and children for sexual purposes include the Prevention and Suppression of Prostitution Act, the Penal Code

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Amendment Act (1997), and the Amendment of the Criminal Proceedings Act (1997). The Prevention and Suppression of Prostitution Act punishes the procurement, seduction, or induction of another person for the purpose of prostitution with imprisonment of one to ten years and a fine of 20,000– 200,000 baht (approximately US 487-4,870).578 The victim’s consent is immaterial, and the law applies to both intra- and extraterritorial acts.579 The Penal Code Amendment Act prescribes a similar penalty for such acts; the punishment is more severe when the victim is a minor aged 15–17, and is increased even further when the child victim is under age 15.580 The Amendment of the Criminal Proceedings Act introduces more child-friendly procedures, such as allowing child victims of trafficking to offer testimony.581 Under the Money Laundering Control Act (1999), the state may confiscate all property of an offender who is guilty of trafficking in women and children.582 The Memorandum of Understanding on Common Guidelines of Practices among Concerned Agencies for Operation in Case Women and Children Are Victims of Human Trafficking is a policy agreement signed in 1999 by government and law enforcement agencies and NGOs involved in addressing the problem of the trafficking of women and children.583 The memorandum expands the definition of human trafficking to include forced labor, forced begging, or any other related immoral act,584 and provides protection for female and child victims regardless of whether they are Thai citizens, foreigners, or stateless persons residing in Thailand.585 The memorandum instructs the police to interview victims immediately after they have secured their release from captivity, and to coordinate with public prosecutors to file a petition, even if the investigation of the case is not yet complete.586 In cases involving foreign victims who enter the country illegally, the police are instructed to work with immigration authorities to provide for the victims’ temporary residence in Thailand in accordance with the Immigration Act (1979), after which the victims are to be transferred to shelters run by the government or by approved private organizations.587 The memorandum also prescribes various forms of assistance to be provided to victims such as food, clothing, health care, and counseling. In practice, most police officials have no knowledge of the memorandum, so many attempts to apprehend offenders are still unsuccessful and widespread trafficking violations persist.588 Although Thai laws and policies addressing trafficking increasingly have been used to arrest offenders in recent years, the number of convictions remains low and the convictions largely result in light sentences. In 2003, there were 211 trafficking arrests and 20 convictions, with most offenders receiving light sentences.589 There are also reports of complicity

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and participation in trafficking violations by police officers, soldiers, and other government officials and, although a few officials have been convicted, there is no systematic plan to address this problem of corruption.590 There is also no law that provides witness protection in trafficking cases.591 Government activities to address the problem of trafficking include undertaking public information campaigns, establishing a hotline for calls to report violations, and collaborating with NGOs to provide support services for victims. The government operated 97 shelters in 2003 for victims of trafficking.592 In July 2003, the cabinet approved a draft National Policy and Plan on the Prevention, Suppression and Resolution of the Problems of the Domestic and Transnational Traffic in Women and Children.593 The policy consists of seven master plans addressing discrete issues, including, among others, prevention; assistance and protection; expatriation and relocation of victims; information, follow-up, and evaluation systems; and international cooperation.594 The policy is in the process of being revised.595 Sexual offenses against minors According to information from an NGO working in the field of child protection, the number of child rape cases it handled in 2002 increased by 39% from the previous year.596 Eighty-six of the 197 girls treated by the NGO were age nine or below, and for 93 of the girls, the perpetrator was their own father, stepfather, or other relative.597 The penal code prescribes punishment for two categories of sexual offenses against minors—rape and “indecent acts.” The severity of punishment for both offenses varies according to the minor’s age; the degree of injury to the minor; the number of offenders involved in the crime; and whether weapons were used to commit the offense.598 The code does not prescribe punishment for an offender who commits rape or indecent acts with his minor wife, and exempts an offender from punishment if he marries the minor after the violation.599 An offender may file an application to the court for permission to marry the minor victim. Statutory rape is defined in the code as sexual intercourse with a girl under the age of 15 who is not the perpetrator’s wife, and is punishable with imprisonment of 10–20 years and a fine of 20,000–40,000 baht (approximately USD 487974).600 Indecent acts with a person under the age of 13, regardless of whether there is mutual consent, is punishable with imprisonment of up to ten years or a fine of up to 20,000 baht (approximately USD 487), or both.601 The punishment is more severe if the act is committed by using threats or violence, taking advantage of the victim’s inability to resist, or through fraud.602

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According to the Thai Department of Public Welfare, an estimated 12,000 to 18,000 children are currently engaged in prostitution.603 Some government and NGO estimates indicate that 20,000 minor girls are working as prostitutes in the country. This number includes girls aged 12–18 who have been trafficked to Thailand from Myanmar, southern China, and Laos.604 Although most commercial sex workers in the country are not imprisoned or kept under physical confinement, a large number of them work under debt bondage, a condition that affects young women in particular.605 In many such cases, parents receive a large advance from the brothel that employs their daughter against her future earnings, which creates added pressure for girls to remain in their situation. In cases of trafficking for the purpose of prostitution, the Prevention and Suppression of Prostitution Act606 and the Penal Code Amendment Act prescribe increasingly severe punishments for younger victims, with penalties being harshest for those who traffic in the youngest victims.607 Offenders who traffic in victims younger than 15 are subject to imprisonment of 10 years and a fine of 200,000–400,000 baht (approximately USD 4,871-9,743). The punishment is still more severe if the offense is committed by means of fraud, deceit, threats, violence, or undue influence or coercion. Parents who have knowledge of and participate in the commission of an offense against a minor under their care are subject to imprisonment of 4–20 years and a fine of 80,000–400,000 baht (approximately USD 1,949-9,742).608 The punishment for owners, supervisors, and managers of establishments that engage in the sex trade is more severe if they employ minors. The Prevention and Suppression of Prostitution Act also includes a statutory rape type penalty for sexual intercourse with a person aged 16–18 in a prostitution establishment, prescribing imprisonment of one to three years and a fine of 20,000–60,000 baht (approximately USD 487-1,461) for offenders. 609 The punishment is more severe if the victim is under the age of 15. 610 A recent assessment of how the Prevention and Suppression of Prostitution Act was being enforced found that, in practice, police officials tended to not report cases of minors working in prostitution establishments for fear of being charged with negligence for letting minors work as prostitutes in the first place.611

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ENDNOTES 1. See Central Intelligence Agency (CIA), U.S. Government, Thailand, in The World Factbook (2005), http://www.cia.gov/cia/publications/factbook/geos/th.html (last modified June 14, 2005). 2. See Federal Research Division, Library of Congress,Thailand: A Country Study, ch. 1, The Crisis of 1893 (Barbara Leitch LePoer ed., 1987), http://lcweb2.loc. gov/frd/cs/thtoc.html (Sept. 1987); see also Central Intelligence Agency (CIA), supra note 1. 3. Federal Research Division, Library of Congress, supra note 2, ch. 1, 1932 Coup. 4. Id. ch. 1, World War. 5. Id. 6. See Bureau of Democracy, U.S. Department of State,Thailand, Country Reports on Human Rights Practices 2004, http://www.state.gov/g/drl/rls/ hrrpt/2004/41661.htm (February 28, 2005) [hereinafter Bureau of Democracy]; see also Central Intelligence Agency (CIA), supra note 1. 7. Ministry of Foreign Affairs, General Information, http://www.mfa.go.th/ web/14.php (last visited July 7, 2005). 8. The World Bank, GenderStats, Summary Gender Profile (estimates for 2000), http://genderstats.worldbank.org/genderRpt.asp?rpt=profile&cty=THA,Thailand&h m=home (last visited July 6, 2005). 9. See Central Intelligence Agency (CIA), supra note 1. 10. See Id. 11. Wikipedia,Thailand, http://en.wikipedia.org/wiki/Thailand (last modified July 5, 2005). 12. Central Intelligence Agency (CIA), supra note 1. 13. United Nations, List of Member States, http://www.un.org/Overview/unmember.html (last modified Feb. 24, 2005). 14. Bureau of East Asian and Pacific Affairs, U.S. Department of State, Background Note:Thailand (2005), http://www.state.gov/r/pa/ei/bgn/2814.htm (Mar. 2005). 15. Id. 16. Thail. Const. §§ 2, 6. See Bureau of Democracy, supra note 6; see also Central Intelligence Agency (CIA), supra note 1. 17. See Central Intelligence Agency (CIA), supra note 1. 18. Thail. Const. § 3. 19. See Central Intelligence Agency (CIA), supra note 1. 20. Thail. Const. §§ 2, 10. 21. Id. § 3. 22. See Bureau of Democracy, supra note 6. 23. Thail. Const. § 18. 24. Id. § 201. 25. Id..§ 202. 26. Id. § 201. 27. Id. §§ 88, 201, 211–212. 28. Id. § 212. 29. Id §§ 211–212. 30. Id. § 217. 31. Id. § 12. 32. National News Bureau,The Thai Monarchy,The Privy Council of Thailand, http://www.thaimain.org/eng/monarchy/privy.html (last visited July 7, 2005). 33. Thail. Const. § 218 34. Id. §§ 221–225 35. Id. § 12. 36. Id. § 12. 37. Id. § 90. 38. Id. § 98. 39 Id. § 114. 40. Id. § 98. 41. Id. § 121. 42. Id. § 130. 43. Regional Office for South-east Asia,World Health Organization,Women of South-east Asia: A Health Profile 181 tbl.68 (2000), [hereinafter WHO,Women of South-east Asia: A Health Profile], http://w3.whosea.org/EN/Section13/Section390/Section1376_5513.htm (last modified Aug. 20, 2004). 44. Thail. Const. § 116. 45. Id. § 169. 46. Id. § 170. 47. Id. § 169. 48. Id. § 169. 49. Id. § 93. 50. Id. § 94. 51. Id. § 94. 52. Id. § 272. 53. 3 Flores, Arturo A. and Reynolds,Thomas H. , Foreign Law, Current Sources of Codes and Legislation in Jurisdictions of the World 3 (2005). 54. Id. 55. Thail. Const. § 272.

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56. Id. § 251. 57. Id. § 272 58. Id. § 273. 59. Id. §§ 255–270. See Bureau of Democracy, supra note 6. 60. Thail. Const. § 281. 61. Id. § 255. 62. Id. § 259. 63. Id. §§ 262, 264. 64. Id. § 266. 65. Id. § 196. 66. Id. § 276. 67. Flores and Reynolds, supra note 53. 68. Office of the Judiciary,The Judiciary of Thailand § 3.1.2, http://www.judiciary. go.th/eng/thejudiciary.htm#t3.1.2 (last visited July 7, 2005). 69. Id. 70. Tilleke and Gibbins,Thailand Legal Basics 4 (2005), http://www.tillekeandgibbins.com/Publications/thailand_legal_basics/thai_legal_system.pdf (Apr. 2005). 71. Human Rights Internet,The Human Rights Databank,Women Lawyers’ Association of Thailand, http://www.hri.ca/organizations/viewOrg.asp?ID=370 (last visited July 6, 2005). 72. Chulalongkorn University, Faculty of Law, http://www.law.chula.ac.th/ en/02/thailand.html (last visited July 6, 2005). 73. Vichai Ariyanontaka, Court-Annexed ADR in Thailand: A New Challenge, http://members.tripod.com/asialaw/articles/adr.htm#f7 (last visited July 6, 2005). 74. Id. 75. Id. 76. Id. 77. Thail. Const. §§ 282–285. 78. Id. § 286. 79. Id. § 285. 80. WHO,Women of South-east Asia: A Health Profile, supra note 43, at 182. 81. Id. 82. Thail. Const. § 286. 83. Id. § 287. 84. Id. § 284. 85. David Winder, Synergos Institute Series on Foundation Building in Southeast Asia, Civil Society Resource Organizations (CSROs) and Development in Southeast Asia: A Summary of Findings 13, 25 (1998), http://www.synergos.org/globalphilanthropy/98/csrosinasia.pdf (last visited July 6, 2005). 86. Id. at 14 . 87. Thail. Const. § 230. 88. Flores and Reynolds, supra note 53, at 2. 89. See Central Intelligence Agency (CIA), supra note 1. 90. Thail. Const. § 4. 91. Id. § 28. 92. Id. § 30. 93. Id. §§ 5, 30. 94. Id. § 30. 95. Id. § 31. 96. Id. § 51. 97. Id. § 39. 98. Id. § 44. 99. Id. § 45. 100. Id. § 38. 101. Id. § 34. 102. Id. § 46. 103. Id. § 52. 104. Id. § 52. 105. Id. § 52. 106. Id. § 53. 107. Id. § 80. 108. Id. § 86. 109. Id. § 199. 110. Id. § 200. 111. Act promulgating the Penal Code, B.E. 2499 (1956) (Thail.) (amended 1982); Civil and Commercial Code, B.E. 2472, (1923, 1929, 1932, 1934) (Thail.). 112. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489 (1946) (Thail.). 113. United Nations, Thailand’s 9th National Plan 2002–2006, http://www.un.or.th/ Thailand_Info/development/plan/plan.html (last visited July 7, 2005). 114. Thail. Const. §§ 193, 224. 115. Convention on the Elimination of All Forms of Discrimination against Women, adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981) (accession with reservations by Thailand Sept. 8, 1985). See also Office of the United Nations H h Commissioner for Human Rights (UNHCHR), Status of Ratifications of the Principle International Human Rights Treaties, http://www.ohchr.org/english/bodies/docs/RatificationStatus.pdf (last modified June 3, 2005).

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116. Optional Protocol to the Convention on the Elimination of Discrimination against Women, Oct. 6, 1999, G.A. Res. 54/4, U.N. GAOR, 54th Sess., U.N. Doc. A/Res/54/4 (1999) (entered into force Dec. 22, 2000) (ratified by Thailand Dec. 22, 2000). See also Office of the United Nations High Commissioner for Human Rights (UNHCHR), supra note 115. 117. Convention on the Rights of the Child, adopted Nov. 20, 1989, G.A. Res. 44/25, annex, U.N. GAOR, 44th Sess., Supp. No. 49, at 166, U.N. Doc. A/44/49 (1989), reprinted in 28 I.L.M. 1448 (entered into force Sept. 2, 1990) (accession by Thailand Apr. 26, 1992). See also Office of the United Nations High Commissioner for Human Rights (UNHCHR), supra note 115. 118. International Covenant on Economic, Social and Cultural Rights, G.A. Res. 2200A (XXI), U.N. GAOR, Supp. No. 16, at 49, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 3 (entered into force Jan. 3, 1976) (accession by Thailand Dec. 5, 1999). See also Office of the United Nations High Commissioner for Human Rights (UNHCHR), supra note 115. 119. International Convention on the Elimination of All Forms of Racial Discrimination, 660 U.N.T.S. 195 (entered into force Jan. 4. 1969 (accession with declaration by Thailand Feb. 27, 2003). See also Office of the United Nations High Commissioner for Human Rights (UNHCHR), supra note 115. 120. International Covenant on Civil and Political Rights, G.A. Res. 2200A (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, U.N. Doc A/6316 (1966), 999 U.N.T.S 171 (entered into force Mar. 23, 1976) (accession with declaration by Thailand Jan. 29, 1997); See also Office of the United Nations High Commissioner for Human Rights (UNHCHR), supra note 115. 121. Vienna Declaration and Programme of Action, World Conference on Human Rights, Vienna, Austria, June 14–25, 1993, U.N. Doc. A/CONF.157/23 (1993); Programme of Action of the International Conference on Population and Development, Cairo, Egypt, Sept. 5–13, 1994, U.N. Doc. A/CONF.171/13/Rev.1 (1995); Beijing Declaration and the Platform for Action, Fourth World Conference on Women, Beijing, China, Sept. 4–15, 1995, U.N. Doc. A/CONF.177/20 (1995); Millennium Declaration, Millennium Assembly, New York, United States, Sept. 6–8, 2000, U.N. GAOR, 55th Sess., U.N. Doc.A/Res/55/2 (2000). 122. Thail. Const. § 52. 123. Id. § 52. 124. Id. § 30. 125. Id. § 82. 126. Kana Kammakan Amnuaikan Jad Tam Pan Pattana Sukhaparb Kheang Chart Chabab Ti Kao [The Steering Committee on the Formulation of the 9th National Health Development Plan], Pan Pattana Sukhaparb Kheang Chart Nai Chuang Pan Pattana Setthakit Lae Sungkom Kheang Chart Chabab Ti Kao B.E. 2545-2549 [The National Health Development Plan under the 9th National Economic and Social Development Plan 2002–2006] (2001) [hereinafter National Health Development Plan]. 127. Id.; World Health Organization, Country Cooperation Strategy for Thailand § 2 (2003), http://www.who.int/countries/en/cooperation_strategy_tha_en.pdf (June 12, 2003) [hereinafter WHO, Country Cooperation Strategy for Thailand]. 128. National Health Development Plan, supra note 126, at 34–35. 129. Id. at 40–41. 130. Id. at 56–57. 131. Id. at i–iii. 132. WHO, Country Cooperation Strategy for Thailand, supra note 127, § 2. 133. Id. § 2.1. 134. National Health Development Plan, supra note 126, at 35. 135. Mati Karn Prachum Kana Kammakarn Patiroop Rabop Sukhaparp Hangchart, Krang Thee 1/2546 [The report of the National Health Reform Committee’s Meeting, No. 1/2003, Wed., 15 Jan. 2003, at The Meeting Room of the Office of the Permanent Secretary, Ministry of Public Health] (2003); WHO, Country Cooperation Strategy for Thailand, supra note 127, at 6. 136. Bureau of Policy and Strategy, Ministry of Public Health,Thailand Health Profile 1999–2000, at 314. (Suwit Wibulpolprasert et al. eds., 2002), http://w3.whosea. org/ehp/thfEnglish.htm (December 2002). 137. Id. 138. Id. 139. Id. 140. Id. 141. Id. at 317–319. 142. Id. at 317. 143. Id. at 318. 144. Id. 145. Id. 146. Id. 147. Id. 148. Id. 149. Id. In 2000, the ratio of staff to population at health centers was 1: 1,324. Id. at 278. 150. Id. 151. Id. at 318–319. 152. See National Health Development Plan, supra note 126, at 10. 153. Bureau of Policy and Strategy, supra note 136, at 318. 154. Id. at 318–319. 155. Id. at 319. 156. Id. 157. Id. 158. Id. at 320 tbl.6.34; See Kana Kammakarn Dan Sataranasuk Nai Rang-ngarn

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Tang Dao, Krasuang Sataranasuk [The Committee on the Health Situation of Foreign Workers, Ministry of Public Health], Sarub Sathanakarn Darn Sataranasuk Nai Rang-ngarn Tang Dao Pi Ngob Pramarn 2545 [Summary of the Health Situation of Foreign Workers in the Fiscal Year 2002], Nguad Ti Nung (Tulakhom 2544– Meenakhom 2545) [First Round, October 2001–March 2002], at 1–2 (for general information on the number of foreign workers who received outpatient or inpatient health care in 2002). 159. Bureau of Policy and Strategy, supra note 136, at 320 tbl.6.34. 160. Kasoung Satharanasuk [Ministry of Public Health], Satiti Satharanasuk B.E. 2544 [Public Health Statistics 2001] 214 tbl.4.4 (2001). This survey aimed at providing the picture of the provincial health situation, therefore, Bangkok, as the capital city, was excluded. About 979,075 persons were surveyed. 161. Id. 162. Id. 163. Id. 164. Bureau of Policy and Strategy, supra note 136, at 278. 165. Id. at 278 tbl.6.1. 166. Id. at 273 tbl.6. 167. National Health Development Plan, supra note 126, at 9. 168. Bureau of Policy and Strategy, supra note 136, at 456. 169. Id. 170. Id. at 450. 171. Id. at 318–319. 172. Id. at 318–319. 173. See Id. at 250. 174. National Health Development Plan, supra note 126, at 9. 175. Bureau of Policy and Strategy, supra note 136, at 317. 176. Kasoung Satharanasuk [Ministry of Public Health], supra note 160, at 214. 177. Id. 178. Id. 179. Bureau of Policy and Strategy, supra note 136, at 314. 180. Id. 181. Management Sciences for Health, Health Financing in Thailand: Final Integrated Report, at viii (1999), http://www.msh.org/resources/online_reports/pdf/ thaifr0.pdf (May 1999). [hereinafter, Management Sciences for Health] 182. Bureau of Policy and Strategy, supra note 136, at 322. 183. Id. 184. Management Sciences for Health, supra note 181. 185. National Health Development Plan, supra note 126, at 64. 186. Bureau of Policy and Strategy, supra note 136, at 324 tbl.6.35. 187. National Health Development Plan, supra note 126. 188. Bureau of Policy and Strategy, supra note 136, at 323. 189. Id. 190. Id. 191. Kong Wang Pan Krobkroa [Family Planning and Population Division], Krasuong Satharanasuk [Ministry of Public Health], Rai Ngaan Pra Jam Pi B.E. 2545 [Annual Report 2002], at 13–14 (2003). 192. Id. 193. WHO,Women of South-east Asia: A Health Profile, supra note 43. 194. Sumnak Ngaan Satiti Haeng Chart [National Statistical Office], Kaan Sum Ruad Anamai Lae Sawatdikaan B.E.2544 [Health and Welfare Survey 2001]; Communication with Women’s Health Advocacy Foundation (WHAF), Thailand WOW Report (draft) 7 (Oct. 6, 2003) (on file with the Center for Reproductive Rights) [hereinafter Communication with WHAF]. 195. Tangcharoensathien Virot, Nonthaburi, Sathaban Wijai Rabob Satharanasuk [Public Health System Research Institute], Rabob Prakan Sukhaparp Nai Parpruam Khong Prathetthai [The Overall Picture of the Health Insurance System in Thailand], in Rabob Prakan Sukhaparp Nai Prathetthai [The Health Insurance System in Thailand] 32 (2001) [hereinafter, Public Health System Research Institute]. 196. Bureau of Policy and Strategy, supra note 136, at 350. 197. Id. 198. Id. at 351 tbl.6.56. 199. Public Health System Research Institute, supra note 195, at 37. 200. Samnakngaan Prakan Sungkom [The Social Security Office], Chamnuan Phoo Prakanton Nai Rabob Prakansangkhom Raiduan Pi 2537-2546 [The Number of the Insured Persons in the Monthly Social Security System, 1994-2003], also available at http://www.sso.molsw.go.th/info/statistic/statisticsmid3.html; Communication with WHAF, supra note 194, at 8. 201. Samnakngaan Prakan Sungkom [The Social Security Office], Chamnuan Karn Chai Borikarn Khong Phoo Prakanton [The Number of the Insured Persons who Applied for Health Benefits], Khor Moon Na Wanthee 5 Mesayon 2546 [Information as of 5 April 2003], also available at http://www.sso.molsw.go.th/info/statistic/statisticsmid4. html; Communication with WHAF, supra note 194, at 8. 202. Rabieb Somnakngaan Prakan Sungkom Wa Duai Rai La Eiet Lae Nguen Kai Kaew Kab Kaan Rab Borikaan Tang Kaan Paet Kong Pu Prakaan Ton Rue Koo Som Rot Kong Pu Prakaan Ton B.E. 2534 [The Social Security Office’s Regulation on the Details and Conditions on the Medical Services Received by the Insured Persons or Their Spouses 1991] (May 17, 1991). 203. Pra Ratchanbunyat Prakan Sukhaparb Hangchart B.E. 2545 [The National Health Insurance Act B.E. 2545] (2002) (Thail.).

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204. Rabieb Kra Suang Satharanasuk Wa Duai Lak Pra Kaan Sukhaparb B.E.2545 [The Ministry of Public Health’s Regulation on the Health Insurance 2002], issued on 31 May 2001; Communication with WHAF, supra note 194, at 8. 205. Practice of the Art of Healing Act, B.E. 2542 (1999) (Thail.). 206. Id. § 4. 207. Id. § 32. 208. Medical Treatment Profession Act, B.E. 2525 (1982) (Thail.). 209. Nursing and Midwifery Profession Act, B.E. 2528 (1985) (Thail.); The Amendments to the Nursing and Midwifery Profession Act, B.E. 2540 (1997) (Thail.). 210. Pharmaceutic Profession Act, B.E. 2537 (1994) (Thail.). 211. Dental Treatment Profession Act, B.E. 2537 (1994) (Thail.). 212. Protection and Promotion of Traditional Thai Medicine Act, B.E. 2542 (1999) (Thail.). 213. Medical Treatment Profession Act, B.E. 2525 (1982) (Thail.). 214. Id. § 7. 215. Id. § 8. 216. Id. § 25. 217. Nursing and Midwifery Profession Act, B.E. 2528 (1985) (Thail.); The Amendments to the Nursing and Midwifery Profession Act, B.E. 2540 (1997) (Thail.). 218. Id. §§ 6–10. 219. Id. 220. Pharmaceutic Profession Act, B.E. 2537 (1994) (Thail.). 221. Practice of the Art of Healing Act, B.E. 2542, §§ 4–5 (1999) (Thail.). 222. Id. § 4. 223. Id.§ 5. 224. Krom Pattan Karnpaet Pan Thai Lae Karnpaet Tang Luak [Department for the Development of Thai Traditional and Alternative Medicine], Prawat Karn Juttang Krom Pattan Karnpaet Pan Thai Lae Karnpaet Tang Luak [History of the Establishment of the Department for the Development of Thai Traditional and Alternative Medicine], http://203.157.19.1/dtam/established.htm (last visited August 14, 2003). 225. Department for the Development of Thai Traditional and Alternative Medicine, Visaithat lae Panthaki [Vision and Commitment] available at http://203.157.19.1/dtam/ vision.htm (last visited August 14, 2003 ); Communication with WHAF, supra note 194, at 12. 226. Medical Treatment Profession Act, B.E. 2525, §§ 32–44 (1982) (Thail.). 227. Id. § 32. 228. Telephone Interview with the Ethical Official, Medical Council, by Sumalee Tokthong, Research Assistant, WHAF (Aug. 1, 2003). 229. Medical Treatment Profession Act, B.E. 2525, § 34 (1982) (Thail.). 230. Id. § 39. 231. Id. 232. Id. § 42. 233. Id. 234. Act promulgating the Penal Code, B.E. 2499, § 59 (1956) (Thail.). 235. Id. § 269. 236. Id. § 323. 237. Paetthayasapaa [The Medical Council], Kam Prakard Sitti Pu Paui [Declaration on Patients’ Rights], http://www.tmc.or.th/hones/40.html (last visited July 17, 2003); Communication with WHAF, supra note 194, at 19. 238. Family Planning and Population Division, Ministry of Public Health, Thailand National Family Planning Programme 19 (1998) [hereinafter Thailand National Family Planning Programme]. 239. See Reproductive Health Division, Ministry of Public Health,Thailand Reproductive Health Profile 6 (2003), http://209.61.208.100/LinkFiles/Reproductive_Health_Profile_completebook.pdf [hereinafter, Reproductive Health Division]. 240. Kong Wang Pan Krobkroa [Family Planning and Population Division], supra note 191, at 12. 241. Thailand National Family Planning Programme, supra note 238, at 19–20. 242. Id. at 20. 243. Id. at 21. 244. Kot Krasuang Baeng Suan Ratchakaan Krom Anamai [Ministerial Regulations on the Department of Health’s Organizational Structure], Krasuang Satharanasuk [Ministry of Public Health], B.E. 2545 (2002). 245. Rai Ngaan Kaan Summanar Ruang Sitti Anamai Jarearnpan Lae Sukhaparb Puuying [Proceedings of a seminar on Reproductive Rights and Women’s Health], organized by the Subcommittee on Reproductive Health and Rights of the Parliamentary Commission on Public Health, Division of Family Planning and Population, Ministry of Public Health, Health System Reform Office, Women’s Health Advocacy Foundation, Women and Constitution Network, and the Population Council, August 26, 2002, Bangkok. (Unpublished report); Communication with WHAF, supra note 194, at 19. 246. Medical Council, Announcement No.1/2540 on the Standards of Services Concerning Reproductive Health Technology, Royal Gazette, General Announcements. No. 114, Special Section, 123 Ngor (Dec. 26, 1997). 247. Virutamasen P, Pruksananonda K, Limpaphayom K, Chokevivat V, Kunaratanapruk S., The regulation of assisted reproductive technology in Thailand, 2001 J Med Assoc Thai 84(10) at 1492. 248. Chulalongkorn University,WHO Collaborating Center for Research in Human Reproduction, http://www.chula.ac.th/international/who_en.html (last visited July 21, 2004). 249. Id.

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250. Id. 251. Reproductive Health Division, supra note 239, § 2, at 7. 252. World Health Organization Regional Office for South-East Asia,Thailand and Family Planning: An Overview [hereinafter WHO,Thailand and Family Planning: An Overview], http://w3.whosea.org/LinkFiles/Family_Planning_Fact_Sheets_thailand.pdf (last visited June 27, 2005). 253. Thailand National Family Planning Programme, supra note 238, at 11. 254. Samnak Ngaan Songserm Sukhapaap [Bureau of Health Promotion], Krasuang Satharanasul [Ministry of Public Health], Kaan Pramern Pon Ngaan Songserm Sukhapaap Nai Pan Pattana Sethakit Lae Sungkhom Hang Chaat Chabub Thee Paed: Ngaan Songserm Sukhapaap Satree Wai Charern Pun [Evaluation of Health Promotion During the Eighth National Economic and Social Development Plan: Health Promotion for Women at Fertility Age] 42 (2001). [hereinafter Bureau of Health Promotion] Other regional percentages were the central region (80.5%) and the northeastern region (78.5%). Id. 255. Thailand National Family Planning Programme, supra note 238, at 12. 256. See Reproductive Health Division, supra note 239, at 14 tbl.5. 257. Bureau of Health Promotion, supra note 254, at 44. 258. Id. 259. Id. 260. Id.; Bureau of Policy and Strategy, supra note 136, at 391. 261. Krom Anamai [Department of Health], Krasuang Satharanasuk [Ministry of Public Health], Jaumnuan Phoo Rub Borikaan Wang Paen Krobkrua Rai Mai Doi Karn Thammun Por Sor 2540–2543 [Number of New Persons who Obtained Family Planning Services by Sterilization, 1997–2000]. 262. Id. 263. Id. 264. Id. 265. Nattaya Boonpakdee & Dusita Phuengsamran, Community-based Census on Pregnancy History of Women in Two Communities in Thailand (2002) (on file with the Center for Reproductive Rights). 266. Communication with WHAF, supra note 194, at 20. (information provided by Thai state officer overseeing reporting system within the Ministry of Public Health) (on file with the Center for Reproductive Rights). 267. Ministry of Public Health, Ministerial Order No.349/2543 on Abolishing Registered Drugs (May 27, 1991). 268. Ministry of Public Health, Announcement No.11 on Condom (1992). 269. Id.; Medical Device Act; Communication with WHAF, supra note 194, at 20. 270. Drug Act B.E. 2510, §§ 6–11 (1967). 271. Division of Family Planning and Population, Ministry of Public Health, Services and Counseling on Emergency Birth Control: Handbook for Health Provider (1999). 272. Ministry of Public Health, Ministerial Order No. 1037/2543 on the Alteration to Registered Birth Control Pills with Progestogen High Dose, Royal Gazette Item 117, Special section 132d (Dec. 27, 2000). 273. Id. 274. Ministry of Public Health, Announcement on Types of Medicines Required to Provide Indications for Uses (May 26, 1978). 275. The Ministry of Public Health’s Regulation on Persons whom the Ministry, Departments Concerned, Bangkok Metropolitan Administration, Pattaya District, Provincial Administrative Organizations, Municipalities, Sanitary (Sukhaphibal) Units, Other Local Administrative Organizations, or the Thai Red Cross, assign to work under the control of officers who work as medical practitioners, B.E.2539 (1996), Article 11; Communication with WHAF, supra note 194, at 29. 276. Ekasaan Kun Torn Nai Kaan Tidtor Pua Kaan Tham Mun Hang [The Procedures on the Application for Tubal Ligation], Ekasaan Jaek Na Rongpayabaan Siriraj [Documents distributed at the Siriraj Hospital], obtained on July 20, 2003. 277. Labour Protection Act, B.E. 2541, § 33 (1998) (Thail.). 278. Id. 279. Interview with Officials of the Reproductive Health Division, Ministry of Public Health, by Sumalee Tokthong, Assistant Researcher, WHAF (July 21, 2003). 280. Interview with an obstetrician of a private hospital at Nakorn Sawan Province by Nattaya Boonpakdee, author, 19 July 2003; Communication with WHAF, supra note 194, at 29. 281. Ministry of Public Health, 2000, at 268-269; Communication with WHAF, supra note 194, at 19. 282. Thailand National Family Planning Programme, supra note 238, at 38. 283. WHO,Thailand and Family Planning: An Overview, supra note 252. 284. See Reproductive Health Division, supra note 239, at 15 tbl.6. 285. Rabieb Kra Suang Satharanasuk Wa Duai Lak Pra Kaan Sukhaparb B.E.2545 [The Ministry of Public Health’s Regulation on the Health Insurance 2002], issued on 31 May 2001; Communication with WHAF, supra note 194, at 8-9. 286. Notification of the Social Security Office on the Criteria and Ratio for Compensation in the case of encountering danger or illness not resulting from work dated, October 14, 1996, Chapter 1: Medical Service Payment to Health Centre; Communication with WHAF, supra note 194, at 29. 287. Regulation of the Ministry of Public Health on the Universal Health Coverage, B.E. 2545. Chapter 4 : Criteria and Condition in Receiving Medical Services, Article 20; Communication with WHAF, supra note 194, at 29.

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288. Division of Civil Registration, Department of Local Administration, Ministry of Interior at 43; Bureau of Policy and Strategy, supra note 136; Communication with WHAF, supra note 194, at 20. 289. Siripon Kanshana, National Reproductive Health Profile,Thailand 70 (1999). 290. Management Sciences for Health, Bringing Services to Hard to Reach Populations,Working Solutions—Thailand, http://erc.msh.org/mainpage. cfm?file=2.2.3o.htm&module=chs&language=English (last visited June 27, 2005). 291. Chaninat Varothai,Women’s Health and Development: Country Profile, Thailand, Module C, C.7(b)(v) (1998), http://www.journ.freeserve.co.uk/thai/thai11. html (last modified Feb. 10, 2001). 292. Reproductive Health Division, supra note 239, at 91. 293. Maternal and Child Health Subdivision, Ministry of Public Health, http://www. anamai.moph.go.th/hp/download/situa.pdf (last visited June 30, 2005). 294. Id. 295. Public Health System Research Institute, supra note 195, at 37–38. 296. WHO, Country Cooperation Strategy for Thailand, supra note 127, § 2.1. 297. Id. 298. Reproductive Health Division, supra note 239, at 26. 299. Id. 300. See Suwanna Warakamin & Mukda Takrudtong, Reproductive Health in Thailand: An Overview, Factsheet, 1 Fam. Plan. and Population (1998), www.anamai.moph.go.th/factsheet/health1-6_en.htm (Mar. 1998); Mukda Takrudtong, Reproductive Health in Thailand: Issues of Interest, Factsheet, 1 Fam. Plan. and Population (1998), www.anamai.moph. go.th/factsheet/health1-11.htm (Aug. 1998). 301. Samnak Songserm Sukhpaap [Bureau of Health Promotion], Krom Anamai [Department of Health], Krasuang Satharanasuk [Ministry of Public Health], Rai Ngaan Rueng Kaan Fao Rawang Sukhapaap Ying Mee Kan [Report on the Surveillance of Pregnant Women’s Health], Ekasaan Prakorb Kaan Prachum Wethee Senthang Louk Rak [Document used in the Meeting on The Path of Our Beloved Children], 5-6 August 2002, Bangkok, unpublished report [hereinafter Report on the Surveillance of Pregnant Women’s Health ]; Communication with WHAF, supra note 194, at 22-23. 302. Report on the Surveillance of Pregnant Women’s Health; Communication with WHAF, supra note 194, at 23. 303. Reproductive Health Division, supra note 239, at 29. 304. Bureau of Policy and Strategy, supra note 136, at 384. 305. Report on the Surveillance of Pregnant Women’s Health; Communication with WHAF, supra note 194, at 23. 306. The Criminal Procedure Code, B.E.2477 (1934), Book 6: Enforcement of the Court Judgments and Court Fees; Title 1: Enforcement of the Court Judgments; Section 246; Communication with WHAF, supra note 194, at 23. 307. Id. 308. The Corrections Act B.E.2479 (1936), amended in B.E. 2523 (1980), Section 29: Sick or pregnant inmates have to be provided with medical treatment as appropriate; and the Ministry of Interior’s Order, issued in compliance with Section 58 of the Corrections Act (1936), Chapter 3: Medical Treatment, No. 74: Inmates who are pregnant or mothers with young infants are to be considered sick persons; Communication with WHAF, supra note 194, at 23. 309. Richard Heaver & Yongyout Kachondam, Health, Nutrition and Population Discussion Paper,Thailand’s National Nutrition Program: Lessons in Management and Capacity Development 4–6 (2002), http://siteresources.worldbank. org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/ Heaver-ThailandsNational-whole.pdf (Jan. 2002). 310. Id. 311. Id. at 35. 312. See Suttilak Smitasiri & Sakorn Dhanamitta, International Center for Research on Women, Sustaining Behavior Micronutrient Status: Communityand Women-Based Interventions in Thailand (1999), http://www.dec.org/pdf_ docs/PNACH760.pdf (Mar. 1999); Heaver & Kachondam, supra note 309, at 35. 313. Id. 314. Heaver & Kachondam, supra note 309, at 36. 315. 3 Population Division, United Nations, Abortion Policies: A Global Review 125. (2002). 316. Worakamin, Suwanna & Nongluk Boonthai, Sarup Phon Kaan Samruad Sathanankaan Thamthang Nai Prathetthai Por Sor 2542 [Summary of the Survey on Abortion in Thailand, 1999] Ekasaan Prakorb Kaan Prachum Rueng Panha Kaan Yuti Kaan Tangkan [Document presented in the Meeting on the Problems of the Termination of Pregnancy], 6 August 2001, Bangkok, at 6-8; Communication with WHAF, supra note 194, at 24-25. 317. Id. 318. Nattaya Boonpakdee & Dusita Phuengsamran, supra note 265. 319. 3 Population Division, United Nations, supra note 315, at 125. 320. Id. 321. Id. 322. Act promulgating the Penal Code, B.E. 2499, §§ 301–305 (1956) (Thail.). 323. Id. § 305(1)–(2). (the exception for rape also extends to other sexual offenses); 3 Population Division, United Nations, supra note 315, at 124. Women’s health in this context is generally considered only physical health. 66 Reproductive Health Division, supra note 239, at 66. 324. Varothai, supra note 291. 325. Act promulgating the Penal Code, B.E. 2499, §§ 301–305 (1956) (Thail.).

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326. Id. § 301. 327. Id. § 302. 328. Id. § 303. 329. Id. §§ 302–303. When the abortion is performed with the woman’s consent and it causes grievous bodily harm to the woman, the party is liable to imprisonment of up to seven years or a fine of up to 14,000 baht, or both. Id. § 302. In case of death of the woman, the penalty is imprisonment of up to 10 years and a fine of up to 20,000 baht. Id. § 302. When the abortion is performed without the woman’s consent and it causes grievous bodily harm to the woman, the party is liable to imprisonment of one to ten years and a fine of 2,000–20,000 baht. Id. § 303. In case of death of the woman, the penalty is imprisonment of five to twenty years and a fine of 10,000–40,000 baht. Id. § 303. 330. Id.§ 304. 331. Ungprapan, Witoon, Nitiwet Sathok Chabub Kotmai Thamthang: Khor Toyang Thee Yang Mai Yutti [Discourses on Abortion from a Legal Jurisprudence Point of View: An Unfinished Debate], Bangkok, Gender Press, 1994, at 94-102; Communication with Women’s Health Advocacy Foundation (WHAF), Thailand WOW Report (draft) 26 (Oct. 6, 2003) (on file with the Center for Reproductive Rights). 332. Civil and Commercial Code, B.E. 2466, bk. I, § 15 (1923) (amended 1992) (Thail.). 333. Somparn Promtha, Buddhasasan Kub Panha Chariyasaat Sopenee Thamthang Lae Karunyakaat [Buddhism and Ethical Problems: Prostitution, Abortion and Mercy Killings] 97 (1999). 334. Id. at 111. 335. Id. In view of Buddhism, there is a necessary evil for the sake of one’s survival and common good. The necessary evil is considered a sin but the degree of sin varies with one’s intent and its consequential punishment by the Law of Karma is light, should it be conducted unintentionally. Id. 336. Thalangkaan Sapaa Pra Sungkarat Catholic Hang Prathethai Rueng Kaan Thamthang [Announcement of the Council of the Catholic Bishops in Thailand on Abortion] 6 (Aug. 3, 1979). 337. Id. 338. Id.; The Statute of the Church at the Present Time, 51; Communication with WHAF, supra note 194, at 26. 339. Krom Anamai [Department of Health],Tua Cheewat Lae Paomai Krom Anamai Nai Paen Pattana Sukhpaap Chabub Thee 9 (Por Sor 2545–2549) [Indicators and Goals of the Department of Health in the 9th National Health Development Plan (2002–2006)]. 340. Paetthayasapaa [The Medical Council], Naew Thang Kaan Hai Borikaan Thang Sutisart Lai Naree Wittaya [Guidelines on the Provision of Obstetric and Gynecological Services]. 341. Id. 342. Act promulgating the Penal Code, B.E. 2499, § 323 (1956) (Thail.). 343. Drug Act B.E. 2510, § 88(4) (1967). 344. Id.§ 88 345. Reproductive Health Division, supra note 239, at 66. 346. Act promulgating the Penal Code, B.E. 2499, § 305 (1956) (Thail.). 347. Communication with WHAF, supra note 194, at 27. 348. Soon Khor Moon Thang Rabaad Wittaya [Epidemiological Information Center], Samnak Rabaad Wittaya [Office of Epidemiology], Krom Kuabkhum Roke [Disease Control Department], Krasuang Satharanasuk [Ministry of Public Health], Satahnakaan Phoo Puay Roke AIDS Lae Phoo Tid Chua Thee Mee Akaan Nai Prathetthai [The situation of AIDS patients and symptomatic HIV infected persons] (July 31, 2003), http://epid.moph.go.th/epi32aids.html (last visited Aug. 11, 2003). 349. AIDS Division, Bureau of AIDS,Tuberculosis and Sexual Transmitted Diseases, Department of Disease Control, Ministry of Public Health,Tung Yang Anamai [Condom], http://www.aidsthai.org/condom01.html (last visited June 30, 2005). 350. Klum Rok AIDS [AIDS Division], Bureau of AIDS,Tuberculosis and Sexual Transmitted Diseases, Department of Disease Control, Ministry of Public Health, Sathanakaan Poo Tid Chua AIDS Lae Poo Puay AIDS Nai Muang Thai [The situation of HIV infected persons and AIDS patients in Thailand], http:// www.aidsthai.org/sathana.html (last visited June 30, 2005). 351. Id. 352. WHO, Country Cooperation Strategy for Thailand, supra note 127, § 2.1. 353. Id. 354. Tung Yang Anamai [Condom], supra note 349. 355. Thail. Const. § 30. 356. Communication with WHAF, supra note 194, at 31. 357. The Royal Thai Government, Thailand Country Report 2002, Prepared for the 5th Asian and Pacific Population Conference, Bangkok, 11-17 December 2002, at 13; Communication with WHAF, supra note 194, at 33. 358. The Department of Labor Welfare and Protection’s Regulation on the Administration of Welfare Benefits for HIV-infected Workers and Families B.E. 2538, ch. 3, art. 9 (Dec. 1, 1995). 359. Instruction on the Implementation of AIDS Prevention and Control for Local Administrative Organizations prepared by the Committee on Community Enhancement and AIDS Control, September 1998, at 75; Communication with WHAF, supra note 194, at 31. 360. Kong Kama Roke [Venereal Diseases Division], Krom Kuabkhum Roke [Disease Control Department], Krasuang Satharanasuk [Ministry of Public Health], Prawat Lae Wiwattanakaan Ngaan Kuabkhum Kamaroke Nai Prathetthai [History and Develop-

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ment of Sexually Transmitted Diseases Control in Thailand], 2002, at 115; Communication with WHAF, supra note 194, at 33. 361. National AIDS Prevention and Alleviation Committee, Ministry of Public Health, National Plan for the Prevention and Alleviation of HIV/AIDS in Thailand 2002–2006, at 8 (2001), http://www.aidsthai.org/download/PlanAIDS02061. doc (Nov. 2001). 362. Id. at 9. 363. Id. at 10. 364. Id. at 14. 365. Id. 366. Kritaya Archavanitkul, Kabuankaan Thang Sungkhom Bon Miti Kaan Muang Rueng Pate Lae Rangkai Phooying [Sexuality and Body Politics in the Thai Women’s Movement], in Withee Cheewit Withee Soo Khabuankaan Prachachon Ruam Samai [The Ways of Life; the Ways to Fight:The Contemporary Thai People’s Movement] 14 (Pongpaijit Lae Khana ed.). 367. Id. 368. Id. 369. Krom Anamai [Department of Health], Nayabai Kaan Damnern Ngaan Pongkun Khuabkhum Roke Prajum Pee 2546 [The 2003 Policy on the Implementation of Disease Prevention and Control], Nangsue Ratchakaan Wian [An Official Circular] (Dec. 26, 2002). 370. Department of Local Administration, supra note 288; Communication with WHAF, supra note 194, at 55. 371. Communication with WHAF, supra note 194, at 55. 372. Id. 373. Id. 374. Suan Anamai Dek Wai Rian Lae Yaowachon [School-age Children and Youth Section], Samnak Songserm Sukhapaap [Bureau of Health Promotion], Krom Anamai [Department of Health], Krasuang Satharanasuk [Ministry of Public Health], B.E.2545 (2002); Communication with WHAF, supra note 194, at 55. 375. Saroj Pachauri & K.G. Santhya, Contraceptive behaviours of adolescents in Asia: issues and challenges, in Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia 110 (Sarah Bott et al. eds., 2003), http://www. who.int/reproductive-health/publications/towards_adulthood/towards_adultwood.pdf (last visited June 29, 2005). 376. I. Pimonpan (2000), “Sexual attitudes and Experience of Rural Thai Youth” (Bangkok, Institute for Populations and Social Research, Mahidol University). 377. Saroj Pachauri & K.G. Santhya, Contraceptive behaviours of adolescents in Asia: issues and challenges, in Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia 110 fig.1–2 (Sarah Bott et al. eds., 2003), http:// www.who.int/reproductive-health/publications/towards_adulthood/towards_adultwood.pdf (last visited June 29, 2005). 378. Pimonpan (2000), supra note 376. 379. Id. 380. Alan Gray & Srisuman Sartsara, Communication and advocacy strategies, adolescent reproductive and sexual health–Case Study Thailand 4 (1999). 381. Id. at 6. 382. Id. at 4–5. 383. Department of Local Administration, Ministry of Interior, compiled by Statistical Forecasting Bureau, National Statistical Office, May 2003; Communication with WHAF, supra note 194, at 55. 384. Id. 385. Family Planning and Population Division, Ministry of Public Health, Survey on Abortion in Thailand, Document Presented at the Meeting on the Problems of Termination of Pregnancy 7 (Aug. 6, 2001). 386. Id. 387. Id. 388. Kloom Roke AIDS [AIDS Division], Samnak Roke AIDS Wanna Roke Lae Roke Tidtor Thang Petsampan [AIDS,Tuberculosis and STIs Bureau], Krom Kaubkhum Roke [Department of Disease Control], Krasuang Satharanasuk [Ministry Of Public Health],Wikror Sathanakaan Phoo Tid Chua AIDS Lae Phoo Puay AIDS Nai Prathetthai [Analysis of the HIV infected Persons and AIDS Patients in Thailand] (Nov. 30, 2002). 389. Warakamin & Takrudtong, supra note 300, at 8. 390. Thail. Const. § 53. 391. Id. § 80. 392. Thailand National Family Planning Programme, supra note 238, at 20. 393. Paetthayasapaa [The Medical Council], supra note 340. 394. Id. 395. Kong Wang Pan Krobkroa [Family Planning and Population Division], supra note 191, at 5. 396. Id. at 7. 397. Naew Thang Kaan Damnern Ngaan Khon Krom Anamai Pee 2546 [Department of Health’s Operational Strategies in 2003] available at http://www.anamai.moph.go.th/ trend46.htm, last visited August 12, 2003; Communication with WHAF, supra note 194, at 56. 398. Id. at 56–57. 399. Thailand National Family Planning Programme, supra note 238, at 8. 400. Id. 401. Pardthaisong,Tieng, Kaan Lom Salai Kong Sung Kom Thai Jaak Kaan Wang

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Pan Krob Krua [The Ruin of the Thai Society due to Family Planning] 47–48 (1996). 402. Economic Planning Unit, Government of Malaysia, Eighth Malaysia Plan 2001–2005, (2001). 403. Thailand National Family Planning Programme, supra note 238, at 19–20. 404. Ministry of Foreign Affairs, supra note 7. 405. Samnak Ngaan Sathiti Haeng Chaat [The National Statistical Office], Sathiti Prachakorn Lae Kaan Keha [Population and Residential Statistics], http://www.nso.go.th/thai/stat/stat_23/toc_1.html (last visited June 30, 2005). 406. Communication with WHAF, supra note 194, at 17. 407. Malee Lerdmaleewong & Caroline Francis, Abortion in Thailand: a Feminist Perspective, in 5 Journal of Buddist Ethics 23, 43 n.3 (1998), http://jbe.gold.ac.uk/5/aborti1.pdf (last visited June 29, 2005). 408. Id. 409. Bureau of Health Promotion, supra note 254, at 42, 44. 410. Royal Proclamation on the Ninth National Development Plan (B.E. 2545–2549), B.E. 2544, Promulgated in the Royal Gazette, No.118, Special Section, 99 Ngor (2001). 411. Id. 412. Bureau of Health Promotion, supra note 254, at 3. 413. Id. at 10. 414. Id. at 11. 415. Chanpen Chooprapawan, Sukhapaap Khonthai Pee Por Sor 2543 [Thai People’s Health in the year 2000]: Sathana Sukhapaap Khonthai [The Situation of Thai People’s Health] 289. 416. Id. at.5–18. 417. Ministerial regulation on restructuring the Office of the National Social and Economic Development Board, the Office of the Prime Minister, B.E.2545 (2002), October 9th, 2002; Communication with WHAF, supra note 194, at 16. 418. Thailand National Family Planning Programme, supra note 238, at 38. 419. Bot Baat Nathee Khong Soon Anamai Puenthee Soong [Roles and Duties of the Highland Health Promotion Center], also available at http://www.anamai.moph.go.th/ fphc/Role.htm; Communication with WHAF, supra note 194, at 16. 420. Thail. Const. § 30. 421. Id.§ 30. 422. Id.§ 80. 423. Labour Protection Act, B.E. 2541, § 15 (1998) (Thail.). 424. See Civil and Commercial Code, B.E. 2477, bk. V (1934) (amended 1976) (Thail.). 425. The Penal Code Amendment Act, No. 14, B.E. 2540 (1997) (Thail.). 426. The Regulation of the Prime Minister’s Office on Women’s Affairs and Family Development, B.E. 2546 (2003). 427. Id. § 9. 428. Id. § 5. 429. Id. 430. Id. § 9. 431. Id. 432. Communication with WHAF, supra note 194, at 35. 433. Rights and Liberties Protection Department, Ministry of Justice, http:// www.rlpd.moj.go.th (last visited July 1, 2005). 434. This is the Safeguard Division of the Rights and Liberties department. 435. National Human Rights Commission Act, B.E. 2542 (1999) (Thail.). 436. Thail. Const. § 200. National Human Rights Commission Act, B.E. 2542 § 15 (1999) (Thail.). 437. Saneh Chamarik,The Role of National Human Rights Commission,Thailand (2002) (presented at the Conference on National and Regional Systems for the Promotion and Protection of Human Rights, organized by the Friedrich Naumann Stiftung, Strasbourg, France, October 7–11, 2002). 438. Second and third periodic reports of States parties: Thailand, U.N. Committee on the Elimination of Discrimination Against Women, para. 141, U.N. Doc. CEDAW/C/ THA/2-3 (1997). 439. Mulitplecitizenship, Thailand, http://www.multiplecitizenship.com/wscl/ws_ Thailand.html (last viewed July 27, 2004). Site no longer available. 440. Second and third periodic reports of States parties: Thailand, U.N. Committee on the Elimination of Discrimination Against Women, para. 138, U.N. Doc. CEDAW/C/ THA/2-3 (1997). 441. Physicians for Human Rights, No Status: Migration,Trafficking and Exploitation of Women in Thailand, Health and HIV/AIDS Risks for Burmese and Hill Tribe Women and Girls 27 (2004), http://www.phrusa.org/campaigns/aids/ pdf/nostatus.pdf (June 2004). 442. Id. 443. Id. 444. Civil and Commercial Code, B.E. 2477, bk. V (1934) (amended 1976) (Thail.). See also The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489 (1946) (Thail.). 445. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489 (1946) (Thail.). 446. Id. 447. Civil and Commercial Code, B.E. 2477, bk. V, § 1458 (1934) (amended 1976) (Thail.). 448. Id. §§ 1448, 1454, 1456. 449. Id. §§ 1450–1451. 450. Id. § 1452. 451. Act promulgating the Penal Code, B.E. 2499, § 137 (1956) (Thail.).

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452. Civil and Commercial Code, B.E. 2477, bk. V, § 1453 (1934) (amended 1976) (Thail.). 453. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489, § 22 (1946) (Thail.); Civil and Commercial Code, B.E. 2477, bk. V, tit. 1, ch. 2 (1934) (amended 1976) (Thail.). 454. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489 (1946) (Thail.). 455. Id. § 2(4). 456. Id. bk. 1, tit. 1, ch. 2. 457. Id.§ 53. 458. Id. bk. 1, tit. 1, ch. 3, § 49(1). 459. Civil and Commercial Code, B.E. 2477, bk. V, § 1514 (1934) (amended 1976) (Thail.). 460. Id, § 1516(1). 461. Id. 462. Id. § 1516(2)–(4/1), (5)–(10). 463. Id. § 1516(4/2). 464. Id. § 1526 (1934) (amended 1976) (Thail.). 465. Id. § 1598/39 (1934) (amended 1976) (Thail.). 466. Id. § 1598/38 (1934) (amended 1976) (Thail.). 467. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489, bk. 1, tit. 3, ch. 2 (1946) (Thail.). 468. Id. ch. 3. 469. Id. ch. 4. 470. Id. ch. 5. Gross misconduct that may serve as a ground for divorce includes cases where the husband has a sexual relationship with the mother of the wife, or a step child who was born of the wife; or the husband has many wives and one of the wives sucks milk from the breasts of another wife. 471. Id. ch. 4, § 163. 472. Civil and Commercial Code, B.E. 2477, bk. V, § 1520 (1934) (amended 1976) (Thail.). 473. Id. § 1598/38. 474. Id. § 1546. 475. Id. § 1547. 476. Id. § 1539. 477. Id. § 1539. 478. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489, bk. 1 (1946) (Thail.) 479. Id. tit. 3, ch. 4, § 118. 480. Id. tit. 3, ch. 4, § 120. 481. Id. tit. 3, ch. 4, § 121. 482. Thail. Const. § 48. 483. Id. § 49. 484. Civil and Commercial Code, B.E. 2475, bk. 4 (1932) (Thail.). 485. Id.; Civil and Commercial Code, B.E. 2477, bk. V, §§ 1465–1493 (1934) (amended 1976) (Thail.). 486. The Civil and Commercial Code, B.E. 2477, bk. 6, § 1599 (1935). 487. Id. § 1635. 488. Id. 489. Id. § 1636. 490. Id. 491. The Act on the Application of the Islamic Law in Pattani, Narathiwat, Yala, and Satoon, B.E. 2489, bk. 1, tit. 1, ch. 1, § 28 (1946) (Thail.). 492. Thail. Const. § 84. 493. The World Bank, supra note 8. 494. Id. 495. Id.; Bureau of Democracy, supra note 6. 496. Thail. Const. § 86. 497. Labour Protection Act, B.E. 2541, § 15 (1998) (Thail.). 498. Id. §§ 15, 43. 499. Id. § 146. 500. Id. § 144. 501. Id. § 41. 502. Id. §§ 58–59. 503. The Social Security Act, B.E. 2533, § 67 (1990) (amended 1994) (Thail.). 504. Id. § 65. 505. Id.; Communication with WHAF, supra note 194, at 44. 506. The Social Security Act, B.E. 2533, § 74 (1990) (amended 1994) (Thail.); Communication with WHAF, supra note 194, at 44. 507. The Social Security Act, B.E. 2533, § 75 (1990) (amended 1994) (Thail.); Communication with WHAF, supra note 194, at 44. 508. Id. 509. Labour Protection Act, B.E. 2541, § 39 (1998) (Thail.). 510. Id. § 42. 511. Id. § 144. 512. Id. § 38. 513. Civil and Commercial Code, B.E. 2472, bk. III, §§ 650–656 (1929) (Thail.). 514. Civil and Commercial Code, B.E. 2477, bk. V, § 1476 (1934) (amended 1976) (Thail.). 515. Amara Pongsapit & Wimolsiri Chamnanwej, Rai Ngaan Sathanapaab Satree Thai Thang Kotmai Lae Sangkhom [Report on Thai Women’s Legal and Social Status] 4, http://www:thaiwomen.net/tncwa/html/html_special_th/special_2.htm, (last visited August 8, 2003). Site no longer available. 516. Asian Development Bank, Country Assistance Plan (2001–2003), Thailand § 113

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(2000), http://www.adb.org/Documents/CAPs/tha.pdf (Dec. 2000); See Barbara Crosstte, Experts Question Wisdom of Micro-credit for Women, Women’s Enews, Mar. 30, 2003, http://www.womensenews.org/article.cfm/dyn/aid/1239/context/cover/. 517. Khana Kammakaan Songserm Lae Prasanngaan Satree Hang Chaat [The National Commission on Women’s Affairs], Samnak Nayok Rathamontree [The Prime Minister’s Office], Pan Pattana Satree Nai Chuang Pan Pattana Sethakit Lae Sangkhom Hang Chaat Chabub Thee 9 (B.E. 2545–2549) [The Women’s Development Plan under the 9th National Economic and Social Development Plan (2002–2006)], at 6. 518. Id. 519. Id. 520. Communication with WHAF, supra note 194, at 58. 521. Id. 522. Id. 523. Khana Kammakaan Songserm Lae Prasanngaan Satree Hang Chaat [The National Commission on Women’s Affairs], supra note 517, at 6. 524. Id. 525. Thail. Const. § 43. 526. Id. § 81. 527. The National Education Act, B.E. 2542, § 10 (1999) (Thail.). 528. The Compulsory Education Act, B.E. 2545, § 4 (2002) (Thail.). 529. Id. § 6. 530. Id. § 4. 531. Id. 532. Gray & Sartsara, supra note 380, at 4. 533. Id., “Sexual relations among young people in developing countries: Evidence from WHO case studies,” WHO/RHR/01.8. 1: Demographic Characteristics. Section E: STDs/HIV/AIDS. Page 4. 534. Id. at 6. 535. Id. 536. Id. 537. Id. at 6–7. 538. Thailand National Family Planning Programme, supra note 238, at 20. 539. Communication with WHAF, supra note 194, at 59. 540. Id. 541. Id. 542. Act promulgating the Penal Code, B.E. 2499, § 276 (1956) (Thail.) (amended 1997). 543. Id. § 276. 544. Id. § 277 bis. (1)–(2). 545. Id. § 277. 546. Id. § 276. However, the Civil and Commerical Code prohibits the marriage between man and woman who are blood relations. Civil and Commercial Code, B.E. 2477, bk. V, § 1450 (1934) (amended 1976) (Thail.). 547. Act promulgating the Penal Code, B.E. 2499, § 285 (1956) (Thail.) (amended 1997). 548. Bureau of Democracy, supra note 6. 549. Institute for Population and Social Research, Mahidol University & Foundation for Women, Fact Sheet on Intimate Partner Violence in Thailand (2003). 550. Id. 551. Ava Vivian Gonzalez, Home is Where the Hurt is, Women in Action (2001), http:// www.isiswomen.org/pub/wia/wia101/hurt.html (last visited July 1, 2005) [hereinafter Home is Where the Hurt Is]. 552. Thail. Const. § 53. 553. Act promulgating the Penal Code, B.E. 2499, §§ 276–287 (1956) (Thail.) (amended 1982). 554. Child Protection Act, B.E. 2543, § 398 (2004) (Thail.); Act promulgating the Penal Code, B.E. 2499, § 398 (1956) (Thail.) (amended 1982). 555. Pramuan Rabiab Kaan Tamruat [Compilation of the Police Procedures], Paak Thee Nung Rabiab Kaan Tamruat Kiew Kab Khadee [Part 1:The Police Procedures on Offences] tit. 1, ch. 2 art. 3(2). 556. Police Major-General Thawee Tatayanond, Rabiab Kaan Tamruat Kiew Kab Khadee Thee Prupprung Mai [The Revised Police Procedures on Offences], B.E. 2540 (1997). 557. Id., at 638. 558. Supra note 551. 559. Bureau of Democracy, supra note 6. 560. Khana Kammakaan Songserm Lae Prasanngaan Satree Hang Chaat [The National Commission on Women’s Affairs], Samnak Palad Samnak Nayok Rathamontree [Office of the Permanent Secretary of the Prime Minister’s Office], Nayobai Lae Pan Khajud Kwam Roonrang Tor Dek Lae Satree [Policy and Plan on the Elimination of Violence against Children and Women] (2002); Communication with WHAF, supra note 194, at 59. 561. Id. at 18. 562. Id. at 18–19. 563. Khana Kammakaan Songserm Lae Prasanngaan Satree Hang Chaat [The National Commission on Women’s Affairs], supra note 517. 564. Labour Protection Act, B.E. 2541, § 16 (1998) (Thail.). 565. Id. § 147 (1998) (Thail.). 566. Act promulgating the Penal Code, B.E. 2499, §§ 278–279 (1956) (Thail.). 567. Rabiab Krasuang Suksathikaan Wa Duay Kaan Songserm Lae Khumkrong Sitthi Dek Lae Yaowachon Doi Sathansuksa B.E. 2543 [The Ministry of Educa-

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tion’s Regulation on the Promotion and Protection of the Rights of children and Youth by Educational Institutions 2000] art. 16 (2000). 568. Ministry of Education, Announcements on Measures on the Prevention of Sexual Harassment against Pupils and Students (Sept. 10, 2001); Ministry of Education, Announcements on Procedures to be Taken in the Cases of Sexual Harassment against Pupils and Students by Educational Personnel (Dec. 3, 2001); Ministry of Education, Announcements on the Policy, Measures and Guidelines on the Prevention and Solutions of the Problems of Sexual Harassment and Prostitution of Pupils and Children (Oct. 15, 2002). 569. Ministry of Education, supra note 568. 570. U.S. Department of State,Victims of Trafficking and Violence Protection Act of 2000:Trafficking in Persons Report 110 (2004), http://www.state.gov/g/ tip/rls/tiprpt/2004/ [hereinafter U.S. Department of State] (last visited July 1, 2005); Bureau of Democracy, supra note 6. 571. U.S. Department of State, supra note 570; See Siriporn Skrobanek et al.,The Traffic in Women: Human Realities of the International Sex Trade (1997). 572. See Human Rights Watch,The Human Rights Watch Global Report on Women’s Human Rights n.29, http://www.hrw.org/about/projects/womrep/General-125.htm#P1956_541986 (last visited July 1, 2005). 573. See The Royal Thai Embassy,Washington, DC,Thailand’s Actions for the Prevention of Trafficking in Women and Children, http://www.thaiembdc.org/ socials/actionwc.html (last modified Jan. 24, 2003). 574. See Bureau of Democracy, supra note 6. 575. Bureau of Democracy, U.S. Department of State,Thailand, Country Reports on Human Rights Practices 1999, http://www.usemb.se/human/human1999/thailand.html (Feb. 2000). 576. Praratchabunyat Matrakaan Nai Kaan Pongkan Lae Prappram Kaan Kha Ying Lae Dek B.E. 2540. [The Measures in Prevention and Suppression of Trafficking in Women and Children Act, 1997] (1997) (Thail.). See The Royal Thai Embassy,Washington, supra note 573. 577. Praratchabunyat Matrakaan Nai Kaan Pongkan Lae Prappram Kaan Kha Ying Lae Dek B.E. 2540. [The Measures in Prevention and Suppression of Trafficking in Women and Children Act, 1997], § 11 (1997) (Thail.). In the case that the victimized person is not a Thai citizen, the repatriation of the victim shall be done in accordance with the agreement set forth in a treaty with the state party, or a convention of which Thailand is an acceding state. Id. 578. The Prevention and Suppression of Prostitution Act, B.E. 2539, § 9 (1996) (Thail.). 579. Id. 580. The Penal Code Amendment Act, No. 14, B.E. 2540, §§ 282–284, 312 (1997) (Thail.). 581. The Amendment of Criminal Proceedings Act, No.20, B.E. 2542 (1997). 582. Communication with WHAF, supra note 194, at 53. (citing Praratchabunyat Pongkan Lae Prapram Kaan Fork-ngern B.E. 2542 [The Money Laundering Control Act 1999], § 49 (1999)). 583. Sub-Committee on the Resolution of the Problems of Transnational Trafficking of Children and Women, National Commission on Women’s Affairs, Memorandum of Understanding on Common Guidelines of Practices among Concerned Agencies for Operation in Case Women and Children are Victims of Human Trafficking, B.E. 2542 (1999). 584. Id. art. 2(1). 585. Id. art. 3. 586. Id. art. 4(1). 587. Id. art. 5(3). 588. Anti-slavery International, Human Traffic, Human Rights: Redefining Victim Protection 173–185 (2002), http://www.antislavery.org/homepage/resources/ humantraffic/Hum%20Traff%20Hum%20Rights,%20redef%20vic%20protec%20final% 20full.pdf (last visited July 1, 2005). 589. U.S. Department of State, supra note 570. 590. Id. 591. Anti-slavery International, supra note 588, at 179. See also U.S. Department of State, supra note 570. 592. U.S. Department of State, supra note 570. 593. Communication with WHAF, supra note 194, at 54. 594. Id. 595. Id. 596. S. Ekachai, Is this a society we can be proud of?, Bangkok Post, Jan. 3, 2002; ECPAT Foundation, Editor Challenges Country to Stem Child Abuse, UN Wire, Apr. 1, 2002, http://www.expat.net/preventionproject/eng/new/articles_0006.htm. 597. Id. 598. Act promulgating the Penal Code, B.E. 2499, §§ 277, 279 (1956) (Thail.). 599. Id. §§ 277–281. 600. Id. § 277. 601. Id. § 278. 602. Id. § 279. 603. End Child Prostitution, Child Pornography and Trafficking of Children for Sexual Purposes’ (ECPAT) International, Country Report:Thailand, http:// www.ecpat.net/eng/Ecpat_inter/projects/monitoring/online_database/countries. asp?arrCountryID=173&CountryProfile=facts&CSEC=Overview,Prostitution,Pronog raphy,trafficking&Implement=Coordination_cooperation,Coordination_cooperation,P rotection,Recovery&Nationalplans=&DisplayBy=optDisplayCountry#cs1 (last visited July 1, 2005).

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604. Bureau of Democracy, U.S. Department of State,Thailand, Country Reports on Human Rights Practices 1999, http://www.usemb.se/human/human1999/thailand.html (Feb. 2000). 605. Id. 606. The Prevention and Suppression of Prostitution Act, B.E. 2539, § 9 (1996) (Thail.). 607. Act promulgating the Penal Code, B.E. 2499, §§ 282–283 (1956) (Thail.); The Penal Code Amendment Act, No. 14, B.E. 2540, §§ 276–287 (1997) (Thail.). 608. The Prevention and Suppression of Prostitution Act, B.E. 2539, § 10 (1996) (Thail.). 609. Id. § 8. 610. Id., § 8. 611. The Development of Children’s Protection Organization, Report on the Study of the Enforcement of the 1996 Prevention and Suppression of Prostitution Act, Bangkok, Department of Public Welfare (2000).

LAWS AND POLICIES AFFECTING THEIR REPRODUCTIVE LIVES

5. Vietnam Statistics GENERAL

Population ■

Total population (millions): 84.2.1

■

Population by sex (thousands): 41,382.0 (female) and 41,099.0 (male).2

■

Percentage of population aged 0–14: 31.4.3

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Percentage of population aged 15–24: 20.7.4

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Percentage of population in rural areas: 74.5

Economy ■

Annual percentage growth of gross domestic product (GDP): 7.6.6

■

Gross national income per capita: USD 480.7

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Government expenditure on health: 1.5% of GDP.8

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Government expenditure on education: 2.8% of GDP.9

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Percentage of population below the poverty line: 29.10

WOMEN’S STATUS ■

Life expectancy: 73.1 (female) and 69.1 (male).11

■

Average age at marriage: 23.1 (female) and 24.4 (male).12

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Labor force participation: 79.4 (female) and 86.0 (male).13

■

Percentage of employed women in agricultural labor force: Information unavailable.

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Percentage of women among administrative and managerial workers: Information unavailable.

■

Literacy rate among population aged 15 and older: 92% (female) and 95% (male).14

■

Percentage of female-headed households: 32.15

■

Percentage of seats held by women in national government: 27.16

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Percentage of parliamentary seats occupied by women: 27.17

CONTRACEPTION ■

Total fertility rate: 2.23.18

■

Contraceptive prevalence rate among married women aged 15–49: 79% (any method) and 57% (modern method).19

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Prevalence of sterilization among couples: 6.8% (total); 6.3% (female); 0.5%(male).20

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Sterilization as a percentage of overall contraceptive prevalence: 9.21

MATERNAL HEALTH ■

Lifetime risk of maternal death: 1 in 290 women.22

■

Maternal mortality ratio per 100,000 live births: 130.23

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WOMEN OF THE WORLD:

■

Percentage of pregnant women with anemia: 52.24

■

Percentage of births monitored by trained attendants: 85.25

ABORTION ■

Total number of abortions per year: 1,520,000.26

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Annual number of hospitalizations for abortion-related complications: Information unavailable.

■

Rate of abortion per 1,000 women aged 15–44: 83.3.27

■

■

Breakdown by age of women obtaining abortions: 0.9% (under 20); 11.3% (age 20–24); 22.4% (age 25–29); 30.7% (age 30–34); 21.3% (age 35–39); 13.3% (40 or older).28 Percentage of abortions that are obtained by married women: 96.2.29

SEXUALLY TRANSMISSIBLE INFECTIONS (STIS) AND HIV/AIDS ■

Number of people living with sexually transmissible infections: Information unavailable.

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Number of people living with HIV/AIDS: 220,000.30

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Percentage of people aged 15–49 living with HIV/AIDS: 0.3 (female) and 0.7 (male).31

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Estimated number of deaths due to AIDS: 9,000.32

CHILDREN AND ADOLESCENTS ■

Infant mortality rate per 1,000 live births: 28.33

■

Under five mortality rate per 1,000 live births: 37 (female) and 52 (male).34

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Gross primary school enrollment ratio: 97% (female) and 105% (male).35

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Primary school completion rate: 88 (female) and 90 (male).36

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Number of births per 1,000 women aged 15–19: 19.37

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Contraceptive prevalence rates among married female adolescents: 14.9% (modern methods); 3.2% (traditional methods); 18.1% (any methods).38

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Percentage of abortions that are obtained by women younger than age 20: 0.9.39

■

Number of children under the age of 15 living with HIV/AIDS: Information unavailable.

VIETNAM

ENDNOTES 1. See United Nations Population Fund (UNFPA),The State of World Population 2005, at 112 (estimate for 2004). 2. See United Nations Population Fund (UNFPA), Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003 (2003), http://www.unfpa.org/profile/default.cfm. [hereinafter UNFPA Country Profiles]. 3. See The World Bank,World Development Indicators 2004, at 40 (2004), http:// www.worldbank.org/data/ (estimate for 2002). [hereinafter The World Bank]. 4. See UNFPA, Country Profiles, supra note 2. 5. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimate for 2003). 6. See The World Bank, supra note 3, at 184 (estimate for 1990-2002). 7. See The World Bank,World Development Indicators 2004: Data Query (2004), http://devdata.worldbank.org/data-query/ (statistical figure was obtained through the Atlas method) (estimate for 2003). 8. See UNFPA,The State of World Population 2005, supra note 1, at 112. 9. See United Nations CyberSchoolBus, InfoNation: Government Education Expenditure (2004), http://www.un.org/Pubs/CyberSchoolBus/infonation/e_ infonation.htm (estimate for 1997). 10. See The World Bank, Country at a Glance Tables for Vietnam 2004, at 1 (2004), http://www.worldbank.org/data/countrydata/countrydata.html. 11. See UNFPA,The State of World Population 2005, supra note 1, at 108. 12. See UNFPA, Country Profiles, supra note 2. 13. See Id. 14. See UNFPA, Country Profiles, supra note 2. 15. See Social and Demographic Statistics Branch, United Nations Statistics Division,The World’s Women 2000:Trends and Statistics 49 (2000) (estimate for 1991/1997). 16. See Save the Children, State of World’s Mothers 2004, at 38 (2004), http:// www.savethechildren.org/mothers/report_2004/images/pdf/SOWM_2004_final.pdf (estimate for 2004). 17. See United Nations Statistics Division, Millennium Indicators Database (2005), http://unstats.un.org/unsd/mi/mi_series_results.asp?rowId=557 (last updated Mar. 16, 2005) (estimate for 2005). 18. See UNFPA,The State of World Population 2005, supra note 1, at 112 (estimate for 2000-2005). 19. See Id. at 108. 20. See Engenderhealth, Contraceptive Sterilization: Global Issues and Trends, tbl. 2.2, at 47 (2002) (estimates for 1997). 21. See Id. at tbl. Supp. 2.5, at 56 (estimate for 1997). 22. See World Health Organization (WHO) et al., Maternal Mortality in 1995: Estimates Developed by WHO, United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), 47 (2000) (estimate for 1995). 23. See UNFPA,The State of World Population 2005, supra note 1, at 108. 24. See Save the Children, supra note 16, at 38 (estimate for 1989-2000). 25. See UNFPA,The State of World Population 2005, supra note 1, at 112. 26. See Stanley K. Henshaw et al., The Incidence of Abortion Worldwide, 25 Int’l Fam. Planning Persp. S30–S38 (Supp. 1999), http://www.agi-usa.org/pubs/journals/ 25s3099.html (estimate for 1995-96). 27. See Department of Economic and Social Affairs, United Nations Population Divisions, United Nations World Abortion Policies 1999, U.N. Doc. ST/ESA/ SER.A/178 (1999), http://www.un.org/esa/population/publications/abt/abt.htm (estimate for 1996). 28. See Akinrinola Bankole et al., Characteristics of Women who Obtain Induced Abortion: A Worldwide Review, 25 Int’l Fam. Planning Persp. 68–77 (1999), http://www. guttmacher.org/pubs/journals/2506899.html (statistical figure obtained through incomplete national statistics) (estimates for 1991). 29. See Id. 30. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., UNAIDS/World Health Organization (WHO) Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections – 2004 Update:Vietnam 3 (2004), http://www.who.int/GlobalAtlas/PDFFactory/HIV/EFS_PDFs/EFS2004_VN.pdf (estimate for 2003). 31. See UNFPA,The State of World Population 2005, supra note 1, at 108. 32. See Joint United Nations Programme on HIV/AIDS (UNAIDS) et al., supra note 30. 33. See UNFPA,The State of World Population 2005, supra note 1, at 108. 34. See UNFPA, Country Profiles, supra note 2. 35. See UNFPA,The State of World Population 2005, supra note 1, at 108. The ratio may be more than 100 because the figures remain uncorrected for individuals who are older than the level-appropriate age due to late starts, interrupted schooling or grade repetition. 36. See Id. 37. See UNFPA,The State of World Population 2005, supra note 1, at 108. 38. See Saroj Pachauri & K.G. Santhya, Reproductive Choices for Asian Adolescents: A Focus on Contraceptive Behavior, 28 Int’l Fam. Planning Persp. 186–195 (2002), http://www. agi-usa.org/pubs/journals/2818602.html (estimates for 1997). 39. Bankole et al., supra note 28.

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T

he Socialist Republic of Vietnam is situated in Southeastern Asia, bordering the Gulf of Thailand, Gulf of Tonkin, South China Sea, China, Laos, and Cambodia.1 Vietnam has existed as an independent state for half a century. In 111 BC, the Chinese Han dynasty conquered northern Vietnam and ruled with other Chinese dynasties for the next thousand years.2 Vietnam finally achieved independence under a native dynasty in 939 AD.3 There were civil wars between the powerful northern and southern families in the 17th and 18th centuries.4 France began its efforts to seize control of Vietnam in 1858 and colonized the nation in 1885.5 In 1930, the Communist Party of Vietnam waged a protracted revolutionary struggle against French colonialism.6 Although Vietnam declared independence after the departure of Japanese troops in 1945 and created the Democratic Republic of Vietnam, French colonial rule persisted until Communist forces under Ho Chi Minh defeated the French at Dien Bien Phu in 1954.7 As a result of that defeat, France and the Democratic Republic of Vietnam signed the 1954 Geneva Agreement on Vietnam which ended French colonial rule.8 The agreement called for an election in July 1956 to unify the Communist North and the non-Communist South under one government; however, the South Vietnamese government refused and declared itself the Republic of Vietnam on October 26, 1955.9 A period of extended conflict between North and South Vietnam, sometimes termed the Second Indochina War, followed.10 The United States government’s involvement escalated from providing economic and military aid to South Vietnam to sending troops.11 The United States withdrew its armed forces in 1973 following a cease-fire agreement under the Paris Accords.12 Two years later, North Vietnamese forces occupied the South, taking Saigon on April 30, 1975, and announced the reunification of the country.13 North Vietnam absorbed South Vietnam to form the Socialist Republic of Vietnam on July 2, 1976.14 In 2002, Vietnam’s total population was 80.2 million,15 of which approximately 50.6% was female.16 The official national language is Vietnamese. Other languages include English, increasingly favored as a second language; French; Chinese; Khmer; and mountain area languages such as MonKhmer and Malayo-Polynesian.17 The ethnic composition of Vietnam consists of Vietnamese (85%–90%), Chinese (3%), Hmong, Thai, Khmer (Cambodians), Cham, and about 30 mountain groups of various cultures and dialects.18 Religions practiced in Vietnam include Buddhism, Hoa Hao, Cao Dai, Christianity (predominantly Roman Catholic, some Protestant), indigenous beliefs, and Islam.19 Vietnam has been a member of the United Nations

WOMEN OF THE WORLD:

(UN) since 1977.20 It is also a member of the Association of Southeast Asian Nations (ASEAN), the ASEAN Regional Forum (ARF), and the Asia-Pacific Economic Cooperation (APEC) forum,21 and holds observer status, while applying for full membership, at the World Trade Organization (WTO).22

I. Setting the Stage: the Legal and Political Framework of Vietnam Fundamental rights are rooted in a nation’s legal and political framework, as established by its constitution. The principles and goals enshrined in a constitution, along with the processes it prescribes for advancing them, determine the extent to which these basic rights are enjoyed and protected. A constitution that upholds equality, liberty, and social justice can provide a sound basis for the realization of women’s human rights, including their reproductive rights. Likewise, a political system committed to democracy and the rule of law is critical to establishing an environment for advancing these rights. The following section outlines important aspects of Vietnam’s legal and political framework. A. THE STRUCTURE OF NATIONAL GOVERNMENT

The Constitution of Vietnam came into force on April 15, 1992, and was amended on December 25, 2001.23 It establishes a constitutional republic dominated by the Vietnamese Communist Party (VCP).24 Vietnam is a “law governed socialist State of the people, by the people, and for the people.”25 State power is vested in the people and exercised through the National Assembly and the People’s Councils under the principle of democratic centralism.26 The constitution is the supreme law of the land27 and divides Vietnam’s national government into three distinct but interrelated branches: executive, legislative, and judicial. The constitution “institutionalizes the relationship between the Party as leader, the people as master, and the State as administrator.”28 The constitution reaffirms the central role of the Communist Party and cites the National Assembly as the highest representative body of the people, overseeing all government functions.29 In recent years, the National Assembly has been increasingly vocal and assertive in exercising its lawmaking authority but remains subject to Communist Party direction.30 Executive branch The president is the head of state,31 commander of the armed forces, and chair of the National Defense and Security Council.32 The National Assembly elects him or her from among its members for a five-year term.33 The government is

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the executive organ of the National Assembly and the highest organ of executive or administrative power. It is composed of the prime minister, who is the head of government, the deputy prime ministers, the cabinet ministers, and other members.34 The president, on the basis of resolutions of the National Assembly or its Standing Committee, has authority to appoint or dismiss deputy prime ministers and cabinet ministers.35 The president also has authority to appoint and dismiss vice presidents and judges of the Supreme People’s Court, the deputy head, and members of the Supreme People’s Office of Supervision and Control.36 The vice president, who is elected by the National Assembly from among its members,37 assists the president38 and may act as president, in case of the president’s incapacity or vacancy, until a new president is elected.39 The prime minister directs the work of the government and People’s Councils at all administrative levels and chairs cabinet meetings.40 The prime minister has authority to appoint or dismiss vice ministers, and approves the election and dismissal of the chair and deputy chair of People’s Committees of provinces and cities under direct central rule.41 If he or she finds that they contravene the constitution or Vietnamese law in general, the prime minister may suspend or annul decisions and circulars made by cabinet ministers or decisions and directives issued by People’s Councils or chairs of People’s Committees of provinces and municipalities.42 The deputy prime ministers assist the prime minister and, in his or her absence, choose a delegate from among themselves to direct the work of the government.43 Legislative branch Legislative power rests with a unicameral National Assembly, or Quoc-Hoi. The National Assembly consists of 498 members who are elected by popular vote to serve five-year terms.44 The National Assembly exercises supreme control over all activities of the state and is the only organ formally vested with constitutional and legislative powers.45 Deputies to the National Assembly are elected by their regional constituencies to represent their “will and aspirations.”46 The National Assembly has the right to amend the constitution with the approval of at least two-thirds of its total membership.47 It also has the power to make and amend laws, and to abrogate laws and official written documents that contravene the constitution.48 The National Assembly has authority to elect and remove from office the president; vice president; chair of the National Assembly; vice chair and members of the Standing Committee; prime minister; tribunal president of the Supreme People’s Court; and head of the Supreme People’s Office of Supervision and Control.49 The assembly

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determines domestic and foreign policy; decides issues of national defense, security,50 and war and peace; and has the authority to proclaim a state of emergency.51 Once a member of the National Assembly has lost the people’s confidence, he or she may be removed from office by his or her electors or the National Assembly.52 The Standing Committee of the National Assembly is the permanent representative body of the National Assembly and is composed of its chair, the vice chair, and the members.53 A member of the Standing Committee cannot be a member of the government.54 The Standing Committee calls and presides over the election of the National Assembly;55 interprets the constitution, the law, and decree-laws;56 and supervises and controls the People’s Councils.57 The National Assembly elects a Nationalities Council that comprises a chair, a vice chair, and members.58 The council makes proposals to the National Assembly on ethnic issues, and it supervises and controls the implementation of policies regarding national minorities.59 The president, the Standing Committee, the Nationalities Council, the Committees of the National Assembly, the government, the Supreme People’s Court, the Supreme People’s Office of Supervision and Control, the Vietnam Fatherland Front and its members, and individual deputies to the National Assembly may present bills to the National Assembly.60 Laws and resolutions of the National Assembly must be approved by more than half of the assembly’s total membership.61 Decisions to remove an assembly member, to reduce or prolong the assembly’s tenure, or to amend the constitution must be approved by at least two-thirds of the assembly’s total membership.62 After the National Assembly adopts a bill, it is signed by the assembly president.63 The president of the nation then promulgates the law, which is effective no later than 15 days from adoption.64 The fifteen-member Politburo, headed by the Communist Party’s general secretary, determines government policy, and its nine-person Secretariat oversees day-to-day policy implementation.65 A party congress meets every five years to set the direction of the party and the government.66 The 150member Central Committee, elected by the Party Congress, meets at least twice a year.67 B. THE STRUCTURE OF LOCAL GOVERNMENTS

Regional and local governments For administrative purposes, Vietnam is divided into fifty-nine provinces and five municipalities.68 Provinces are divided into districts, provincial cities, and towns, which are further divided into communes, townlets, and wards.69 Municipalities are divided into urban districts, rural districts, and towns;

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and urban districts are further divided into wards.70 Provinces and municipalities are centrally administered by the national government. Other administrative divisions are accountable to the locally elected People’s Councils and their People’s Committees.71 People’s Councils are local organs of state power that are composed of elected representatives of the local people and established in administrative divisions in accordance with the law.72 People’s Councils pass resolutions for the implementation of the constitution and national laws, and for the improvement of people’s living conditions.73 A People’s Council member may be removed by the electors or by other council members in the event of a loss of public confidence.74 The People’s Committees are elected by the People’s Councils and are the latter’s executive organs.75 The chair of the People’s Committee gives leadership and operational guidance to the activities of the People’s Committee.76 Judicial branch The constitution establishes an integrated hierarchical system of courts composed of the Supreme People’s Court, local People’s Courts, military tribunals, and other tribunals established by law.77 The Supreme People’s Court is the highest judicial organ.78 It is headed by the tribunal president, who is elected by the National Assembly upon the recommendation of the president for a five-year term.79 The Supreme People’s Court hears appeals from the local People’s Courts.80 It supervises and directs the judicial work of Special People’s Courts and military tribunals.81 The Supreme People’s Court has ten Special Courts, including three appeal divisions and a Central Military Court.82 The appeal divisions hear appeals from the Provincial and City People’s Courts, and from the District People’s Courts.83 The three appeal divisions also act as trial courts for Hanoi, Da Nang, and Ho Chi Minh City.84 The Provincial and City People’s Courts have original jurisdiction over cases beyond the jurisdiction of the District People’s Courts and appellate jurisdiction over cases decided by the District People’s Courts. District Courts hear criminal cases where punishments do not exceed seven years’ imprisonment. Cases arising from economic contracts are subject to a separate arbitration system.85 Judicial decisions are binding on a case-specific basis and are not subject to constitutional review.86 The Supreme People’s Office of Supervision and Control ensures obedience of the law by ministries, local organs of power, economic bodies, social organizations, people’s armed units, and citizens.87 It exercises the right to initiate public prosecutions and ensures a serious and uniform implementation of the law.88 The heads of local offices of supervision and control and the heads of military offices of

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supervision and control are subject to the overall leadership of the head of the Supreme People’s Office of Supervision and Control, who serve five-year terms.89 The head of the Supreme People’s Office of Supervision and Control appoints and dismisses the heads, deputy heads and members of the local people’s offices of supervision and control and of military offices of supervision and control in military zones. 90 C. THE ROLE OF CIVIL SOCIETY AND NONGOVERNMENTAL ORGANIZATIONS (NGOS)

Individual membership and voluntary participation in a variety of social groups and certain state-controlled groups is common in Vietnam. However, these groups have limited influence over policy on the local and national levels. Studies reveal that 25%–30% of the Vietnamese population is associated with women’s groups and almost 15% belong to voluntary health groups.91 Less than 5% of the Vietnamese population is associated with human rights and development groups.92 The high level of social group membership in Vietnam is attributed to the government’s efforts to mobilize participation in state-controlled groups such as youth groups and women’s groups.93 Some social scientists have noted that the doi moi (renovation or renewal) reforms, a broad reform effort introduced in 1986 to transform Vietnam’s economy into a market economy, along with the process of social modernization in general have contributed to the development of civil society in Vietnam.94 D. SOURCES OF LAW AND POLICY

Domestic sources Sources of domestic law include the constitution and enactments by the National Assembly. Other forms of legislation, such as decrees, instructions, circulars, regulations, and ordinances,95 made by an authorized person under legislative or constitutional authority, are also an important source of Vietnamese law. The Vietnamese legal system is based on communist legal theory and the French civil law system.96 The Civil Code, effective since 1996, is a comprehensive codification of Vietnamese laws, including a separate codification for family law.97 The code of civil commercial procedure is based on French civil procedure and colonial civil and commercial legislation.98 Customary laws of ethnic minorities that are not contrary to existing laws are also recognized.99 The constitution promotes a socialist-oriented economy based on a system of ownership by the entire population, including collectives and private individuals.100 It guarantees respect for human rights101 and recognizes citizens’ duties to the state and society.102 The constitution guarantees equal rights between men and women in political, economic, cultural, and social fields and in the family.103 It also guarantees equal

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pay for equal work and bans all acts of discrimination against women and all acts damaging women’s dignity.104 The constitution promotes the creation of conditions that raise women’s qualifications in all fields, including the development of maternity homes, pediatric departments, crèches, and other social welfare units to lighten house work and allow women to engage more actively in work and study.105 It further protects marriage and the family106 by requiring marriage to conform to the principles of free consent, progressive union, monogamy, and equality between husband and wife, and it protects children against discrimination.107 It is the responsibility of the state, society, the family, and the citizen to implement the nation’s population program and family planning policies.108 The constitution guarantees freedom of opinion and speech; freedom of the press; the right to be informed; and the rights to assemble, form associations, and hold demonstrations.109 It guarantees freedom of belief and religion, provides that all religions are equal before the law, and protects against misuse of beliefs and religions to contravene the law and state policies.110 The constitution guarantees the inviolability of the person and the protection of life, health, honor, and dignity. It forbids harassment, coercion, torture, and violations of honor or dignity.111 International sources The constitution authorizes the president to sign treaties or international agreements.112 Such agreements become valid and effective when ratified by the National Assembly.113 Vietnam has ratified the following international human rights instruments: the Convention on the Elimination of All Forms of Discrimination against Women;114 the Convention on the Rights of the Child;115 the International Covenant on Economic, Social, and Cultural Rights;116 the International Covenant on Civil and Political Rights;117 the International Convention on the Elimination of All Forms of Racial Discrimination;118 the Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict;119 and the Optional Protocol to the Convention on the sale of children, child prostitution and child pornography.120

II. Examining Reproductive Health and Rights In general, reproductive health matters are addressed through a variety of complementary, and sometimes contradictory laws and policies. The scope and nature of such laws and

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policies reflect a government’s commitment to advancing the reproductive health status and rights of its citizens. The following sections highlight key legal and policy provisions that together determine the reproductive rights and choices of women and girls in Vietnam. A. GENERAL HEALTH LAWS AND POLICIES

The constitution requires the government to provide for health initiatives in both its budget and economic planning processes.121 It also enjoins the state to organize health insurance and create the necessary conditions for all citizens to enjoy health care.122 The constitution requires the state to invest in, ensure the development of, and oversee the protection of the people’s health.123 In particular, prevention is to be combined with treatment, as are traditional and modern medicine.124 The constitution emphasizes that priority will be given to the health care of highlanders and national minorities.125 Long-term policies and strategies for the health sector are established through five- and ten-year plans as well as in specific decrees issued by the Government of Vietnam and/ or the Ministry of Health.126 In 2001, the Government of Vietnam released a Ten Year Socio-Economic Development Strategy (SEDS) for 2001–2010.127 The overall objective of SEDS is “to bring [the] country out of underdevelopment; improve noticeably the people’s material, cultural and spiritual life; and [to] lay the foundations for [becoming] … a modernoriented industrialized country by 2020.”128 In conjunction with SEDS, the government also released the Strategy for People’s Health Care and Protection129 and the National Strategy for Reproductive Health Care, among others.130 Objectives The Strategy for People’s Health Care and Protection established the following key goals to be met by 2010: ■ increase life expectancy to 71 years of age; ■ improve the quality of life by reducing the spread of preventable infections and diseases; ■ assure equal and effective access to health-care services for all citizens, especially for the treatment of disease; ■ improve the quality of health care for disease prevention, treatment, and rehabilitation; and ■ reorganize the health sector to reflect the country’s new model of socioeconomic development.131 In 2002, the government introduced the Comprehensive Poverty Reduction and Growth Strategy,132 which outlines SEDS’s specific goals and the steps that must be taken to realize them. They include the following: ■ promote the grass-roots health system;

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maintain and develop community health services; prioritize protection from health problems that affect low-income communities, including child malnutrition, HIV/AIDS, diseases that affect reproductive health, and infectious diseases; ■ improve the quality of health services; ■ ensure that the poor have access to quality health services; and ■ provide health-service subsidies to low-income populations.133 Significant changes in the health system took place in 1986, when the Government of Vietnam launched doi moi reforms. The doi moi campaign shifted Vietnam from a centralized economy to a decentralized “socialist-oriented market economy” and sparked the development of the private sector.134 As a result of privatization, fees for health-care services were introduced135 and the quality of public health care declined due to the lack of funding by local governments.136 Although these reforms have improved the general quality of life in Vietnam, 28 million people still live below the poverty line.137 Furthermore, since the doi moi reforms, use of public healthcare services has declined significantly, and there are increasing inequalities in health-care provision between geographical regions and population groups, mainly due to the high cost of health care and the lack of facilities in remote areas.138 Infrastructure of health-care services Government facilities The public health-care system is divided into four tiers: the Ministry of Health, provincial health bureaus, district health centers, and commune health centers. The Ministry of Health formulates and implements national health policies and manages the public health-care system. The ministry’s policy department develops health policy in conjunction with the Committee on Health Strategies, a senior-level body chaired by the Minister of Health. In addition, the ministry works with several specialty institutes, such as the Institute for the Protection of Mothers and Newborns. These institutes function as tertiary care referral centers as well as professional training and medical research centers.139 The Ministry of Health works with a number of committees, including the National Committees for the Prevention and Control of HIV/AIDS and for the Prevention and Control of Narcotics and Prostitution.140 In addition, the ministry routinely issues norms and regulations on reproductive health and family planning services.141 It also regulates the conditions and norms of private medical practices, and administers medical licensing and certification for government-approved private, semipublic, nongovernmental, and foreign-financed medical facilities.142 The ministry oversees the manufacture and ■ ■

distribution of pharmaceuticals, physician training, medical research, and the establishment of fee scales for private healthcare facilities.143 Occasionally, the Government of Vietnam addresses specific health concerns through specially created bodies that are separate from the Ministry of Health. For example, in 1993 the government created the National Committee for Population and Family Planning, which develops and implements national population and family planning strategies on behalf of the government.144 Health bureaus are responsible for planning health services in the provinces. In 2001, there were 61 provincial health bureaus, each of which provided services for anywhere from 250,000 to 5 million people.145 In 2000, there were a total of 698 general hospitals, 71 specialized hospitals, 10 research institutes, 45 traditional medicine hospitals, 1,009 specialized clinics, and 41 regional maternity homes.146 Each province has one large general hospital with two hundred to one thousand beds147 and in most cases seven departments: emergency care, internal medicine, obstetrics and gynecology, surgery, pediatrics, infectious diseases, and traditional medicine. The hospital serves as a referral center for the entire province. A district health center serves each of the 631 towns or districts in Vietnam. Each district has one general hospital with a laboratory. Usually, a mother and child care and family planning unit is also attached to the hospital.148 District hospitals accept referrals from commune health centers (CHCs), which are staffed by three to five people who are selected by the local community and trained by the hospital.149 In 2002, Vietnam had 11,103 CHCs.150 The head of the CHC may be an assistant physician or a nurse who in some centers may be assisted by a pharmacist. At times, the core team will include an assistant physician in traditional medicine, a public health worker, and another nurse. In exceptional cases, there will be a physician on staff.151 Government facilities are staffed by a large number of public health workers, with an average of 5.65 doctors and 22.37 beds per ten thousand people in 2002.152 In recent years, the government has promoted the use of village health workers in remote areas. These workers have no formal medical training, but receive basic training from provincial health bureaus that enables them to address the daily health care needs of the local community. Village health workers are also trained to provide basic health education and assist with antenatal care and family planning programs.153 Privately run facilities In 1986, the Government of Vietnam approved the use of private health-care facilities.154 Private providers fall into two

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categories: full time providers who own their practice facilities and part-time private providers who are also on staff at public health facilities.155 In 1993, the government enacted the Ordinance on Private Medical and Pharmaceutical Practice, which governs the private practice of health-care services and establishes ethical requirements.156 The Ministry of Health and provincial health bureaus oversee private health-care providers and facilities, including pharmacies.157 There is limited information about the size of the private health-care sector. In 1998, the Ministry of Health reported a total of 34,018 privately run health-care facilities, 70% of which were in urban areas.158 In 1999, the government estimated that 12% of private health-care facilities were unlicensed.159 During the initial stage of the doi moi reform process, annual individual public use of medical services declined dramatically from 2.3 visits in 1984 to only one visit in 1990.160 A number of factors contributed to the decline, including the poor quality of services, the rapid—and minimally regulated—growth of costly private health-care services, the widening gap between rich and poor, and the imposition of hospital fees.161 Since health-sector reforms were introduced in 1992,162 the quality of medical services has improved and rising living standards have led more people to seek health-care services.163 The average number of visits to public medical facilities per capita increased from one visit per year in 1990 to 1.72 visits in 2000.164 According to a 1998 government survey, wealthy individuals make the most use of both private and public health-care facilities.165 Financing and cost of health-care services Government financing In addition to requiring the government to provide for health initiatives in both its budget and economic planning processes,166 the constitution also enjoins the state to organize health insurance and create the necessary conditions for all citizens to enjoy health care.167 In 2002, the estimated national total public health expenditure was 1.35% of the gross domestic product (GDP).168 This is significantly lower than state expenditure for other areas, such as public education.169 Similarly, state health-care expenditure as a percentage of GDP is also lacking compared with other areas.170 According to experts, the lower state expenditure reflects the development of the private health-care sector following the 1986 doi moi reforms.171 The doi moi reforms that eliminated the fully subsidized health-care system also eliminated agricultural work brigades, which had been responsible for funding commune health centers and were long considered to be the backbone of the health-care system. With their demise, brigade nurses, who had been charged with assisting medical staff at commune

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health centers, also disappeared. Commune health centers were forced to turn to less reliable sources of funding, which in turn lessened the quality of and limited the accessibility of health-care services. Meanwhile, the number of private health-care facilities and providers grew at a pace that surpassed the government’s ability to regulate them.172 As a result of these problems, the government tried to counteract the erosion of health care.173 One of its first initiatives was the 1993 Ordinance on Private Medical and Pharmaceutical Practice, which entitled the government to collect user fees in public hospitals to help finance its healthcare program.174 In 1989, a system of user fees was introduced in national, provincial, and district health-care systems.175 The fee structure was revised in 1995 to correspond to the type of facility and the nature of the service.176 Vietnam finances health care in three ways: ■ government financing based on general tax revenues; ■ out-of-pocket payments; and ■ government and private health insurance programs.177 In 1992, the Vietnamese government introduced mandatory and voluntary health insurance schemes that are administered by Vietnam Health Insurance (VHI) under the supervision of the Ministry of Health. These insurance schemes cover 16% of the Vietnamese population;178 of that group, 62% are members of the mandatory scheme, 30% are members of the voluntary scheme, and 8% are covered by government-subsidized programs.179 The mandatory health insurance scheme covers all civil servants (active and retired) and salaried workers of businesses with ten or more employees. Employers pay a premium of 3% of total wages and employees pay 1% of total wages. However, only 13% of workers in the private sector are currently covered under the scheme, and their coverage remains inadequate, especially among self-employed people and informal sector workers and their families.180 Voluntary insurance schemes include the School Health Insurance Scheme, which covers school children and higher education students and is administered by educational institutions and the provincial Ministries of Education; and the Farmer Voluntary Insurance Scheme, in which provincial governments pay 70% of the premiums while farmers contribute 30%.181 The government also provides fully subsidized schemes to people in poverty under the Free Health Card for the Poor program.182 Private and international financing Various national and international organizations, including United Nations agencies, provide significant assistance for many of Vietnam’s health and family welfare programs. For instance, the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and other bilateral donors

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contribute to the country’s Reproductive Health Programme and the HIV/AIDS Programme. Other major donors to the health sector include the governments of Australia, Belgium, France, Japan, the Netherlands, and Sweden.183 Cost Individual citizens have largely shouldered the costs of health care through out-of-pocket payments, which are fees that patients pay directly to health-care professionals at the time of treatment.184 In 2001, out-of-pocket health payments represented 87.6% of health-care costs nationwide.185 These payments covered public health-care user fees, informal charges at public health facilities, private payments, and drug costs.186 Providers of public health facilities can decide what level of fees to charge, and because their salaries are subsidized by user fees, they often discriminate against patients who are exempted from fees or covered by health insurance.187 In general, uninsured patients, or those who are not eligible for fee exemptions, must pay for services before they are rendered.188 All patients are expected to purchase their own medications at a public or private pharmacy.189 Those who cannot afford user fees, informal charges, or the cost of pharmaceuticals are denied access to health care.190 The Ministry of Health recently submitted a proposal to the Government of Vietnam to increase user fees at state-run hospitals and clinics. If approved, the burden of patient spending is expected to increase by 30%.191 In 1989, the government began regulating the collection of hospital fees, including those for patient beds, sanatorium stays, medication, blood work, tests, X-ray films, and other technical services. Several key components of Decrees No. 95/CP and No. 33/CP address the allocation of hospital fees. States are expected to use hospital fees as a source of revenue to be allocated as follows: ■ The collector will receive 70% of fees to help cover expenses related to medicine, blood, transfusion solution, chemical products, X-ray film, and other material and equipment for patient care; and ■ Thirty percent of fees will go to a reward fund for outstanding medical workers who have demonstrated a high degree of responsibility toward their patients; ■ Two percent to five percent of this money will be set aside for hospitals that are unable to collect fees and for outstanding workers or establishments at the national level, such as at the Ministry of Health.192 Since their introduction, the government has relied increasingly on user fees collected at public health facilities to finance the country’s health care. Recent decrees No.10/2002/ ND-CP and No. 25/2002/TT-BTC regarding financial regulations for revenue-raising public service facilities reflect

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the government’s intention to shift health-care costs from the state to the individual consumer.193 The government has exempted certain groups from paying user fees, including the following: ■ war veterans; ■ indigent individuals;194 ■ families or parents of children killed during the war who receive monthly allowances; ■ minority groups living in the highland; ■ government workers, army personnel and their dependents, and vocational school students; ■ individuals with disabilities or mental illnesses; ■ working people and their families who move to new economic zones;195 and ■ orphans and children under the age of five.196 The Labour Code provides exemptions from hospital fees for the following individuals: ■ persons with disabilities, orphans, or elders who have no means of support; ■ children under the age of six; ■ persons who suffer neurosis, epilepsy, leprosy, or tuberculosis; ■ minority groups who live in the highlands; and ■ patients who are extremely poor.197 In addition to these exemptions, the government has established preferential health policies for migrant workers.198 Regulation of drugs and medical equipment The manufacture, sale, and distribution of drugs and medical devices are regulated by the Ministry of Health through the Vietnam Drug Administration Department. Foreign companies provide more than 60% of all prescription drugs in the country.199 Between 2003 and 2004, the price of drugs went up by almost 10%.200 To counter unreasonable price increases that would make medical treatment unaffordable, the drug administration department in 2005 prohibited foreign companies that manufacture and trade drugs in Vietnam from raising drug prices without obtaining permission from the Ministry of Health.201 Regulation of health-care providers Several laws and corresponding statutory bodies regulate health-care providers in Vietnam, including their education and professional conduct. The 2003 Ordinance on Private Medical and Pharmaceutical Practice regulates private health-care professionals. Pursuant to the ordinance, practitioners are required to carry out their professional and technical responsibilities in accordance with regulations issued by the Ministry of Health and serve their patients with the utmost care.202 The ordinance prohibits these practitioners from doing the following:

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selling medicine or providing services that have not been approved by the Ministry of Health; ■ selling medicine that is improperly packaged; and ■ failing to comply with regulations outlined in the private medical practice or pharmacy certificates.203 The constitution obliges the Government of Vietnam to develop traditional medicine and to integrate it with modern medicine and pharmacology.204 One way the Government of Vietnam supports traditional medicine is through training. For example, there are three medical schools, two pharmaceutical colleges, and two secondary schools that focus on traditional medicine. Other government initiatives include training health workers at the community level to use traditional medicine and encouraging citizens to plant medicinal vegetables, fruits, and plants.205 Traditional medicine may be practiced by medical doctors who receive special training in medical school, or by traditional medicine practitioners who have no formal education or training.206 In 1989, the government first attempted to regulate practitioners of traditional medicine by passing public health legislation which subjects the practice of traditional medicine to government oversight and lays out guidelines for ensuring appropriate conditions in facilities where traditional medicine is practiced.207 Regulations enacted in 1991 specify qualifications for traditional medicine practitioners and detail the types of permissible treatment methods; they also contain criminal sanctions for breaches of the regulations that result in serious harm to a person’s life or health.208 An assessing committee established by the government issues licenses to these practitioners.209 Practitioners are required to secure approval from the government and the Traditional Medicine Association before employing new, unapproved treatments.210 In addition, licensed traditional medicine practitioners are restricted to practicing in certain geographical areas and health-care facilities.211 The practice of traditional medicine based on superstition is barred.212 The 2003 Ordinance on Private Medical and Pharmaceutical Practice contains provisions for regulating the practice of traditional medicine by private practitioners.213 Private practitioners must be medical doctors or assistant doctors specializing in traditional medicine and have practiced traditional medicine for a minimum of five years.214 They may only engage in activities related to traditional medicine for which they have been certified and must obtain government permission before using new treatment methods or drugs.215 They may not base their practice on superstition.216 Administrative, disciplinary, and criminal sanctions may be imposed for breaches of the ordinance.217 ■

Patients’ rights Citizens of Vietnam are free to choose the treatment they wish to undergo.218 Under the 2003 Ordinance on Private Medical and Pharmaceutical Practice, medical practitioners can be held liable for illegal acts resulting in injury to a patient and may be required to pay compensation.219 Additionally, the Penal Code adopted in 2000 provides recourse for breaches of medical duty. Medical practitioners who violate regulations for medical examination and treatment, production, preparation, supply, sale of drugs, or other medical services and cause a loss of life or serious damage to another’s health are punished with one to five years’ imprisonment.220 Depending on the seriousness of the consequences of a wrongful act, the wrongdoer can be sentenced to three to ten years’ imprisonment or seven to fifteen years’ imprisonment.221 A practitioner may also be required to pay a fine of up to VND 50 million (USD 3,306), and/or may be removed from his or her post or be barred from practicing his or her profession.222 B. REPRODUCTIVE HEALTH LAWS AND POLICIES

In 2001, the Ministry of Health formulated a National Strategy on Reproductive Health Care,223 which is the primary government policy on reproductive health.224 During the 1990s, the government’s focus was on maternal and child health care. In the view of the ministry, Vietnam required “a reproductive health strategy to provide health care to the people, particularly to women, mothers, and children, in a broader sense and with a more comprehensive approach.”225 The strategy, it was noted, had to be consistent with the principles set forth in the United Nations International Conference on Population and Development (ICPD) Programme of Action.226 The goal and objectives set out in the strategy are based on the following principles: ■ Investment in health care, including reproductive health, is also an investment in the continuing development of the nation; ■ All people should have equal access to information and services. In this regard, particular attention must be paid to disadvantaged groups, the poor, those who rendered meritorious services to the country, and inhabitants of mountainous, remote, and environmentally sensitive areas; ■ Gender equality should be ensured. This involves an awareness of women’s roles in making decisions about reproductive health issues and men’s roles and responsibilities in family planning and reproductive health; ■ A more active role should be taken with respect to preventive aspects of reproductive health and repro-

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ductive health care; ■ Modern medicine and traditional medicine should be combined; and ■ Reproductive health care is a societal concern and a shared responsibility.227 To improve the reproductive health status of women and narrow the disparities between regions and certain groups,228 the strategy identifies the following tactics: ■ generate a better understanding of the components and objectives of reproductive health care to secure more support and commitment from the general public and government officials; ■ sustain declining fertility rates, reduce the number of unwanted pregnancies and abortion-related complications, and ensure the rights of women and couples to have children or choose contraceptive methods of good quality; ■ improve the health status of women and mothers by continuing to reduce high rates of maternal mortality and morbidity, perinatal deaths, and infant mortality, particularly among low-income populations; ■ reduce the incidence of reproductive tract infections and sexually transmissible infections through preventive methods and offer appropriate treatment when they occur; ■ improve reproductive health care for the elderly, particularly for older women, and provide early diagnosis and treatment of breast cancer and other cancers of both male and female reproductive tracts; ■ advance the sexual and reproductive health of adolescents through age-appropriate education, counseling, and health care; and ■ educate men and women about sexual relations and sexuality so that they can fully exercise their rights and responsibilities in regard to fertility, have safe and responsible sexual relations based on equality and mutual respect, and generally improve their reproductive health and quality of life.229 The strategy contains the following targets for key health indicators: ■ reduce the fertility rate to 2.0 children for women of reproductive age; ■ reduce the maternal mortality rate to 70 per 100,000 live births; ■ reduce the infant mortality rate to 25%; ■ reduce the perinatal mortality rate to 18%; ■ reduce the percentage of low birth weight babies (under 2500 grams) to 6%; and ■ lower the malnutrition rate among children

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under five to 20%.230 The strategy outlines a number of policies that the government may implement in pursuit of its goals, including those that: ■ encourage the acceptance of small families; ■ promote the equal treatment of children of both sexes; ■ encourage the use of a wide range of contraceptive methods; ■ provide incentives to health-care practitioners to work in underserved areas; ■ increase subsidization of health-care services; ■ promote reproductive health education for adults; and ■ increase government regulation of reproductive health-care services.231 The 2001–2010 National Strategy for the Advancement of Women, formulated by the Government of Vietnam, highlights the importance of advancing women’s rights and health through education, investment in the health infrastructure of underserved communities, and full participation by men in family planning and women’s health needs in general.232 Vietnam’s 2003 Ordinance on Population also has specific objectives and policies related to reproductive health. Relevant strategies include the following: ■ ensure that women have the right to decide when to have a child, the number of children and the spacing between births; and ■ ensure that women have the freedom to choose contraceptive methods according to individual needs and preferences.233 The state has also developed policies intended to aid low-income ethnic minorities. These include programs for socioeconomic development, hunger eradication, and poverty alleviation as well as services intended to improve the community’s reproductive health, family planning, and “population quality-raising services.”234 Regulation of reproductive health technologies Vietnam’s first in vitro fertilization birth took place in 1998. By March 2003, 1,090 such births had occurred. In 2002, there were 86,279 infertile couples (0.63% of all couples) in Vietnam.235 Measures to prevent infertility and access to treatment through advanced technologies are very limited.236 In its National Strategy on Reproductive Health Care for the 2001–2010 Period, the government pledged to work towards the prevention and treatment of infertility, in part by introducing laws regulating the donation and reception of ova, sperm, and embryos, and other issues concerning in vitro fertilization.237

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A decree issued on January 12, 2003, prescribes conduct for infertile couples and single women who seek to use assisted reproductive technologies (ART); sperm donors and recipients; ovum donors and recipients; embryo donors and recipients; and ART facilities.238 Sperm donors must be between 20 and 55 years of age and ovum donors must be between 18 and 35 years of age. Sperm, ovum, and embryo recipients must be between 20 and 45 years of age. Donors and recipients are required to be physically fit and free of disease.239 Foreigners can use in vitro fertilization services but are prohibited from donating or receiving ova, sperm, or embryos.240 The new law bans all human cloning and surrogate motherhood.241 A population ordinance which came into effect in 2003, also obliges the government to invest in and to encourage organizations and individuals to devote resources to improving ART.242 This ordinance also bans human cloning.243 Family planning General policy framework In 1989, the government enacted the Law on Protection of People’s Health.244 Article 43(2) directs the state to use incentives, policies, and measures “to create the necessary conditions” to implement a reduced family size policy,245 but prohibits “all acts of preventing or forcing the implementation of family planning.”246 It directs obstetric and gynecological care providers and facilities to “respect everyone’s desire to use the method of birth control of their own choosing.”247 In the past decade, the government has introduced a number of laws and policies regarding family planning. The government recently embraced a National Population Strategy for the Period 2001—2010, which replaces Vietnam’s first population strategy, adopted in 1993.248 The current strategy is wider in scope than the earlier one and is linked to ICPD goals, identifying population issues as key to the country’s social and economic development.249 The National Strategy for Reproductive Health Care for the Period 2001–2010 and the Comprehensive Poverty Reduction and Growth Strategy also detail the government’s family planning strategies.250 (See “Population” for more information.) Contraception National-level data from 1997–1998 indicates that 99.48% of female respondents claim to have heard of or to know about contraceptive measures.251 In 2003, 78.5% of Vietnamese women in the reproductive age group (15–49) used some kind of contraceptive method and 56.7% used modern contraceptive methods.252 This is a notable increase in the use of contraceptive methods since 1990, when only 53.2% reported using some kind of birth control and 35.3%

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reported using a modern method.253 Government sources estimate that 38.3% of women use IUDs, 17.42% practice withdrawal, 15.33% follow the “rhythm/safe period” method, 6.08% depend on condom use by their spouses, and 3.69% use oral contraceptives.254 Contraception laws and policies All forms of contraception are legal in Vietnam. The Ordinance on Population prohibits activities involving “producing, dealing in, importing, and supplying contraceptive devices which are fake, fail to satisfy quality standards, have expired, or have not yet been” approved by the government.255 The ordinance further urges individuals and organizations to provide contraceptive devices and/or family planning services. Family planning providers are responsible for ensuring the safety and quality of their contraceptive devices and services, and must monitor and treat any adverse effects of their services.256 The 1989 Law on Protection of People’s Health also contains provisions on family planning, and it recognizes the duty of all persons to implement the government’s family planning program and choose their preferred method of contraception. The law also establishes a small family norm, stating that couples should have one to two children.257 It instructs the state to develop policies, introduce measures, and create the necessary conditions for proper implementation of the family planning program.258 It encourages public health, educational, and cultural facilities as well as the media and social organizations to widely disseminate family planning information.259 Sterilization is not a commonly used form of contraception in Vietnam.260 About 6.3% of females and 1% of males undergo sterilization.261 The law provides incentives to people to undergo sterilization procedures.262 Men are given an allowance equaling 40 kilos of rice and are exempted from public labor for one year. Male civil servants (cadres) receive a month’s worth of salary and a leave of seven days with full pay.263 With their consent, women who have at least two children are eligible to have sterilization procedures provided free of charge by the government.264 Women who undergo sterilization are given an allowance equaling 40 kilos of rice and are exempted from public labor until the end of their working age. If the woman is a civil servant, she is entitled to a leave of 20 days with full payment.265 The use of IUDs is encouraged, and in some instances women are offered monetary incentives to use IUDs.266 Regulation of information on contraception There are no formal restrictions on the advertisement of contraceptives.

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Government delivery of family planning services The constitution charges “the State, society, the family and the citizen to ensure care and protection for mothers and children; [and] to carry into effect the population program and family planning.”267 The government’s service network for family planning operates at these four levels: ■ the “Basic Line,” composed of intercommune centers for family planning; ■ the “District Line,” composed of family planning teams, obstetric facilities, and a central hospital; ■ the “Provincial Line,” composed of maternal and child health-care centers, family planning offices, and obstetric and provincial hospitals; and ■ the “Central Line,” composed of hospitals and centers for research and specialized technical training.268 The Ministry of Health organizes and guides the implementation of the program for reproductive health care and family planning, and strengthens the network that provides reproductive health care and family planning services to the wards and communes.269 Family planning services are delivered primarily through the family planning network and with the direct support of family, village, commune levels, maternity houses, clinics, and district hospitals.270 The 1989 Law on Protection of People’s Health requires the Ministry of Health to strengthen and expand “the network of obstetrics and newborn health care down to the grassroots in order to ensure medical care for women.”271 Public health facilities and individual practitioners that provide obstetric and gynecological care are also directed by the law to respect the right of individuals to choose their preferred method of birth control.272 Family planning services are also provided in private clinics and by NGOs. However, according to a survey, 88% of those who use contraception rely on the state, not the private sector, to provide it.273 Maternal health In 2003, Vietnam’s maternal mortality rate was 130 deaths per 100,000 live births.274 This is a significant decrease from the rate of 200 per 100,000 in 1990. Between 1990 and 1999, the percentage of obstetric complications during pregnancy decreased by 52%.275 However, there are studies that show that the percentage of pregnant women receiving prenatal care decreased from around 73% in 1990 to about 68% in 2003.276 Seventy percent of births in 2002 were attended by health professionals, down from 90% in 1990.277 The Ministry of Health recommends that pregnant women receive at least three prenatal checkups.278 However, women in urban areas generally receive prenatal checkups

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more often than rural women, and women with higher levels of education receive checkups more frequently than those who are less educated.279 Laws and policies A key objective of the National Reproductive Health Care Strategy for 2001–2010 is to reduce maternal mortality and morbidity. The strategy aims to achieve the following goals by the year 2010: ■ increase the percentage of women who receive prenatal care to 90%; ■ increase the percentage of pregnant women receiving at least one postnatal checkup to 60%; ■ increase the percentage of deliveries at health facilities to 80%; ■ reduce maternal mortality rate to 70 deaths per 100,000 live births; and ■ reduce the rate of obstetric complications as a percentage of total deliveries by 50%.280 The National Strategy for Advancement of Women in Vietnam for the Period 2001–2010 also establishes the following targets for maternal health: ■ increase the percentage of women receiving three prenatal checkups to 60%; and ■ increase the percentage of medical establishments with obstetric nurses to 80%.281 Delivery of services The 1989 Law on Protection of People’s Health guarantees women the right to obstetric and gynecological care and obliges the Ministry of Health to strengthen and expand the network of obstetrics and newborn health care to the grassroots level to promote women’s health.282 Village health workers are responsible for identifying pregnancies, providing first aid for common obstetric conditions, instructing mothers about proper nutrition during pregnancy and breastfeeding, encouraging pregnant women to seek prenatal care and deliver in health facilities, assisting in normal deliveries, and making periodic visits to mothers and newborns.283 Commune Health Centers (CHCs) and maternity homes provide prenatal care, iron and folic acid supplements, tetanus toxoid vaccinations, breastfeeding and nutrition instructions, and neonatal care; perform normal deliveries and perineum surgeries; manage minor obstetric complications; and identify high-risk pregnancies for referral to higher level health facilities.284 District health centers offer further maternal health-care services including management of high-risk pregnancies, treatment of eclampsia, hemorrhages, and ectopic pregnancies, and cesarean sections. Provincial general and obstetric hospitals and national-level facilities have the

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additional responsibility of diagnosing fetal abnormalities and treating serious obstetric conditions.285 Safe abortion It is estimated that the average Vietnamese woman has 2.5 abortions during her lifetime.286 This rate of abortion is among the highest in the world and reflects the lack of adequate access to safe and affordable family planning services throughout Vietnam.287 For women aged 15–19, the rate of abortion is significant at 13.4%, and for those aged 25–29 it increases to 24.9%.288 The overall abortion rate declined from 14.8% in 1998 to 10.8% in 2002, most noticeably in urban areas. However, regional disparities exist: abortion rates remain high in the northwest part of the country (44.5%) and low along the south central coast (2.8%).289 In 2002, approximately 8% of women who had abortions—primarily those from rural areas—suffered some type of postoperative complication. The most common complications are bleeding (2.5%), infection (2%), and uterine rupture (0.5%).290 Abortion laws and policies Abortion is legal in Vietnam. The 1989 Law on Protection of People’s Health recognizes a woman’s right to decide to have an abortion.291 In an effort to better guarantee quality medical care for women, including access to safe abortion services, the law requires the Ministry of Health to standardize the quality of care and increase access to obstetric and newborn health-care centers throughout the country, even in the smallest communes.292 Under the Penal Code, any person who causes a pregnant woman to miscarry or whose conduct results in serious harm to a woman’s health may be punished with imprisonment ranging from five to fifteen years.293 The offender can also be fined from 5 million to 50 million VND (USD 330 to USD 3,306), and may concurrently be removed from his or her position and/or banned from the practice of medicine for one to five years.294 One major goal of the National Reproductive Health Care Strategy for 2001–2010 is to reduce the number of unwanted pregnancies and to manage abortion-related complications effectively.295 The strategy states that qualified health personnel, medical equipment and other supplies, and counseling should be a standard part of post-abortion care.296 Local policies provide incentives such as allowances and maternity leave for women who terminate their pregnancies. A circular in Ho Chi Minh City, for example, entitles women who have terminated a pregnancy to a fully paid maternity leave of seven to thirty days and ten kilos of rice.297 Delivery of abortion services Medical institutions and practitioners are forbidden to perform abortions unless they have been authorized to do so

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by the Ministry of Health or local health bureau.298 Medical establishments and practitioners that terminate pregnancies are required to have professional certificates issued by the Ministry of Health.299 Failure to comply with this requirement is a violation of the Penal Code.300 Public health facilities at all levels provide counseling on safe abortion to women and adolescents. National, provincial, and district health facilities as well as maternity homes and intercommune polyclinics staffed with an obstetrician may perform abortions by D&C (Dilation and Curettage) or vacuum aspiration on women who are less than 12 weeks pregnant.301 HIV/AIDS and other sexually transmissible infections (STIs) The cumulative number of HIV infections at the end of 2003 was estimated at 220,000, of which 20,000 were children.302 Between 2001 and 2003, the prevalence of HIV/AIDS among 15- to 49-year-olds increased from 0.3% to 0.4%.303 New HIV cases are also on the rise, especially among adolescents, intravenous drug users (IDUs), and sex workers.304 According to the Ministry of Health, there were 14,460 new cases reported in 2003 compared with 9,501 new cases in 2002,305 and 40 to 120 Vietnamese become HIV infected every day.306 The World Health Organization listed HIV/AIDS as the fifth leading cause of death in 2002.307 Almost 60% of new HIV infections in 2003 were among IDUs and 3% were among sex workers; since 1999, about 40% of all reported HIV cases have been reported among youths aged 15 to 24.308 Although the current incidence of HIV infection by sexual transmission is low compared with IDUs, who account for 57% of reported HIV cases, it is on the rise and is expected to become the dominant mode of HIV transmission in the next decade.309 Laws and policies The principal national-level law relating to HIV/AIDS is the 1995 Ordinance on the Prevention and Fight Against HIV/ AIDS Infection, which outlines the rights and responsibilities of the government as well as individuals with respect to people living with HIV/AIDS.310 The ordinance prohibits discrimination against persons living with HIV/AIDS.311 Among its key provisions are the following: ■ Individuals are responsible for protecting themselves from HIV/AIDS by employing preventive measures as well as by participating in preventive activities against the spread of HIV/AIDS in the family and community; ■ A spouse who is aware that he or she is carrying the HIV virus or has AIDS should inform his or her spouse, otherwise the medical establishment will do so; and

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It is strictly prohibited to pass the HIV/AIDS virus to others intentionally.312 Additionally, the Penal Code makes it a crime for anyone to infect others with HIV/AIDS knowingly and prescribes punishments including imprisonment for up to ten years. Transmission of the disease to adolescents or multiple persons is considered an aggravating circumstance and may result in a prison sentence of 20 years.313 The primary policy to address HIV/AIDS is the Prevention of HIV/AIDS Strategy 2000, aimed at preventing transmission of the virus through sexual intercourse, blood transfusion, and from mother to child. The strategy also provides treatment and care for persons infected with HIV, including socioeconomic support for their families.314 The government has also expressed concern over the high incidence of HIV infection in the National Strategy for Reproductive Health Care.315 The first National Strategy on HIV/AIDS Prevention and Control up to 2010 with a vision to 2020 was launched in March 2004. The strategy promotes a multisectoral approach to reducing the stigma of HIV/AIDS and discrimination against people who have it; increasing the national and provincial capacity for preventing HIV/AIDS; and piloting community-based harm-reduction, treatment, and care programs in several cities.316 The strategy is partially funded by a USD 35 million grant from the World Bank.317 Adolescent reproductive health In 2004, there were 24 million adolescents and youths (aged 10 to 24) in Vietnam, constituting about one-third of the Vietnamese population.318 Despite the growing trend of marrying at a later age, the number of adolescents who give birth before the age of 20 remains high, and about one-fifth of women become mothers before age 19.319 In rural areas up to 6.6 % of girls between the ages of 15 and 19 become mothers; in urban areas the rate is 1.6%.320 Studies reveal an increase in unprotected sex among adolescents.321 Evidence shows that the rate of young people infected with HIV is also on the rise. According to the Ministry of Health, in 2001, 60.1% of HIV carriers were adolescents.322 Those infected with HIV in the 13–19 age group increased from zero in 1992, to almost 10% in 2001.323 In 1997, Vietnam ranked 11th among 38 countries in the number of children under the age of 15 who lost a parent due to AIDS.324 The Ministry of Health estimates the number of children under five infected with HIV increased from 7 in 1997 to 210 in March 2002.325 Furthermore, a survey conducted in 1998 in Hanoi, Thai Binh, Binh Dinh, Binh Duong, and Ho Chi Minh City showed that of 4,675 adolescents in the 10–19 age group, 11.6% of females and 6.5% of males said they had suffered reproductive tract infections.326 ■

Laws and policies The Vietnam Population Strategy 2001–2010 calls for giving adolescents and youths both reproductive health information and access to reproductive health services.327 Government concern about adolescent reproductive health is also reflected in the National Strategy on Reproductive Health Care 2001–2010.328 The strategy aims to provide reproductive health information, education, and counseling (IEC) at 80% of the country’s reproductive health-care facilities and to educate 70% of all adolescents about sexual development and sexuality.329 One of the strategy’s goals is to create counseling centers that will provide adolescents with reproductive health-care services, including supplying contraceptive methods such as condoms for preventing STIs; provide safe abortions; and, where conditions permit, establish gynecological wards for young female patients.330 Delivery of information and services Currently, reproductive and health education is provided through many channels, such as schools, family, mass media, community activities, youth organizations, and counseling centers. The Government of Vietnam, with the assistance and support of the United Nations Population Fund (UNFPA) and other international and nongovernmental organizations, introduced sex education into the curricula of selected schools in 1984.331 However, important topics such as STIs, family planning methods, and abortion have yet to be included in these curricula.332 In Vietnam, a variety of television programs address reproductive and sexual health for adolescents and youths.333 From Eye to Heart is one such program, which features a group of ten youths who discuss issues such as sexuality, premarital sex, pregnancy, and abortion.334 There is also Girls’ Program, a weekly show that targets 12- to 15-yearolds and focuses on physical and psychological sexual development and education.335 C. POPULATION

Since the 1960s, Vietnam has had several different population policies that have reflected the country’s stages of development. From 1961 to 1975 a campaign to limit the family size to three children was targeted toward women in urban areas, rural areas in the Red River delta, the former fourth interzone, and the midland and highland provinces.336 From 1975 to 1984, there was a countrywide push to encourage the use of birth control, and the government issued specific instructions to promote and increase birth control use.337 Dramatic changes in family planning occurred between 1991 and 1996, when the government attempted to implement a two-child policy.338 This policy was abandoned in 2000339

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and replaced the following year by the Vietnam Population Strategy 2001–2010, which emphasizes the benefits of small family size and voluntary family planning.340 Today, population growth remains a primary concern for the Government of Vietnam. With a population of just over 82 million in 2004, Vietnam is one of the most populous countries in South East Asia and in the world.341 While the rate of population growth has decreased significantly in recent years, the large population size is viewed by the government as one of the “ongoing constraints that continue to fence Vietnam in the group of poor countries in the world.”342 Laws and policies Vietnam’s current population policy is set forth in the Vietnam Population Strategy for the Period 2001–2010.343 The implementation of the strategy has been divided into two periods. The first period (2001–2005) was supposed to focus on achieving a steady reduction of birth rates with special attention given to areas with high fertility rates. The goal was to balance the birth rate with the death rate countrywide by 2005. Additionally, pilot models and programs to improve the quality of the population were to be implemented, as were combined information campaigns designed to change reproductive behavior and to provide reproductive health care and family planning services in remote and poor regions with high birth rates. Finally, a national population database system was scheduled to be created to expand successful experimental models.344 For the second period (2006–2010), the goals of the strategy include maintaining a balance between the average birth and death rates through reproductive health and family planning services, perfecting and expanding intervention measures to “raise the quality of the population physically, intellectually and spiritually,” and consolidating the national population database system.345 The main objective of the strategy is to promote the concept of the small family to stabilize the population and improve the overall quality of life in the country. In the long run, the policy aims to improve people’s skills to meet the demands of industrialization and modernization in order to contribute to the rapid and sustainable development of the country.346 Other major objectives include achieving a stable population by 2005 (by 2010 in poor and rural areas) at a level consistent with the requirements of socioeconomic development; and improving the overall health and educational development of the population to achieve a more advanced human development index (HDI) by 2010.347 Implementing agencies The National Committee on Population and Family

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Planning is the government branch charged with carrying out the Vietnam Population Strategy and overseeing population planning.348 The committee has several important functions: it builds and implements programs to enhance the management capacity of civil servants working in the field; promotes behavioral change to ensure compliance with population laws and strategies; improves the quality of available information regarding population and family planning; integrates population and family development programs with credit and saving activities and economic development; strengthens population and family planning services in poor and remote areas; and works closely with the Ministry of Health to undertake reproductive health and family planning programs.349 The Ministry of Education and Training is responsible for implementing those parts of the strategy relevant to education and training in and outside of school, especially education about reproductive health, gender, and sex.350 The Government of Vietnam views the issue of ethnicity as one of special importance. The population and family planning policies pay particular attention to ethnic groups, and this commitment is reflected in two key documents: ■ Resolution No. 04-NQ/HNTW of January 14, 1993, on population and family planning calls for the creation of policies for the protection and development of ethnic minorities with declining populations; ■ Decision No. 270/TTg of June 3, 1993, on the Population and Family Planning Strategy requires the government to counter declining population rates and poor living conditions among certain ethnic minorities by expanding their access to and improving the quality of maternal and child health-care services, combating malnutrition, and fighting such ailments as malaria and goiter.351

III. Legal Status of Women and Girls The health and reproductive rights of women and girls cannot be fully understood without taking into account their legal and social status. Laws relating to their legal status not only reflect societal attitudes that shape the landscape of reproductive rights, they directly impact their ability to exercise these rights. A woman or adolescent girl’s marital status, her ability to own property and earn an independent income, her level of education, and her vulnerability to violence affect her ability to make decisions about her reproductive and sexual health and access to appropriate services. The following section

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describes the legal status of women and girls in Vietnam. A. RIGHTS TO EQUALITY AND NONDISCRIMINATION

The first Constitution of the Republic of Vietnam, approved by the National Assembly in 1946, provided that “all power in the country belongs to the Vietnamese people, irrespective of . . . sex . . . and that women are equal to men in all respects.”352 Subsequent amendments have strengthened women’s legal status.353 The 2001 constitution includes several guarantees of the rights to equality and nondiscrimination. It provides that “[a]ll citizens are equal before the law”354 and that “[m]ale and female citizens have equal rights in all fields—political, economic, cultural, social, and the family.”355 The constitution strictly prohibits all acts of discrimination against women and all acts harmful to women’s dignity.356 Further, the constitution obliges the government and civil society to help women reach their full potential both within and outside of the home. It proposes a new social ethic that would relieve women of the sole responsibility for housework, enabling them to complete their education, advance their career, obtain access to health care, and enjoy periods of rest in addition to being able to fulfill their maternal obligations.357 Finally, the constitution prohibits discrimination between sons and daughters.358 The right to gender equality is also recognized in a number of national laws, including the Penal Code, the Civil Code, the Marriage and Family Law, the Labour Code, and the Education Law. The strongest and most sweeping of these laws is the Penal Code, which penalizes anyone who uses “force” or performs other “serious actions” in an attempt to keep women from participating in political, economic, scientific, or social activities with imprisonment ranging from three months to a year.359 The Marriage and Family Law prohibits discrimination on the basis of sex.360 Formal institutions and policies The Government of Vietnam has created several institutions and a number of strategies designed to achieve gender equality.361 National organizations committed to promoting women’s equality include the National Committee for the Advancement of Women in Vietnam (NCFAW), the Vietnamese Women’s Union (VWU), and the Board for Women’s Affairs under the Vietnam Labor Confederation.362 NCFAW was established in 1993 and serves as the principal coordinating and strategizing body for promoting women’s status and enhancing women’s roles in Vietnam.363 It oversees the creation and expansion of women’s subcommittees in agencies under the authority of ministries and administrations, and governing bodies in provinces, districts, towns,

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communes, and wards.364 By 2001, all provinces and cities and most ministries had established subcommittees for the advancement of women, raising the total number of national ministries with such committees to 50 out of a total of 53.365 Women’s subcommittees at all levels are required to develop an action plan that sets forth concrete measures to implement the National Strategy for the Advancement of Women.366 The key responsibilities and roles for NCFAW are outlined in the National Strategy for the Advancement of Women in Vietnam 2001–2010 and its first implementing plan, the National Plan of Action for the Advancement of Women in Vietnam 2001–2005,367 and include the following: ■ disseminate information on the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) and other laws and policies concerning women;368 ■ integrate CEDAW into the current legal system;369 ■ conduct training courses to promote gender awareness among policy makers, civil servants, and those responsible for implementing government policies, especially men and high-ranking officers;370 ■ research and assess the impact of national laws and policies on women and develop a database of gender statistics;371 ■ advise government officials and monitor government agencies that enforce laws, policies, and training activities relating to women’s rights;372 ■ conduct public information, education, and communication activities to promote gender equality in all sectors;373 ■ emphasize the importance of women’s full and equal participation in all aspects of social and family life;374 and ■ advance the rights and interests of the girl-child.375 Other goals specified in the Strategy for the Advancement of Women and the Plan of Action for the Advancement of Women include the following: ■ expand employment opportunities for women; ■ improve women’s access to economic resources;376 ■ eradicate illiteracy and increase opportunities in education and training for women;377 ■ improve the quality of health care for women, including reproductive health services;378 and ■ enhance the role and position of women leaders and increase the number of women in government.379 The VWU mobilizes women across socioeconomic divides to participate directly in drafting laws and policies relating to women and children.380 The VWU further collaborates with state ministries and administrations at all levels to implement

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programs that satisfy the needs of women and children.381 The VWU functions at the central, provincial, district, and commune administrative levels.382 B. CITIZENSHIP

The 1996 Civil Code guarantees every individual’s right to citizenship and provides that “[t]he recognition, change, naturalization, and renunciation of Vietnamese citizenship shall be carried out in accordance with the conditions, orders, and procedures provided for by the law on citizenship.”383 C. MARRIAGE

The Marriage and Family Law was endorsed by the National Assembly in June 2000 and took effect in January 2001. The law establishes marriage as a right and endorses the principle of monogamous union based on equal relations between a man and a woman.384 Marriages between Vietnamese citizens of different ethnicities and/or different religions, between religious and nonreligious people, and between Vietnamese citizens and foreigners are respected and protected by law.385 The state, society, and family have the duty to protect women and children, and to help mothers fulfill the functions of motherhood.386 Under the Marriage and Family Law, the minimum marriage age is 20 for men and 18 for women. The decision to marry must be made voluntarily by both parties; the use of force, deception, or obstruction is strictly prohibited.387 The law also stipulates conditions under which marriage is forbidden, some of which include the following: ■ between people who are already married; ■ between people who have lost their civil capacity to act; ■ between family members within three generations; ■ between current or former adoptive parents and their adopted children; and ■ between people of the same sex.388 To protect the sanctity of marriage and the family, the Marriage and Family Law prohibits acts of false marriage, coercive marriage, marriage and divorce scams, cheating, and requiring dowry upon marriage.389 It guarantees equality between the husband and wife and endows each with “equal obligations and rights in all aspects of the family”.390 The law further dictates that husband and wife must respect each other and must not mistreat one another, or injure the other’s honor, dignity, or reputation in any way.391 Women’s rights in marriage are also protected by the 1996 Civil Code. According to the code, the wife and husband have equal rights and obligations in all aspects of their family and civil lives.392 In addition, men and women have the right

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to choose a family name and forename;393 the right to exercise full freedom of choice in marriage, including the right to choose a spouse of a different nationality or religion;394 and the right to request, for a legitimate reason, the termination of a marriage.395 Finally, the Civil Code also emphasizes the principle of monogamous marriage which is based on the union of one husband and one wife.396 The Marriage and Family Law stipulates that cohabiting couples without a marriage registration are not legally recognized as husband and wife.397 Laws governing marriages for ethnic minorities The laws and customs of ethnic minority groups must conform to the Marriage and Family Law. Those customs not conflicting with national law are to be respected.398 Decrees No. 32/2002/ND-CP and No. 38/2002/NDCP regarding the application of the Marriage and Family Law to ethnic minorities aim to eliminate customs that contravene the 2000 Marriage and Family Law.399 They include strict prohibitions on kidnapping girls and forcing them into marriage and on the use of superstition to hinder men and women from marrying freely.400 Additionally, they affirm the right of widows and widowers to remarry freely without having to compensate the families of the late spouse.401 Other customs banned by Decree No. 32/2002/NDCP include marriages to underage persons; marriages not registered at the communal People’s Committee; marriages between relatives; and the prohibition of marriages on the basis of differences in ethnicity or religion.402 D. DIVORCE

The 2000 Marriage and Family Law also governs divorces in Vietnam.403 The law recognizes the right of a husband or wife to ask the court to settle a divorce case.404 Husbands are prohibited from seeking a divorce if the wife is pregnant or nursing a child under one year of age.405 According to the Marriage and Family Law, the court can review an application for divorce “when the situation is serious, the cohabitation can no longer exist, or the goal of the marriage fails.”406 There are two types of divorces: ■ Divorce requested by both parties with agreement on the division of property and child custody arrangements. In this instance, the court will review the agreement to ensure that the best interests of the wife and children are protected.407 ■ Divorce by request of one party following failed mandatory reconciliation attempts. In this case, the court determines whether divorce is appropriate.408 Maintenance and support laws Vietnamese laws do not require financial support for

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either the wife or the husband upon divorce. However, the Marriage and Family Law contains provisions that determine the division of property at the time of divorce.409 Upon divorce, property is to be divided according to the mutual wishes of the parties.410 If the parties fail to agree, the court may divide the property.411 Each party retains his or her own property.412 Common property is to be divided so that each side obtains the same value amount.413 If there is a difference in value, the side getting the higher value must pay the difference to the other.414 When deciding how to divide the property, the law requires that the needs of each side as well as of each dependent be considered.415 Parental rights According to the Marriage and Family Law, a couple must agree at the time of divorce on who will have custody of the children and on each spouse’s responsibilities towards the children.416 If the couple cannot agree, the mother receives custody of children under three years old.417 After the divorce, both the mother and father remain obligated to care for, educate, and raise their adolescent children and adult children with disabilities who are unable to support themselves.418 The law also states that “those who do not take primary responsibility for the children shall have the obligation to provide financial assistance.”419 E. ECONOMIC AND SOCIAL RIGHTS

Ownership of property and inheritance The constitution guarantees the right to enjoy property without interference from the government. However, it allows the state to forcibly purchase or requisition citizens’ property for national security reasons.420 The Civil Code of the Socialist Republic of Vietnam approaches the right to enjoy private ownership in a nondiscriminatory way.421 For instance, the code provides the right to inheritance in the following order: “the wife, husband, biological father, biological mother, adoptive father, adoptive mother, biological children adopted children of the decedent.”422 The 2000 Marriage and Family Law establishes that spouses have “the right to inherit each other’s property as defined by laws on inheritance.”423 Women are promised the same opportunities as men to participate independently in civil transactions, contracts, property management, and litigation to legally protect their interests.424 All civil transactions made in accordance with established law are valid and enforceable regardless of whether they are carried out by a man or a woman.425 The Marriage and Family Law requires that land use contracts for rural land be listed with the names of both spouses to indicate shared ownership.426 However, 80% of

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land use contracts are registered in the name of the male head of household as stipulated by the 1993 Land Law.427 The Marriage and Family Law also provides that property be equitably and logically divided between the husband and wife upon divorce.428 Labor and employment In 2001, almost 80% of Vietnamese women participated in the labor force,429 accounting for over 48% of the labor force.430 Only 38% of salaried workers are women.431 Women earn on average only 78% of the wages earned by their male colleagues with similar qualifications in the same sector.432 Women are disproportionately employed in the fields of education, sales, accounting, and industrial labor and are less likely than men to be employed in management positions and technical jobs.433 Since the doi moi reforms, there has been a 40% decline in the number of women hired by the state and as a result the number of women working in the private sector has risen substantially.434 The constitution states that men and women have equal rights in the labor force and should receive equal pay for equal work.435 It mandates maternity leave for all female workers and fully paid prenatal and postnatal leaves for female civil servants and salaried workers.436 Both the Civil Code and the Labour Code recognize the right to work.437 The Civil Code also confers the freedom to choose a job or occupation without discrimination on the basis of sex.438 The Labour Code, revised in 2002, articulates the rights and obligations of employees and employers and outlines labor standards.439 In addition to the right to work, the code guarantees the freedom to select a job or occupation, to learn a trade, and to receive vocational skills training irrespective of sex.440 The Labour Code stresses the right to gender equality in the workplace441 and asserts that qualified female job applicants be given priority.442 The state is urged to adopt a policy of “preferential treatment” (in the form of tax breaks) for businesses that employ many female workers,443 and it has the responsibility to develop “various forms of training in favor of female workers” that will enable them to increase their flexibility in the job market.444 Furthermore, the Labour Code prohibits employers “from conduct which is discriminatory toward a female employee or conduct which degrades the dignity and honor of a female employee.”445 It maintains that women and men should receive equal pay for equal work and should be treated equally with respect to wage increases.446 In a workplace with women, the Labour Code states that there must be changing rooms, shower facilities, and toilets for women.447 Additional guidelines exist regarding the treatment of women in the workforce. Under the Labour Code, a woman

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must not be assigned “heavy or dangerous work, or work requiring contact with toxic substances, which has adverse effects on her ability to bear and raise a child.”448 The Law of Protection of People’s Health stipulates that “organizations and individuals using women’s labor must follow regulations aimed at protecting women’s health, and implement policies toward pregnant women, women in childbirth, nursing mothers, and applied family-planning methods.”449 Employers may not hire women of any age for work in mines or for jobs that require constant immersion in water.450 Businesses that employ women in these restricted fields must adopt plans to train and gradually transfer female employees to jobs that are more appropriate for their health and must intensify measures to protect the health of female employees.451 To help rural women advance their agricultural productivity and improve the quality of their lives, the VWU and the Ministry of Agriculture and Rural Development issued Joint Resolution No. 47/2000/NQLT/LHPN-BNN in April 2000.452 The resolution sets forth concrete measures to implement an action plan adopted by the Ministry of Agriculture and Rural Development and the Vietnam Women’s Union Central Committee.453 These measures include encouraging women to apply technical advances to agricultural production, maintenance, processing, and the selling of farm produce; to assist each other in developing household, farm, and forestry economies; and to protect the environment.454 Circular 05/TT-TLD dated May 1, 1989, issued by the Vietnam General Federation of Trade Unions, lays out special allowances that can be granted to female employees who miscarry or undergo abortion, menstrual regulation, or the insertion of IUDs.455 These allowances are as follows: ■ Female workers who have two or more children are entitled to 20 days of rest (including Sundays and holidays) after having an abortion that took place before the third month of pregnancy and 30 days of rest after having an abortion that took place after the third month of pregnancy, with allowances provided by a social security fund equivalent to 100% of their salary and bonus. ■ Female workers who have two or more children are entitled to seven days of leave (including Sundays or holidays) following any procedure to regulate menstruation, or after they have been fitted with an IUD, with allowances provided by a social security fund equivalent to 100% of their salary and bonus. ■ Female workers who have no children or who have one or two children are entitled to a sum of VND 2,500 (USD 0.16) toward their health allowance, after

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undergoing a procedure to regulate menstruation. This is in addition to a specified rest period and other standard allowances detailed in circulation 01/TLD dated January 1, 1989.456 Pregnant employees are legally entitled to unilaterally terminate their employment contract without penalty if a doctor concludes that their fetus will be harmed if they continue working.457 In such cases, the time limit provided by the doctor determines when the woman must notify her employer.458 The Labour Code states that female employees are entitled to pre- and postnatal leaves of absence that range from a total of four to six months “as determined by the government on the basis of working conditions and nature of the work, whether the work is heavy, harmful, or in remote locations.”459 At the end of her maternity leave, a woman can arrange with her employer to take additional unpaid leave.460 A female employee is also entitled to return to work after two months of maternity leave if her doctor approves.461 Women who exercise this option must notify their employers in advance. They continue to receive maternity benefits in addition to their regular salaries for the days they work.462 The Labour Code also stipulates that female workers employed in heavy manual labor who are seven or more months pregnant should be assigned to lighter jobs, or should have their daily work hours cut by one hour while continuing to receive full pay.463 In general, employers are not permitted to assign women who are seven or more months pregnant, or women who are nursing children under the age of one, to “work overtime, at night, or in distant places.”464 Furthermore, female employees are entitled to 30 minutes of rest per workday during their periods,465 and if they are nursing children under 12 months, they are entitled to 60 minutes off during working hours while continuing to receive full pay.466 In workplaces where the number of female employees is high, the employer is responsible for organizing a daycare center or preschool class, or for covering part of the kindergarten or preschool costs incurred by female employees with young children.467 The Labour Code identifies the following circumstances under which a female employee is entitled to receive social insurance benefits when taking leave:468 a prenatal examination; an abortion; caring for a sick child under seven years of age; or adopting a newborn. Under these circumstances, female employees are entitled to a social insurance benefit, or their employer must pay them a sum equivalent to the social insurance benefit.469 The length of time of the leave and the level of social benefit are determined by the government.470 After maternity leave, or even after

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permitted unpaid leave, a female employee is assured of her job upon returning to work.471 During her maternity leave, a female employee is entitled to receive a social insurance benefit equal to 100% of her salary, plus an additional benefit equal to one month’s wages if she is giving birth to her first or second child and has paid her social insurance premium.472 Aside from the Labour Code, social insurance benefits are also discussed in the 1995 Regulations on Social Insurance.473 The regulations guarantee social insurance benefits for workers who take time off to attend to a sick child under the age of seven.474 The regulations also contain provisions for maternity benefits during pregnancy and childbirth,475 including three full days of paid leave for medical examinations.476 If an employee suffers a miscarriage, she is entitled to 20 days of paid leave if the miscarriage occurs before the third month of pregnancy and 30 days if the miscarriage occurs after the third month.477 The regulations also detail the time limits for maternity leave that were initially outlined in the Labour Code.478 They provide four months of prenatal and postnatal leave for women who work in “normal conditions.”479 The leave is extended to five months or more for women engaged in harmful or special occupations as determined by the Ministry of Labour, Invalids, and Social Affairs.480 Special provisions exist for women in unique circumstances. For example, when an employee gives birth to twins or other multiples, she is entitled to an extra 30 days of leave per additional child.481 In cases where a child is stillborn, or dies before the age of 60 days, the female employee is entitled to 75 days of leave after the date of delivery, with full benefits.482 If the child dies after the age of 60 days, the female worker is entitled to 15 days of leave after the day the child dies.483 A number of policies articulated in the National Strategy for the Advancement of Women in Vietnam for the Period 2001–2010 and the National Plan of Action for the Advancement of Women in Vietnam 2001–2005 aim to improve women’s economic status in labor and employment. These include the following: ■ hire women for 50% out of the total 13.5 million new job placements; ■ increase the rate of women receiving professional training to 40%; ■ reduce the rate of urban women’s unemployment to 5%; and ■ increase the proportion of female participants in agricultural extension services to 50%.484 The policies seek to achieve these goals through the following actions: ■ strengthening gender mainstreaming activities in all

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social and economic programs; revising and strengthening the enforcement labor and employment policies to ensure gender equality in recruitment, maternity leave, labor safety, vocational training, income, retirement, and social insurance;485 ■ increasing women’s access to economic resources including land, credit, technical training, and agricultural extension;486 ■ investing in professional, vocational, and technical training programs for women;487 ■ developing a database of women’s status in the labor and employment market;488 and ■ researching the impact of economic development and structure on female workers.489 The retirement age for Vietnamese women is generally five years younger than that of their male counterparts. Salaried women reach compulsory retirement by age 55, but men may work until age 60.490 Access to credit A number of lending channels are available to women in both the formal and informal sectors. The majority of women borrow from private informal sources where interest rates are higher and funds are limited.491 Women hold 41% of all loans in Vietnam, but only 29% of the loans are from formal institutions such as the Vietnam Bank for Agriculture and Rural Development (VBARD), the Vietnam Bank for the Poor (VBP), and the People’s Credit Fund.492 Rural women constitute 10% of borrowers from the VBARD,493 and the number of rural women with access to loans has risen steadily in recent years.494 These institutions provide loans through savings borrowing groups, or with the guarantee of the commune people’s committee, and do not ask for collateral security.495 In 1999, banks provided loans to 2,340 households with a total value of VND 4,086 billion (USD 270 million), an increase from 1998 of VND 797 billion (USD 53 million).496 The VWU manages a revolving credit scheme of VND 4,000 billion (USD 265 million) that provides small, lowinterest loans to women.497 However, these loans are contingent upon participation in family planning, literacy, or other social programs.498 The VWU organizes more than 30% of the 197,000 saving groups in all provinces and cities nationwide.499 Education Literacy rates in Vietnam are generally high. In 2003, the literacy rate for women above the age of 15 stood at 92%, while the rate for men above age 15 was 95%.500 Yet statistics reveal that the rate of illiterate women and girls living in remote and highland areas can be as high as 50% to 60%, particularly in ■

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the Central Highlands and northern mountainous areas and among ethnic minorities.501 Vietnam has an 89% primary education enrollment rate and is close to achieving gender balance in primary education.502 In 2000, girls constituted 47.9% of primary school students, 46.9% of junior secondary school students, and 46.8% of senior secondary school students.503 The number of girls who drop out of primary education is disproportionately high (girls account for 70% of all dropouts), and girls receive an average of 1.1 fewer years of schooling than boys.504 The number of females in higher education is significantly lower (39%) than that of males, which the Vietnamese government considers one of the biggest constraints in education equality.505 The constitution affirms that “the citizen has both the right and the duty to receive training and instruction” and that “[p]rimary education is compulsory and dispensed free of charge.”506 Education and training are “top-priority policies” for the government.507 The 1998 Law on Education gives legal force to the guarantees to equal education outlined in the constitution.508 The law aims to strengthen the national education system, improve the quality and accessibility of education, and raise the education level and professional capacity of the population in order to complement the industrialization and modernization of the country.509 The national general education system comprises five years of compulsory primary education; four years of junior secondary education; and three years of senior secondary education or one to four years of vocational secondary school.510 Under the law, the state must create conditions that ensure gender equality at all levels of education.511 Families are responsible for sending their children between the ages of six and fourteen to compulsory primary education facilities.512 The Vietnamese Population Strategy 2001–2010 emphasizes gender equality in education, listing universal education for all girls of school age and job training for female workers as two of its primary goals.513 It also establishes specific benchmarks for equal education, including raising the proportion of literate adults to 97%–98%, and increasing to 22%–25% the rate of people attaining a general school education by the year 2010.514 Other long-term goals of the strategy include establishing universal junior secondary schooling by the year 2010.515 The Education Development Strategy 2001–2010 and the Comprehensive Poverty Reduction and Growth Strategy 2001–2010 also address gender equality in education. Both strategies aimed to eliminate gender differentials in primary and secondary education by 2005 and at all levels of education by 2010.516

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F. PROTECTIONS AGAINST PHYSICAL AND SEXUAL VIOLENCE

Rape The Penal Code provides the legal framework for prosecuting crimes of rape (hiep dam). The code defines the crime of rape as occurring when any person uses force or threatens to use force or coercion of any kind to have sexual intercourse with another person who either did not or could not (because of a physical or mental handicap) consent to the act.517 A convicted rapist is subject to imprisonment from two to seven years.518 The punishment for rape is increased to seven to fifteen years’ imprisonment when it is committed under some of the following circumstances: ■ as part of organized crime; ■ where the perpetrator is the victim’s guardian, caretaker, teacher, or medical provider; ■ where the victim is raped by multiple persons or multiple times by one person; ■ incest; or ■ where the rape results in serious health problems for the victim.519 Crimes of rape under other circumstances can result in 12 to 20 years’ imprisonment, life imprisonment, or the death penalty.520 These circumstances include the following: ■ severely harming the health of the victim, resulting in a disability; ■ knowledge by the rapist of his HIV-positive status; and ■ causing the victim’s death or suicide.521 The rape of adolescents between the ages of 16 and 18 is subject to higher terms of imprisonment, ranging from five to ten years.522 Persons convicted of rape are prohibited from holding professional positions or accepting certain specific jobs for a period of one to five years.523 Marital rape is not explicitly mentioned as a criminal offense of the Vietnamese Penal Code.524 In theory, women may bring cases of marital rape to the court under the Penal Code’s provisions for crimes of sexual violation (cuong dam), which, depending on the circumstances, can be punishable by six months to eighteen years’ imprisonment.525 Domestic violence No specific national legislation on domestic violence exists in Vietnam, and the government has not required officials dealing with this type of violence to undergo any special training. Several legal provisions provide relief to victims of physical or mental spousal abuse; nevertheless, domestic violence is widespread in Vietnam. One study found that 40% of women in a lowland village and 70% in a highland village reported being regularly subjected to physical violence.526

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The constitution and the Civil Code protect the right of Vietnamese citizens to life, health, honor, and dignity.527 The Penal Code is the only source of law, however, that is directly relevant to domestic violence. It stipulates that repeat and firsttime offenders who “ill-treat or persecute” family members and cause “serious consequences” may be given a formal warning, probation for up to two years, or imprisonment for three months to two years.528 The Marriage and Family Law similarly forbids “illtreatment [or] persecution against grandparents, parents, spouses, children, grandchildren, siblings, or other family members.”529 It provides that “agencies, organizations, and individuals have the right to request the court or other competent bodies to take measures to promptly stop and handle” violators of the law.530 Violations of these provisions result in administrative sanctions, penal liability, or the payment of monetary compensation.531 Sexual harassment There is no specific law regarding sexual harassment in Vietnam. However, the constitution strictly prohibits all acts of discrimination against women and acts harmful to a woman’s dignity.532 It obliges the state and society to “create all necessary conditions for women to raise their qualifications in all fields and fully play their roles in society,” including the workplace.533 Commercial sex work and sex-trafficking Commercial sex work is prohibited in Vietnam. According to the Ministry of Labor, Invalids, and Social Affairs, two hundred thousand women are involved in the sex industry in Vietnam.534 The Penal Code prescribes punishment for persons harboring and procuring commercial sex workers.535 It also prohibits paid sexual intercourse with minors between the ages of 16 and 18 and punishes violators with up to eight years’ imprisonment.536 Any person convicted of organizing or encouraging commercial sex work will be imprisoned for six months to five years.537 Sex workers who are aware of their HIV status and knowingly spread the disease to others are held criminally liable.538 The 2003 Ordinance for Prevention and Control of Prostitution outlined a series of social and economic measures to prevent commercial sex work and to support the women who were involved in it. These measures include job training, job creation, medical assistance, and educational opportunities.539 The government enacted stiffer penalties for traffickers in the 2000 revisions to the Penal Code. The revised code criminalizes trafficking of women and prescribes prison sentences ranging from two to seven years for violators, as well as fines and probation.540 Additionally, persons found

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guilty of organizing the illegal entry or exit of persons to or from Vietnam face prison terms of up to twenty years and a maximum fine of VND 50 million (USD 3,306).541 Prime Minister’s Directive No.766/TTg outlines how various ministries and governmental agencies should collaborate and implement measures to prevent crossborder illegal trafficking of women and children and punish trafficking ringleaders. These ministries include Internal Affairs; Foreign Affairs; Labor, Invalids and Social Affairs; Justice; Trade; Culture and Information; Finance, Investment, and Planning; Tourism Administration; and the National Committee for the Care and Protection of Children.542 The directive instructs the Ministry of Internal Affairs to coordinate with Interpol and police forces of neighboring countries, especially China and Cambodia, to discover, prevent, and eradicate organized trafficking chains.543 Furthermore, the people’s committees at the province and district levels must guide and empower local police forces to strengthen border patrols, find missing persons, and spearhead efforts to end the trafficking of women and children.544 The VWU, with the support of the International Organization for Migration, has been a leading body in the implementation of the directive through its IEC antitrafficking campaigns in 14 provinces and cities, and in its provision of support to trafficked victims for community reintegration efforts.545 Sexual offenses against minors According to the Ministry of Public Security, the rape of minors increased from 14.8% of total rape cases in 1993 to 31% in 1996.546 The percentage of juveniles involved in commercial sex work has also risen from 7% to 14% in recent years547 The Ministry of Labor, Invalids, and Social Affairs estimates that there are at least twenty thousand girls involved in the sex industry.548 A 2000 survey of two thousand sex workers in Ha Noi and Ho Chi Minh shows 70% of commercial sex workers are under 25 years of age, and many of them are HIV-positive.549 The Vietnamese Penal Code addresses rape and other sexual offenses committed against minors. It defines sexual intercourse with a girl who is between the ages of 13 and 16, without her consent, as rape (hiep dam tre em).550 The crime is punishable by seven to twenty years’ imprisonment, or in serious circumstances, life imprisonment or death.551 An adult who has consensual sexual intercourse with a girl who is between the ages of 13 and 16 is penalized by one to ten years’ imprisonment.552 Sexual intercourse with a girl under the age of 13, regardless of consent, is considered statutory rape under the Penal Code.553 The code prescribes a minimum sentence of twenty years’ imprisonment, to life imprisonment, or the death penalty.554

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Persons who have sexual intercourse with an adolescent sex worker between the ages of 16 and 18 may be subject to one to eight years’ imprisonment.555 Sexual molestation of a minor is characterized as a crime of sexual violation (cuong dam) under the Penal Code. Where the act is committed against an adolescent between the ages of 16 to 18, imprisonment of two to seven years’ is prescribed.556 If the victim is under 16, the perpetrator will be subject to a minimum sentence of five years’ imprisonment or, at maximum, life imprisonment.557

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ENDNOTES 1. Federal Research Division, Library Of Congress, Country Studies:Vietnam, Country Profile 4 (Ronald J. Cima ed., 2004), http://lcweb2.loc.gov/frd/cs/profiles/ Vietnam.pdf [hereinafter Library of Congress, Country Studies:Vietnam Country Profile 2004]. 2. Bureau of East Asian and Pacific Affairs, U.S. Department of State, Background Notes: Vietnam (2005), http://www.state.gov/r/pa/ei/bgn/4130.htm (last visited July 8, 2005). 3. U.S. Department of State, supra note 2. 4. Id. 5. Central Intelligence Agency (CIA), U.S. Government, Vietnam, in The World Factbook (2005), http://www.cia.gov/cia/publications/factbook/geos/vm.html. 6. Vietnam Const. pmbl. (1992) (amended 2001). 7. Central Intelligence Agency, supra note 5; U.S. Department of State, supra note 2; Library Of Congress, Country Studies: Vietnam Country Profile 2004, supra note 1, at 2. 8. U.S. Department of State, supra note 2; Ministry of Foreign Affairs, Government of Vietnam,Vietnam: Political System, http://www.mofa.gov.vn/en/tt_vietnam/ nr040810155159/ns040826100350 (last visited July 11, 2005). 9. U.S. Department of State, supra note 2; Federal Research Division, Library Of Congress, Country Studies: Vietnam, ch. 1, The Aftermath of Geneva, tbl. A. Chronology of Important Events (Ronald J. Cima ed., 1987), http://lcweb2.loc.gov/frd/ cs/cntoc.html (last visited July 8, 2005) [hereinafter Library of Congress, Country Studies:Vietnam 1987]. 10. Robert K. Brigham, Public Broadcasting Service, Battlefield Vietnam: A Brief History, http://www.pbs.org/battlefieldvietnam/history/index.html (last visited Sept. 17, 2005). 11. U.S. Department of State, supra note 2. 12. Central Intelligence Agency, supra note 5; U.S. Department of State, supra note 2. 13. Central Intelligence Agency, supra note 5; U.S. Department of State, supra note 2. 14. U.S. Department of State, supra note 2. 15. See United Nations Population Fund (UNFPA), The State of World Population 2002, at 73 (2002). 16. The World Bank, GenderStats: Summary Gender Profile, http://genderstats. worldbank.org/genderRpt.asp?rpt=profile&cty=VNM,Vietnam&hm=home (last visited July 8, 2005) (estimates for 2000). 17. Central Intelligence Agency, supra note 5. 18. Id.; U.S. Department of State, supra note 2. 19. Central Intelligence Agency, supra note 5. 20. United Nations, List of Member States (2004), http://www.un.org/Overview/ unmember.html (last updated Feb. 24, 2005). 21. Central Intelligence Agency, supra note 5. 22. U.S. Department of State, supra note 2. 23. The Constitution was unanimously adopted at the 11th Session of the Eighth National Assembly and amended by Resolution 51-2001-QH10 at the 10th Session of the Tenth National Assembly; See Central Intelligence Agency, supra note 5. 24. U.S. Department of State, supra note 2. 25. Vietnam Const. art. 2 (1991) (amended 2001). 26. Id. arts. 2, 6. Democratic centralism is a Marxist-Leninist organizational principle that prescribes a hierarchical framework of party structures established through democratic elections. Library Of Congress, Country Studies: Vietnam 1987, supra at 9, Glossary. 27. Vietnam Const. art. 146 (1992) (amended 2001). 28. Id. pmbl. 29. U.S. Department of State, supra note 2; See Library Of Congress, Country Studies: Vietnam Country Profile 2004, supra note 1, at 14. 30. U.S. Department of State, supra note 2. 31. Vietnam Const. art. 101 (1992) (amended 2001). 32. Id. art. 103.2. 33. Id. art. 102; Central Intelligence Agency, supra note 5. 34. Vietnam Const. art. 110 (1992) (amended 2001). 35. Id. art. 103.4. 36. Id. art. 103.8. 37. Id. art. 84.7. 38. Id. art. 107. 39. Id. art. 108. 40. Id. art. 114.1. 41. Id. art. 114.3. 42. Id. art. 114.4. 43. Id. art. 110. 44. Id. art. 85; Central Intelligence Agency, supra note 5. 45. Vietnam Const. art. 83 (1992) (amended 2001). 46. Id. arts. 6, 97. 47. Id. arts. 84.1, 88, 147. 48. Id. arts. 84.1, 84.9. 49. Id. art. 84.7. 50. Id. art. 83. 51. Id. art. 84.12.

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52. Id. art. 7. 53. Id. art. 90. 54. Id. 55. Id. art. 91.1. 56. Id. art. 91.3. 57. Id. art. 91.6. 58. Id. art. 94. 59. Id. 60. Id. art. 87; The Vietnam Fatherland Front is “a political alliance and a voluntary union of political organizations, sociopolitical organizations, social organizations and individuals representing their social classes and strata, nationalities, religions, and overseas Vietnamese.” Id. art. 9. 61. Id. art. 88. 62. Id. 63. The National Assembly of the Socialist Republic of Vietnam, Government of Vietnam, Functions, http://www.na.gov.vn/english/na_functions.html (last visited July 11, 2005). 64. Id. 65. U.S. Department of State, supra note 2. 66. Id. 67. Id. 68. Vietnam Const. art. 118 (1992) (amended 2001); Central Intelligence Agency, supra note 5. 69. Vietnam Const. art. 118 (1992) (amended 2001). 70. Id. art. 118. 71. Id. 72. Id. arts. 118–119. 73. Id. art. 120. 74. Id. art. 7. 75. Id. art. 123. 76. Id. art. 124. 77. Id. art. 127. 78. Id. art. 134. 79. Id. arts. 128, 84.7; Central Intelligence Agency, supra note 5. 80. Thomas H. Flores & Arturo A. Reynolds, Foreign Law: Current Sources of Codes and Basic Legislation in Jurisdictions of the World (2000). 81. Vietnam Const. art. 134 (1992) (amended 2001). 82. Flores & Reynolds, supra note 80. 83. Id. 84. Id. 85. Id. 86. Id. 87. Vietnam Const. art. 137 (1992) (amended 2001). 88. Id. 89. Id. art. 138. 90. Id. 91. Russell J. Dalton & Nhu-Ngoc T. Ong, Center for the Study of Democracy, The Vietnamese Public in Transition:The 2001 World Values Survey 10 (2001), http://repositories.edlib.org/csd/01-09 (last visited July 20, 2005); Russell J. Dalton & Nhu-Ngoc T. Ong, Civil Society and Social Capital in Vietnam, in Modernization and Social Change in Vietnam 4 (forthcoming 2005), http://www.worldvaluessurvey.com/ Upload/104_social_capital_vitenam.pdf (last visited July 20, 2005). 92. Dalton & Ong, supra note 91, at 4. 93. Id. at 10; Center for the Study of Democracy, supra note 91, at 4. 94. Dalton & Ong, supra note 91, at 11. 95. See Vern Weitzel,Vietnam Law Documents: A Selection of Vietnamese Law Documents (Ministry of Agriculture and Rural Development of Vietnam et al., trans., 1998), http://coombs.anu.edu.au/~vern/luat/luat.html (last visited July 11, 2005). 96. Central Intelligence Agency, supra note 5. 97. Id. 98. Id. 99. Decree No. 32/ND-CP (2002); See To Dong Hai, Tradition: Customary Laws and the Development of the Community of Nationalities in Vietnam, Vietnam Law & Legal Forum, Aug. 17, 2004, http://news.vnanet.vn/vietnamlaw/Service.asp?CATEGORY_ ID=4&SUBCATEGORY_ID=9&NEWS_ID=131. 100. Vietnam Const. art. 15 (1992) (amended 2001). 101. Id. art. 50. 102. Id. art. 51. 103. Id. art. 63. 104. Id. 105. Id 106. Id. art. 64. 107. Id. 108. Id. art. 40. 109. Id. art. 69. 110. Id. art. 70. 111. Id. art. 71. 112. Id. art. 103.10. 113. Id. art. 84.13. 114. Convention on the Elimination of All Forms of Discrimination against Women,

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adopted Dec. 18, 1979, G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1979) (entered into force Sept. 3, 1981) (ratified by Vietnam Mar. 19, 1982). 115. Convention on the Rights of the Child, adopted Nov. 20, 1989, G.A. Res. 44/25, annex, U.N. GAOR, 44th Sess., Supp. No. 49, at 166, U.N. Doc. A/44/49 (1989), reprinted in 28 I.L.M. 1448 (entered into force Sept. 2, 1990) (ratified by Vietnam Sept. 2, 1990). 116. International Covenant on Economic, Social and Cultural Rights, G.A. Res. 2200A (XXI), U.N. GAOR, Supp. No. 16, at 49, U.N. Doc A/6316 (1966), 999 U.N.T.S. 3 (entered into force Jan. 3, 1976) (accession with declaration by Vietnam Dec. 24, 1982). 117. International Covenant on Civil and Political Rights, G.A. Res. 2200A (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171 (entered into force Mar. 23, 1976) (accession with reservation and declaration by Vietnam Dec. 24, 1982). 118. International Convention on the Elimination of All Forms of Racial Discrimination, 660 U.N.T.S. 195 (entered into force Jan. 4, 1969) (accession with reservation and declarations byVietnam July 9, 1982). 119. Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict, adopted May 25, 2000, G.A. Res. 54/263, U.N. G.A.O.R. 54th Sess., U.N. Doc. A/RES/54/263 (entered into force Feb. 12, 2002) (ratified by Vietnam Feb. 12, 2002). 120. Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution, and child pornography, adopted May 25, 2000, G.A. Res. 54/263, U.N. GAOR, 54th Sess., U.N. Doc. A/RES/54/263 (2000) (entered into force Jan. 18, 2002) (ratified by Vietnam Jan. 18, 2002). 121. Vietnam Const. art. 39 (1992) (amended 2001). 122. Id. 123. Id. 124. Id. 125. Id. 126. Human Development Sector Unit & Vietnam Country Unit, The World Bank,Vietnam Growing Healthy: A Review of Vietnam’s Health Sector 65 (2001) [hereinafter Vietnam Growing Healthy: A Review of Vietnam’s Health Sector]. 127. Ministry of Planning and Investment, Government of Vietnam, SocioEconomic Development Strategy (2001), http://www.mpi.gov.vn/strategy. aspx?Lang=2 (last visited July 20, 2005). 128. Id. sec. I.B. Strategic Goals and Development Approaches, sec. 1. 129. Ministry of Health, Government of Vietnam, Strategy for People’s Health Care and Protection, Prime Minister’s Decision No. 35/2001/QD-TTg (2001), http://www.moh.gov.vn/English/?act=3 (last visited July 20, 2005). 130. Ministry of Health, Government of Vietnam, National Strategy on Reproductive Health Care: For the 2001-2010 Period, Prime Minister’s Decision No. 136/2000/QD-TTg (2000), [hereinafter National Strategy on Reproductive Health Care: For the 2001-2010 Period]. 131. Ministry of Health, Government of Vietnam, Strategy for People’s Health Care and Protection, supra note 129. 132. Government of Vietnam,The Comprehensive Poverty Reduction and Growth Strategy 2 (2002), http://www.worldbank.org.vn/strategy/cprs/pdf/ CPRGS_final.pdf (last visited July 22, 2005) (approved by the Prime Minister at Document No. 2685/VPCQ-QHQT). 133. Id. 134. Library Of Congress, Country Studies:Vietnam Country Profile 2004, supra note 1, at 7–8. 135. Id. at 7; Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 49 (fees for district, provincial and national level health-care facilities were introduced in 1989). 136. Library Of Congress, Country Studies:Vietnam Country Profile 2004, supra note 1, at 7. 137. United Nations Country Team Vietnam, Health Care Financing for Vietnam 1 (Discussion paper No. 2, 2003). 138. Id. at 3; Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 33, 38–39, 193. 139. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 65. 140. Id. 141. Government of Vietnam, Nghi Dinh Cua Chinh Phu Quy Dinh Chuc Nang, Nhiem Vu, Quyen Han Va Co Cau To Chuc Cua Bo Y Te [The Function, Mission, Power, and Structure of the Ministry of Health], Decree No. 49/2003 ND-CP, art. 2.6 (2001), http://www.moh.gov.vn/Hethongtochuc/?act=menugiua (last visited July 20, 2005) (translation by Center for Reproductive Rights). 142. Id. art. 2.7(f). 143. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 65. 144. Government of Vietnam,The Function, Responsibilities, Powers, Mechanism, and Working Regulations of the National Committee for Population and Family Planning, Decree No. 42/CP, art. 2.1 (1993), http://www.unescap.org/esid/ psis/population/database/poplaws/law_viet/vi_010.htm; Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 65. 145. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 65. 146. Planning and Financing Department, Ministry of Health, Health Statistics Yearbook 2000, at 24 (2000). 147. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note

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126, at 66. 148. Id. at 66–67. 149. Id. at 67. 150. Regional Office for the Western Pacific,World Health Organization (WHO), Country Health Information Profile 2004:Vietnam 401 (2004), http:// www.wpro.who.int/countries/vtn/country_health_information.htm (referring to data from Vietnam Ministry of Health’s Health Statistics Yearbook 2002) [hereinafter WHO Country Health Information Profile 2004: Vietnam]. 151. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 67, n.32. 152. WHO Country Health Information Profile 2004: Vietnam, supra note 150, at 393 (referring to data from Safe Motherhood Maternal Mortality Survey 2002). 153. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 67–68. 154. Id. at 93. 155. Id. at 94. 156. Id. at 93. 157. Id. at 93–95. 158. Id. at 95–96 (referring to figures from the Ministry of Health’s Vietnam Living Standard Survey 1997–98). 159. Id. at 95–96. 160. Id. at 33. 161. Id. at 33, 191–193. 162. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 4. These reforms include payment of commune health worker’s salaries, creation of a social insurance system, introducing user fees for health services, legalizing private health providers and deregulation of pharmaceutical market. Id. 163. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 4; Ministry Of Health, Government Of Vietnam, Nguyen TuNguyen Thi Thanh: Bao Cao Tong Hop Cac Van De Chinh Sach Trong Linh Vuc Cai Cach Benh Vien Va De Xuat Mot So Giai Phap [Report On Policy Issues In Reformation Hospital And Solutions] 26 (2001). 164. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 33. 165. Id. at 98; See also United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 4. 166. Vietnam Const. art. 39 (1992) (amended 2001). 167. Id. 168. WHO Country Health Information Profile 2004:Vietnam, supra note 150, at 398 (referring to data from the Ministry of Health’s Health Statistics Yearbook 2002). 169. Le Thi Nham Tuyet & Hoang Ba Thinh, Research Center for Gender, Family and Environment in Development (CGFED),Vietnam: Laws and Policies Affecting Reproductive Lives of Women 13 (Feb. 22, 2004) (draft) (on file with the Center for Reproductive Rights) [hereinafter Vietnam: Laws and Policies Affecting Reproductive Lives of Women]. 170. Id. 171. United Nations Vietnam & Ministry of Labour,War Invalids and Social Affairs of the Socialist Republic of Vietnam, Basic Social Service in Vietnam: An Analysis of State Official Development Aids Expenditures 25 (1999), http://www. un.org.vn/undocs/bss/index.htm. 172. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 1. 173. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 6. 174. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 93. 175. Id. at 49, 146. 176. Vietnam: Laws and Policies Affecting Reproductive Lives of Women, supra note 169, at 13 (referring to Decrees 95/CP issued on Aug. 27, 1994 and 33/CP issued on May 23, 1995 for the collection of hospital fees at public health facilities). 177. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 6. 178. WHO Country Health Information Profile 2004:Vietnam, supra note 150, at 399 (referring to data from Vietnam Social Security Statistics Yearbook 2002). 179. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 8–9. 180. Id. 181. Id. 182. Id. 183. Poverty Reduction and Economic Management Unit,The World Bank, Vietnam 2010 Entering the 21st Century: Joint Report of World Bank, Asia Development Bank, and United Nations Development Programme (UNDP) 64–65 (2000), http://www-wds.worldbank.org/servlet/WDS_IBank_Servlet?pcont=d etails&eid=000094946_00121905570051. 184. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 6. 185. World Health Organization (WHO),WHO Statistical Information System: Core Health Indicators:Vietnam, http://www3.who.int/whosis/country/compare. cfm?language=english&country=VNM&indicator=strOopEOHPctOfPrvEOH2001 (last visited July 22, 2005).

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186. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 144; United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 7. 187. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 8. 188. Id. 189. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 146. 190. United Nations Country Team Vietnam, Health Care Financing for Vietnam, supra note 137, at 4, 6. 191. Higher Hospital Fees Envisioned in Draft Decree, Thanh Nien News (Vietnam), Aug. 12, 2004, http://www.accessvietnam.net/Archive/040816.html (last visited July 22, 2005). 192. Ministry of Health & Ban Khoa Giao Trung Uong [Central Commission for Science and Education],Vien Phi, Bao Hiem Y Te Va Su Dung Dich Vu Y Te [Hospital Cost, Health Insurance and Use of Health Service 30–32 (2002) (translation by Center for Reproductive Rights). 193. United Nations Country Team Vietnam, Health Care Financing for Vietnam, at supra note 137, at 12. 194. Id. (e.g. Prime minister’s Decision No. 139/2002/QD-TT “to establish the provincial Health Care Fund for the Poor”). Poor households are given the “Free Health Card for the Poor (FHCP)” under the Hunger Eradication and Poverty Reduction Program launched in 1998. Id. at 9; Susan Adams, International Monetary Fund,Vietnam’s Health Care System: A Macroeconomic Perspective 10 (2005), http://www.econ. hit-u.ac.jp/~appphcs5/paper/vietnam.pdf. 195. The economic zones are part of a forced population resettlement scheme undertaken in southern Vietnam after 1975 to increase food production and alleviate population pressure in congested urban areas, especially Ho Chi Minh City (Saigon). The sites selected for resettlement previously had been undeveloped or had been abandoned in the turbulence of war. 196. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 49. Vietnam Const. art. 61 (1992) (amended 2001) (“The State shall establish a system … of exemption from and reduction of [hospital] such fees”). 197. The Labour Code and Implementing Legislations of the Socialist Republic of Vietnam, arts. 3.1(a)–(g), at 664–665 (1996). 198. Vietnam: Laws and Policies Affecting Reproductive Lives of Women, supra note 169, at 13. 199. Vietnam: Foreign Companies Subject to Drug Price Controls, Asian Medical Newsl. (Pacific Bridge Medical, Bethesda, MD, U.S.A.), Apr. 2004, at 2. 200. Id. 201. Id. 202. Ordinance on Private Medical and Pharmaceutical Practice, Presidential Order No. 07/2003/PL-UBTVQH11, arts. 18.2(a), (c), (g) (2003), http://www.moh.gov.vn/ English/?act=32. 203. Id. arts. 20(1)–(2). 204. Vietnam Const. art. 39 (1992) (amended 2001). 205. World Health Organization, Legal Status of Traditional Medicine and Complementary/Alternative Medicine: A Worldwide Review 171–172 (2001), http://www.who.int/medicines/library/trm/who-edm-trm-2001-2/legalstatus.shtml. 206. Id. at 171. 207. Id. at 172–173. 208. Id. 209. Id. at 173. 210. Id. 211. Id. 212. Id. 213. Ordinance on Private Medical and Pharmaceutical Practice, Presidential Order No. 07/2003/PL-UBTVQH11, arts. 21–25 (2003), http://www.moh.gov.vn/English/ ?act=32. 214. Id. arts. 22.1, .2(a)–(c), .3. 215. Id. arts. 23.1(a), 25(2). 216. Id. art. 25(3). 217. Id. art. 52. 218. Law on Protection of People’s Health, art. 23 (1989) (Vietnam). 219. Ordinance on Private Medical and Pharmaceutical Practice, Presidential Order No. 07/2003/PL-UBTVQH11, arts. 18.2(k), 28.2(h), 52 (2003), http://www.moh.gov. vn/English/?act=32. 220. Penal Code, art. 242(1) (2000) (Vietnam). 221. Id. art. 242(2)–(3). 222. Id. art. 242(4). 223. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130. 224. United Nations Vietnam,Vietnam’s First Reproductive Health Strategy, http://www.un.org.vn/unfpa/news_pub/RHBrief.htm (last visited July 22, 2005). 225. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 11. 226. Id. 227. Id. at 19. 228. Id. at 20. 229. Id. at 20–22.

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230. Id. at 20 . 231. Id. at 28. 232. Government of Vietnam, National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, at 2 (2001) (approved by the Prime Minister’s Decision No. 19/2002/QD-TTg of Jan. 21, 2002) [hereinafter National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010]. 233. Phap Lenh Dan So [Ordinance on Population], No. 06/2003/PL-UBTVQH11, arts. 10.1(a), 2(a) (2003) (Vietnam). 234. Id. art. 15.1. 235. Information Center, National Committee for Population, Family and Children, Legalization of Reproduction Supporting Techniques, 26 Vietnam Population News 4, Jan.–Mar. 2003, http://www.vcpfc.gov.vn/English/Popnews/No26/2.htm [hereinafter National Committee for Population, Family and Children, Legalization of Reproduction Supporting Techniques]. 236. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 17. 237. Id. at 26. 238. National Committee for Population, Family and Children, Legalization of Reproduction Supporting Techniques, supra note 235, at 3–4. 239. Id. 240. Vietnam to Ban Human Cloning and Surrogacy, Australian Broadcasting Cooperation Radio News, Feb. 16, 2003 (on file with Center for Reproductive Rights). 241. National Committee for Population, Family and Children, Legalization of Reproduction Supporting Techniques, supra note 235, at 3–4. 242. Phap Lenh Dan So [Ordinance on Population], No. 06/2003/PL-UBTVQH11, art. 23(2) (2003) (Vietnam). 243. Id. art. 7(6). 244. Law on Protection of People’s Health (1989) (Vietnam). 245. Id. art. 43(2). 246. Id. art. 43(4). 247. Id. art. 43(1)–(2). 248. National Committee for Population and Family Planning, Chien Luoc Dan So Vietnam 2001-2010 [Vietnam Population Strategy for the Period 2001-2010], at 55–56 (2000) [hereinafter Vietnam Population Strategy for the Period 2001-2010]; United Nations Vietnam,Vietnam’s New National Population Strategy, http:// www.un.org.vn/unfpa/news_pub/PopBrief.htm (last visited July 22, 2005). 249. United Nations Vietnam,Vietnam’s New National Population Strategy, supra note 248. 250. Id. 251. General Statistics Office, Government of Vietnam,Vietnam Living Standard Survey 1997-1998, at 100 (2000). 252. United Nations Population Fund (UNFPA) & Population Reference Bureau, Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam (2003), http://www.unfpa.org/profile/ vietnam.cfm (last visited July 24, 2005) [hereinafter Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam]. 253. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 26 (2001); Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam, supra note 252. 254. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 26. 255. Phap Lenh Dan So [Ordinance on Population], No. 06/2003/PL-UBTVQH11, art. 7(3) (2003) (Vietnam). 256. Id. arts. 12(1)–(2). 257. Law on Protection of People’s Health, art. 43(1) (1989) (Vietnam). 258. Id. art. 43(2). 259. Id. art. 43(3). 260. General Statistics Office, National Committee for Population and Family Planning, Survey Changes on Population and Family Planning 44 (1996). 261. National Committee on Population and Family Planning, Dieu Tra Nhan Khau Hoc Va Suc Khoe [Demographic and Health Survey 1997], at 42 (1999) [hereinafter Demographic and Health Survey 1997]. 262. Uy Ban Quoc Gia Dan So Va Ke Hoach Hoa Gia Dinh [National Committee for Population and Family Planning] & United Nations Population Fund (UNFPA), Ky Yeu Chinh Sach Dan So Va Ke Hoach Hoa Gia Dinh Viet Nam [Annals of Vietnamese Policy for Population and Family Planning] 503 (1996). 263. Id. at 503 (referring to Ho Chi Minh City Health and Financial Services’ InterService Notice No. 475/MH-107 of May 10, 1989). 264. Id. at 491 (referring to Ho Chi Minh City Health and Financial Services’ InterService Notice No. 475/MH-107 of May 10, 1989). 265. Id. at 503 (referring to Ho Chi Minh City Health and Financial Services’ InterService Notice No. 475/MH-107 of May 10, 1989). 266. Id. 267.Vietnam Const. art. 40 (1992) (amended 2001). 268. Population and Family Planning Policies and Strategy to the Year 2000, Prime Minister’s Decision No. 270-TTg, in National Committee on Population and Family Planning,Vietnam Policies and Strategy on Population and Development (1993), http://unescap.org/esid/psis/population/database/poplaws/law_viet/vi_009. htm.

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269. Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 56. 270. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 26. 271. Law on Protection of People’s Health, art. 44(2) (1989) (Vietnam). 272. Id. art. 43(2). 273. Demographic and Health Survey 1997, supra note 261, at 47 (1999). 274. Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam, supra note 252. 275. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 15 (citing official health statistics from 1990, 1998 and 1999). 276. Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam, supra note 252. 277. Id. 278. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 24. Vietnam Living Standard Survey 1997-1998, supra note 251, at 99 (2000). 279. Vietnam Living Standard Survey 1997-1998, supra note 251, at 99. 280. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 20–21. 281. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 7. 282. Law on Protection of People’s Health, arts. 44(1)–(2) (1989) (Vietnam). 283. Regulation of Technical Responsibilities in Reproductive Health-care Within Health Facilities, § A, reprinted in Ministry of Health, Government of Vietnam, National Strategy on Reproductive Health Care: For the 2001-2010 Period, Prime Minister’s Decision No. 136/2000/QD-TTg, Annex III, at 44–45 (2000). 284. Id. §§ B–C, reprinted in Ministry of Health, Government of Vietnam, National Strategy on Reproductive Health Care: For the 2001-2010 Period, Prime Minister’s Decision No. 136/2000/QD-TTg, Annex III, at 45–49 (2000). 285. Id. §§ B–C, reprinted in Ministry of Health, Government of Vietnam, National Strategy on Reproductive Health Care: For the 2001-2010 Period, Prime Minister’s Decision No. 136/2000/QD-TTg, Annex III, at 52–55 (2000). 286. Vietnam Growing Healthy: A Review of Vietnam’s Health Sector, supra note 126, at 38. 287. Id. 288. Uy Ban Quoc Gia Dan So Va Ke Hoach Hoa Gia Dinh [National Committee for Population and Family Planning] & Tong Cuc Thong Ke [General Statistics Office], Bao Cao Ket Qua Dieu Tra Bien Dong Dan So Va Ke Hoach Hoa Gia Dinh [Report on the Results of Investigation of Changes of Population and Family Planning] 57 (1998). 289. Information Center, National Committee for Population, Family and Children, Results of the 2002 Population Change and Family Planning Survey, 26 Vietnam Population News, Jan.–Mar. 2003, http://www.vcpfc.gov.vn/English/Popnews/ No26/3.htm. 290. Id. 291. Law on Protection of People’s Health, art. 44(1) (1989) (Vietnam). 292. Id. art. 44(2). 293. Penal Code, art. 182–183 (2000) (Vietnam). 294. Id; Exchange rate of 1USD to 15,121 VND. 295. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 20–21. 296. Id. at 25. 297. Annals of Vietnamese Policy for Population and Family Planning, supra note 262, at 503 (referring to the 1989 Ho Chi Minh City Health Services & Ho Chi Minh City Financial Services’ Inter-Service Notice No.475/MH-107). 298. Id. at 196. 299. Regulation for Medical Treatment and Rehabilitation (1991) (Vietnam). 300. Penal Code, art. 243 (2000) (Vietnam). 301. Regulation of Technical Responsibilities in Reproductive Health-care Within Health Facilities, supra note 283, reprinted in Ministry of Health, Government of Vietnam, National Strategy on Reproductive Health Care: For the 2001-2010 Period, Prime Minister’s Decision No. 136/2000/QD-TTg, Annex III, at 44–55 (2000). 302. Joint United Nations Programme on HIV/AIDS (UNAIDS), Country Profile: Vietnam, http://www.unaids.org/Unaids/EN/Geographical+area/ By+Country/viet+nam.asp (last visited July 25, 2005) [hereinafter UNAIDS, Country Profile: Vietnam]. 303. Population Reference Bureau, 2004 World Population Data Sheet 10 (2004). 304. See United Nations Vietnam Country Team, Millennium Development Goals Progress Report 2003, at 37–38 (2003) [hereinafter Vietnam Millennium Development Goals Progress Report 2003]. 305. See Id. at 37–38, chart 12. 306. Id. at 42. 307. WHO Country Health Information Profile 2004: Vietnam, supra note 150, at 399 (data from Vietnam Ministry of Health’s Health Statistics Yearbook 2002). 308. Vietnam Millennium Development Goals Progress Report 2003, supra note 304, at 37 chart 13, 38. 309. Id. at 37. 310. Ordinance on the Prevention and Fight Against HIV/AIDS Infection, Official Gazette No. 17, art. 1 (1995) (Vietnam). 311. Id. art. 4.

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312. Id. arts. 10, 23, 24.1. 313. Penal Code, arts. 117–118 (2000) (Vietnam). 314. Ho Chi Minh National Political Academy & Trung Tam Xa Hoi Hoc,Van De HIV/AIDS, Chien Luoc Van Nhiem Vu Phong Chong AIDS [HIV/AIDS Problems, Strategy, Duty, and AIDS Prevention] 79–82 (1996) (translation by Center for Reproductive Rights). 315. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 17. 316. UNAIDS, Country Profile:Vietnam, supra note 302. 317. Press Release, The World Bank, Vietnam: Largest World Bank Grant Signed to Support HIV/AIDS Prevention (May 26, 2005) (on file with Center for Reproductive Rights). 318. United Nations Educational, Scientific and Cultural Organization (UNESCO), Project RAS/03/P51 “Advocacy and Behaviour Change Communication” Vietnam RHIYA Programme: General Information (2004), http://www.unescobkk.org/index.php?id=651 (last visited July 22, 2005). 319. Committee for Population, Family and Children (CPEC), Government of Vietnam & Population Reference Bureau, Adolescent and Youth in Vietnam 25 (2003) [hereinafter Adolescent and Youth in Vietnam]. 320. Id. 321. Id. at 30. 322. Id. at 31. 323. Id. 324. Id. 325. Id. 326. Id. at 30. 327. Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 55–56. 328. National Strategy on Reproductive Health Care: For the 2001-2010 Period, supra note 130, at 22, 24, 26. 329. Id. at 22, 24. 330. Id. at 26. 331. Adolescent and Youth in Vietnam, supra note 319, at 37. 332. Id. at 37–38. 333. Id. at 40, 43. 334. Id. at 43. 335. Id. 336. Ho Chi Minh National Political Academy & United Nations Population Fund (UNFPA), Dan So Va Phat Trien: Mot So Van De Co Ban [Population and Development: Some Principal Issues] 203 (2000) (translation by Center for Reproductive Rights). 337. 1 Dang Cong San Viet Nam:Van Kien Dai Hoi Dai Bieu Toan Quoc Lan Thu V [Vietnam Communist Party: Documents of the Fifth National Congress of Representatives] 72 (1982). 338. Resolution on Population and Family Planning (1993) (adopted at the Fourth Meeting of the Seventh Session of Vietnam Communist Party Central Committee), http://unescap.org/esid/psis/population/database/poplaws/law_viet/vi_008.htm; Population and Family Planning Policies and Strategy to the Year 2000, supra note 268. 339. 1 Dang Cong San Viet Nam:Van Kien Dai Hoi Dai Bieu Toan Quoc Lan Thu VIII [Vietnam Communist Party: Documents of the Eighth National Congress of Representatives] 206 (1996). 340. United Nations Population Fund (UNFPA),Vietnam: Overview http://www. unfpa.org/profile/vietnam.cfm (last visited July 22, 2005). 341. United Nations Development Programme (UNDP), Basic Facts about Vietnam (2005), http://www.undp.org.vn/undp/fact/base.htm (last visited July 22, 2005). 342. National Committee for Population, Family and Children of Vietnam, Country Report prepared for The Fifth Asia-Pacific Population Conference 2 (2002). 343. Vietnam Population Strategy for the Period 2001-2010, supra note 248. 344. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, Decision No. 147/2000/QD-TTg, art. 1.5.a (2000), http://unescap. org/esid/psis/population/database/poplaws/law_viet/vi_037.htm; Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 10–11. 345. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, supra note 344, art. 1.5.a; Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 11. 346. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, supra note 344, art. 1.2.a; Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 6. 347. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, supra note 344, art. 1.2.b; Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 6–7. 348. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, supra note 344, arts. 1.4, 2.1–.2. 349. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, supra note 344, arts. 1.4.a–.g; Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 55–56. 350. Government of Vietnam, Ratifying the Vietnam Population Strategy for the Period 2001-2010, supra note 344, arts. 1.4.a–.b, 2.1; Vietnam Population Strategy for

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CEDAW/C/ VNM/3-4, at 14 (2000) [hereinafter CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam]. 362. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 14. 363. Regional and Sustainable Development Department & Mekong Department, Asian Development Bank, Country Briefing Paper:Women in Vietnam 32 (2002) [hereinafter Asian Development Bank,Women in Vietnam]. 364. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 14 (sub-committees were mandated under Prime Minister’s Decision No. 646/TTg of Nov. 7, 1994 and the National Strategy for the Advancement of Women 2001-2005). 365. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 2; CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 14. 366. Asian Development Bank,Women in Vietnam, supra note 363, at 32 (2002); Government of Vietnam, National Plan of Action for the Advancement of Women in Vietnam (2001-2005), pt. II, § 6.2.2, at 12 (2001) [hereinafter National Plan of Action for the Advancement of Women in Vietnam (2001-2005)]. 367. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366. 368. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 11. 369. National Plan of Action for the Advancement of Women in Vietnam (20012005), supra note 366, pt. II, § 6.4.3, at 13. 370. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 10; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 6.1.4, 6.2.6, at 12. 371. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 10–11; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 1.1.5, at 2, 6.4.1, at 13. 372. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 10; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 5.1.4, at 10, 6.2.3, at 12. 373. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 7–8; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 5.1.4, at 10, 6.2.3, at 12. 374. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 9–10; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 5.1–.4, at 9–11. 375. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 6; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 2.1, 2.1.3, .6, at 3–4, 2.3.2, at 5, 3.3.3, at 7, 5.4.3, at 11. 376. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 5–6; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 1.1–.3, at 1–3. 377. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 6–7; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 2.1–.4, at 3–5. 378. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 7; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, § 3.1, at 6–7. 379. 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http://www.phunu.hochiminhcity.gov.vn/web/tintuc/default.aspx?cat_id=428&news_ id=52 (last visited Apr. 19, 2005). 382. Vietnam Women’s Union (VWU), supra note 380, ch. III, art. 10. 383. Civil Code, art. 41 (1996) (Vietnam). 384. The Marriage and Family Law, Official Gazette No. 28, art. 2 (2000) (Vietnam). 385. Id. art. 2.2. 386. Id. art. 2. 387. Id. art. 9. 388. Id. art. 10. 389. Id. art. 4. 390. Id. art. 19. 391. Id. art. 21. 392. Civil Code, art. 36 (1996) (Vietnam). 393. Id. art. 28.1. 394. Id. art. 35. 395. Id. art. 38. 396. Id. art. 35. 397. Vietnam: Laws and Policies Affecting Reproductive Lives of Women, supra note 169, at 43–45. 398. The Marriage and Family Law, art. 6 (2000) (Vietnam); See Vietnam: Laws and Policies Affecting Reproductive Lives of Women, supra note 169, at 43–45. 399. Vietnam: Laws and Policies Affecting Reproductive Lives of Women, supra note 169, at 43–45. 400. Id. 401. Id. (referring to art. 6.1 of Decree 32/2000/ND-CP). 402. Id. 403. The Marriage and Family Law, Official Gazette No. 28, ch. X, arts. 85–99 (2000) (Vietnam). 404. Id. art. 85. 405. Id. 406. Id. art. 89. 407. Id. art. 90. 408. Id. art. 91. 409. Id. art. 95(1)–(3). 410. Id. art. 95(1). 411. Id. 412. Id. 413. Id. art. 95(2)(a). 414. Id. art. 95(2)(d). 415. Id. art. 95(2)(a)–(b). 416. Id. arts. 92–94. 417. Id. 418. Id. art. 92. 419. Id. 420. Vietnam Const. art. 23. 421. Civil Code, art. 4 (1996) (Vietnam). 422. Id. art. 679. 423. The Marriage and Family Law, Official Gazette No. 28, art. 31 (2000) (Vietnam). 424. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, art. 15.1. 425. Id. 426. Asian Development Bank,Women in Vietnam, supra note 363, at 14. 427. Id. at viii–ix, 13–14. 428. The Marriage and Family Law, Gazette No. 28, art. 31 (2000) (Vietnam). 429. Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam, supra note 252. 430. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 1. 431. Asian Development Bank,Women in Vietnam, supra note 363, at 17. 432. United Nations Development Programme (UNDP) & Food and Agriculture Organization of the United Nations (FAO), Gender Differences in the Transitional Economy of Vietnam 12–13 (2002). 433. Id.; Asian Development Bank,Women in Vietnam, supra note 363, at 18. 434. Asian Development Bank,Women in Vietnam, supra note 363, at 21. 435. Vietnam Const. art. 63 (1992) (amended 2001). 436. Id. art. 63. 437. Labour Code of the Socialist Republic of Vietnam, art. 5.1 (1994); Civil Code, art. 45 (1996) (Vietnam). 438. Civil Code, art. 45 (1996) (Vietnam). 439. Labour Code of the Socialist Republic of Vietnam, pmlb. (2002). 440. Id. art. 5.1. 441. Id. arts. 109.1, 111.1. 442. Id. art. 111.2. 443. Id. art. 110.2. 444. Id. art. 110.1. 445. Id. art. 111.1. 446. Id. 447. Id. art. 116.1. 448. Id. art. 113.1. 449. Law on Protection of People’s Health, art. 45 (1989) (Vietnam).

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450. Labour Code of the Socialist Republic of Vietnam, art. 113.2 (2002). 451. Id. art. 113.1. 452. Ministry of Agriculture and Rural Development Vietnam & Vietnam Women’s Union, Inter-ministerial Resolution on the Assistance to Rural Women to Develop Production and Improve Quality of Life, No. 47/2000/NQLT/LHPNBNN, § I(1) (2002); See also CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 44. 453. Ministry of Agriculture and Rural Development Vietnam & Vietnam Women’s Union, supra note 452, § III(1); See also CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 44. 454. Ministry of Agriculture and Rural Development Vietnam & Vietnam Women’s Union, supra note 452, § III(2); See also CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 44. 455. See Vietnam: Laws and Policies Affecting Reproductive Lives of Women, supra note 169, at 31. 456. Annals of Vietnamese Policy for Population and Family Planning, supra note 262, at 234. 457. Labour Code of the Socialist Republic of Vietnam, art. 112 (2002). 458. Id. art. 112. 459. Id. art. 114.1. 460. Id. art. 114.2. 461. Id. 462. Id. 463. Id. art. 115.2. 464. Id. art. 115.1. 465. Id. art. 115.3. 466. Id. 467. Id. art. 116.2. 468. Id. art. 117.1. 469. Id. 470. Id. 471. Id. art. 117.2. 472. Id. art. 144. 473. Regulations on Social Insurance (1995) (Vietnam), http://www.osh.netnam.vn/ html/LUATPHAP/boluat/E_nd12.htm (last visited July 25, 2005). 474. Id. art. 8.1 (only applicable to compulsory social insurance scheme participants which include civil servants, workers of businesses with more than 10 employees, people under vocational training or practicum). 475. Id. arts. 11–14. 476. Id. art. 11. 477. Id. arts. 11, 14. 478. Id. art. 12; See also Labour Code of the Socialist Republic of Vietnam, art. 114.1 (2002). 479. Regulations on Social Insurance, art. 12.1 (1995) (Vietnam), http://www.osh. netnam.vn/html/LUATPHAP/boluat/E_nd12.htm (last visited July 25, 2005). 480. Id. 481. Id. art. 12.2. 482. Id. 483. Id. 484. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 5. 485. Id.; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §1.1.3, at 2. 486. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 5–6; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, §§ 1.1–.3, at 1–3. 487. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 5; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, § 1.3.1–.7, at 2–3. 488. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 6; National Plan of Action for the Advancement of Women in Vietnam (2001-2005), supra note 366, pt. II, § 1.2.6, at 2. 489. National Strategy for the Advancement of Women in Vietnam for the Period 2001-2010, supra note 232, at 5–6. 490. Asian Development Bank,Women in Vietnam, supra note 363, at 17; CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 31. 491. Asian Development Bank,Women in Vietnam, supra note 363, at 22. 492. Id. 493. Id. 494. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 38. 495. Id.; Asian Development Bank,Women in Vietnam, supra note 363, at 22. In practice, women, particularly divorced and separated women, have great difficulty securing trustee-guarantees for loans due to a lack of influence in the commune people’s committees. Id. at 22, 49. 496. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 38. Exchange rate of 1 USD to 15,121 VND. 497. Asian Development Bank,Women in Vietnam, supra note 363, at 22. Based on an

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exchange rate of 1 USD to 15,121 VND. 498. Asian Development Bank,Women in Vietnam, supra note 363, at 22. 499. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 38, 42. 500. See Country Profiles for Population and Reproductive Health: Policy Developments and Indicators 2003,Vietnam, supra note 252. 501. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 28. 502. Id. at 27; United Nations Country Team in Vietnam, Millennium Development Goals: Bringing the MDGs Closer to the People 18 (2002) [hereinafter Millennium Development Goals: Bringing the MDGs Closer to the People]. 503. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 27 (figures for 2000). 504. Millennium Development Goals: Bringing the MDGs Closer to the People, supra note 502, at 18; CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 27. 505. CEDAW Committee, Combined third and fourth period reports of States parties: Vietnam, supra note 361, at 27. 506. Vietnam Const. arts. 59, 63 (1992) (amended 2001). 507. Id. art. 35. 508. Law on Education, No. 11/1998/QH10, pmlb., art. 9 (1998) (Vietnam) (right and duty to education). 509. Id. pmlb., art. 2. 510. Id. arts. 22, 26. 511. Id. art. 9. 512. Id. arts. 10, 22. 513. Vietnam Population Strategy for the Period 2001-2010, supra note 248, at 21–22. 514. Vietnam Women’s Union (VWU),Vietnamese Women in 21st Century (2003). 515. Id. 516. Millennium Development Goals: Bringing the MDGs Closer to the People, supra note 502, at 13, 54. 517. Penal Code, art. 111.1 (2000) (Vietnam). 518. Id.. 519. Id. art. 111.2. 520. Id. art. 111.3. 521. Id. 522. Id. art. 111.4. 523. Id. arts. 111.5, 112.5, 113.5, 114.5. 524. Id. art. 111 525. Bui Thi Thanh Mai & Hoang Tu Anh, Consultation of Investment in Health Promotion, Joint Evaluation: Addressing Reproductive Rights and Health Needs of Young People After ICPD:The Contribution of UNFPA and IPPF 7 (2003). 526. Asian Development Bank,Women in Vietnam, supra note 363, at 15. 527. Vietnam Const. art. 71 (1992) (amended 2001); Civil Code, arts. 32–33 (1996) (Vietnam). 528. Penal Code, art. 151 (2000) (Vietnam). 529. The Marriage and Family Law, Official Gazette No. 28, art. 4 (2000) (Vietnam). 530. Id. 531. Id. art. 107. 532. Vietnam Const. art. 63 (1992) (amended 2001). 533. Id. 534. Asian Development Bank,Women in Vietnam, supra note 363, at 14. 535. Penal Code, arts. 254–255 (2000) (Vietnam). 536. Id. art. 256. 537. Id. art. 202. 538. Ordinance for Prevention and Control of Prostitution, No. 10/2003/PLUBTVQH11, art. 23 (2003). 539. Id. art. 14. 540. Penal Code, art. 119 (2000) (Vietnam). 541. Id. Exchange rate of 1 USD to 15,121 VND. 542. Prime Minister’s Directive on Responsibilities of Ministries to Take Measures to Prevent the Illicit Trafficking of Women and Children Abroad, No. 766/TTg, at 1 (1997); See also Periodic reports of State parties due in 1997: Vietnam, Committee on the Rights of the Child, U.N. Doc. CRC/C/65/Add.20, at 62–63 (2000). 543. Prime Minister’s Directive on Responsibilities of Ministries to Take Measures to Prevent the Illicit Trafficking of Women and Children Abroad, No. 766/TTg, at 1 (1997). 544. Id. at 8 (1997). 545. Vietnam Women’s Union (VWU), International Organization for Migration and Vietnam Women’s Union in Prevention of Trafficking in Women and Children (2004), http://hoilhpn.org.vn/newsdetail.asp?CatId=69&NewsId=246&lang=EN (last visited July 25, 2005). 546. Adolescent and Youth in Vietnam, supra note 319, at 32. 547. Id. 548. Asian Development Bank,Women in Vietnam, supra note 363, at 14. 549. Adolescent and Youth in Vietnam, supra note 319, at 32. 550. Penal Code, art. 112.1 (2000) (Vietnam). 551. Id. art. 112.1–.3 (circumstances include those outlined in adult rapes).

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552. Id. 553. Id. art. 112.4. 554. Id. 555. Id. art. 256.1–.2. 556. Id. art. 113.4. 557. Id. art. 114.1–.3.

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