children

How is children’s health a human rights issue?

What are children’s health rights?

Under international human rights law, children are entitled “to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.” This right is articulated in Article 24 of the 1989 UN Convention on the Rights of the Child (CRC), which is the most widely ratified international human rights instrument1 and consolidates all previous treaties on the rights of children.2 The right to health for children has long been understood as an “inclusive” right, which extends beyond protection from immediately identifiable infringements such as limitations on access to health care or services, and includes the wide range of rights and freedoms that are determinate to children’s health, such the rights to non-discrimination, access to health-related education and information, and freedom from harmful traditional practices.3 The realization of a child’s right to health also requires access to underlying conditions for health, such as “safe water and adequate sanitation, adequate nutritious food and housing, [and] healthy occupational and environmental conditions.”4

The CRC and its Optional Protocols articulate the rights of children (from the perspective of the child “rights-holder”) as well as the responsibilities of State Parties (“duty-bearer”). The CRC is legally binding on all signatories, and also establishes a framework for protection of health rights that are not explicitly provided for in the Convention, for example, the rights of children affected by HIV.5 The CRC defines a child as “every human being below the age of eighteen years.”6 Such a definition includes adolescence, commonly understood to be between the ages of 10 and 19 years.7 Consequently, the CRC imposes on State Parties a legally binding obligation to give effect to the child-specific health rights of all children, including adolescents, up to 18 years of age.8

What are the issues and how are they human rights issues?

The fundamental right to health of children, as with adults, stems from the basic human needs that must be met in order for every individual to achieve the highest attainable standard of health, regardless of sex, race, ethnicity, ability, religion, political belief, or economic or social conditions. However, children’s health rights differ from those of adults in “important normative ways.”9 Children of all ages are uniquely vulnerable to violations of their heath rights due to “the biological and socially constructed characteristics of childhood.”10 This includes their developing physical and mental capacity, their dependence on adults to meet their health needs, and their changing social roles and influences, especially during the onset of puberty. As a result, children have a reduced ability to protect themselves and are more vulnerable to negative consequences of violations of their right to health:

The physical and psychological effects that children suffer… will generally be greater than those experienced by adults due to their lower level of physical and mental development. This is true both in relation to (a) the immediate impact that violations of the right to health may have on a child’s physical and psychological state, and (b) the long-term detrimental effects on the child’s development and future capacity for autonomy resulting from such a violation.11

Because children rely on adults for their growth and development, they have historically been treated as passive beings requiring “positive intervention on their behalf to ensure the realization of their rights.”12 As such children are “an anomaly in the liberal legal order” which otherwise views rights-holders as autonomous individuals capable of exercising free choice.13 A central concern of children’s health right advocates is therefore to promote children’s agency and capacity for autonomy.14 A key component is including children, particularly during adolescence, in decision-making processes about their health, not only with respect to their individual health but also at the systematic level of health policy and service delivery.15

International and regional human rights instruments protecting the health rights of children have articulated respect for what are known as the “four Ps”: “participation by children in decisions affecting them; protection of children against discrimination and all forms of neglect and exploitation; prevention of harm to them; and provision of assistance to children for their basic needs.”16 The participation of children must be meaningful and should proceed “in a manner consistent with their evolving capacities.”17 This requires careful balancing of child protection considerations with efforts to promote the agency and decision-making potential of all children.

Right to Life, Survival and Development

In 2011, there were an estimated 7.6 million deaths of children under 5,18 with more than 70 percent due to preventable causes such as diarrhoea, pneumonia, and malnutrition.19 Another 200 million children under 5 do not achieve their full developmental potential due to poverty, inequality, and inadequate opportunities for learning.20 Adolescents, in particular, experience a high burden of neuropsychiatric disorders (including depression and substance abuse), violence and accidents, maternal conditions, and infectious disease.21 Reducing the mortality and morbidity of children and adolescents is a key priority of the international community.22 Article 6 of the CRC imposes on States a positive obligation to “improve perinatal care for mothers and babies, reduce infant and child mortality, and create conditions that promote the wellbeing of all young children during this critical phase of their lives.”23 This obligation is further elaborated in Article 24, which secures the right to the highest attainable standard of health.

The health of children also reflects more broadly on the social and economic conditions in a community.24 In 2011, a child born in the developing world was eight times more likely to die in childhood than her counterpart in the developed world.25 Similarly, children living in countries with greater socioeconomic inequality have poorer health outcomes, with mortality associated with income inequality.26 Both the CRC Committee and the CESCR regularly express concern over failed or insufficient efforts by State parties to reduce child mortality, and have also drawn attention to disparity among certain groups of children such as indigenous children,27 or children living in rural or remote areas28 who are more vulnerable to violations of their right to life, survival and development.

Right to Non-Discrimination

Freedom from discrimination in access to health care, nutrition, adequate standards of living, and education, ensures that all children are equally positioned to attain their maximum level of health and development. However, given their relative dependence on others to realize their human rights, children are at heightened risk of discrimination. Children can face discrimination based on their age and status in society, but also as members of particular groups. Children belonging to minority groups, indigenous communities, and girls generally are more likely to suffer discrimination in accessing their right to health.

Article 2 of the CRC enshrines this right to non-discrimination of children, and the CRC Committee has articulated its concern over such violations of the right as:

    • Social exclusion and discrimination of children from ethnic minority backgrounds or indigenous children, resulting in disparities of health outcomes.29
    • A lack of culturally appropriate services, including the availability of social and health services adapted to culture, history and languages of minority and indigenous children.30
    • Discrimination against girls that restricts their capacity to contribute positively to society, such as selective abortion, genital mutilation, neglect and infanticide, including through inadequate feeding in infancy.31

To fulfil their obligation to non-discrimination of children, States must work “actively to identify individual children and groups of children the recognition and realization of whose rights may demand special measures,” which may require changes in legislation, administration and resource allocation, as well as educational measures to change attitudes.32

Right to Express Views and Have Them Taken into Account

Children are regularly denied the opportunity to be heard and to express their views freely on matters that affect their health and well-being. Yet the right of children to be heard and to participate is one of the fundamental values of the CRC, as it reiterates the understanding that the child is a fully fledged person having the right to express his or her own views in all matters affecting him and her, and having those views heard and given due weight.33 It is also a right that is often infringed not only by legislation and policy that imposes age limits on the right to be heard, but also by socio-attitudinal contexts that prevent children from expressing their views in a variety of forums. Under the CRC, States are required to take all appropriate measures to ensure that the child’s “freedom to express views and the right to be consulted in matters that affect him or her is implemented from the earliest stage in ways appropriate to the child’s capacities, best interests, and rights to protection from harmful experiences.”34

The notion of “evolving capacities” is critical to the realization of this right, particularly with regard to health care, and indicates that there is no single point in development at which all children can or cannot form and articulate their views about their well-being or best interests. This recognition demands that parents, and where necessary, communities, provide “appropriate direction and guidance” in a way that does not undermine the ability of the child to exercise his or her rights.35 However, the CRC Committee also goes further and calls on States to introduce legislation or regulations to ensure that children have access to confidential medical counselling and advice without parental consent, irrespective of the child’s age, where this is needed for the child’s safety or well-being.

If access to advice and information is conditioned on age, children cannot realize their right to make and freely express informed decisions. As such, and in terms of health care, Article 12 of the CRC obligates State Parties to provide all children with information about proposed treatments and their effects and outcomes, including in appropriate formats and accessible to children with disabilities.36 The CRC Committee has explained that in order for adolescents to be able to safely and properly exercise this right “public authorities, parents and other adults working with or for children need to create an environment based on trust, information sharing, the capacity to listen and sound guidance that is conducive for adolescents’ participating equally including in decision-making processes.”37

Right to Information; Right to Sexual and Reproductive Health and Education, including HIV

Children often lack adequate access to information and services necessary to ensure sexual health, including information related to HIV prevention and care. Critical to youth attaining the highest standard of health and developing in a well-balanced manner is having access to adequate information upon which to understand and make appropriate decisions concerning their well-being. Though children are guaranteed the right to such information under international human rights law,38 often neither health information nor health services are made available, particularly with regard to sexual health. Access to sexual and reproductive services is particularly necessary for the well-being of adolescents, as adolescence is the period when many children begin to explore their sexuality.39 And with 3.4 million children under the age of 15 living with HIV, and teenage pregnancies claiming the lives of young mothers and their children at a substantially higher rate than older mothers, the responsibility of states to provide comprehensive education and information about sexual and reproductive health as well as opportunities to develop the skills necessary for HIV prevention is urgent and critical.40

Where children are denied appropriate health services, including child-sensitive and confidential counselling services, and access to contraceptives, States have failed to uphold their obligation to develop preventive health care. States are responsible for ensuring that sex-education programs exist both inside and outside of school settings, and that efforts are made to raise awareness about the prevention of early pregnancy and the control of sexually transmitted diseases including HIV. The International Guidelines on HIV/AIDS and Human Rights emphasize that “the provision of these services [counseling, testing, and prevention measures] to children/adolescents should reflect the appropriate balance between the rights of the child/adolescent to be involved in decision-making according to his or her evolving capabilities and the rights and duties of parents/guardians for the health and well-being of the child.”41 As such, states must also make efforts to empower parents with information about sexual health and HIV transmission, and effective measures should be taken to counter stigma and discrimination faced by children and families infected and affected by HIV.

Right to Education

Today, 67 million children remain out of school. In sub-Saharan Africa alone, 10 million children drop out every year.42 Ensuring universal access to primary education, a cornerstone for the development of individuals and communities, was recognized as one of eight UN Millennium Goals in 2000 (goals which all UN Member States have agreed to try to achieve by 2015). Education ends cycles of poverty and disease, and equips boys and girls with the necessary skills to confront challenges, adopt healthy lifestyles, and “take an active role in social, economic and political decision-making as they transition to adolescence and adulthood.”43 Education is guaranteed to all children as a fundamental human right in the Universal Declaration for Human Rights (UDHR), the CRC, and the International Convention on Economic, Social and Cultural Rights (ICESCR). Additionally, the International Convention on the Elimination of Racial Discrimination (ICERD) and the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) both secure and emphasize the right of equal access to education for all.

And yet, millions of children are denied the right, with certain children (girls, children in remote areas, children from minority groups and children with disabilities) more likely to be excluded from both primary and secondary education. Under international law, states bear the responsibility for ensuring the realization of this right, and advocates have developed “right to education indicators” which aim to measure the extent to which States fulfill their legal human rights obligation. The indicators are divided into four interrelated categories: availability, accessibility, acceptability and adaptability.44

First, availability examines whether education is generally available. Second, accessibility focuses on the various obstacles in accessing education. Third, acceptability evaluates the various aspects of the content of education. Fourth, adaptability examines whether education is adapted to the needs of various categories of persons.45

According to both the CRC and the ICESCR, primary education should be compulsory and available free to all;46 and thus, any legislation or State policy that restricts access for any child, either by the imposition of school fees, or failure to provide schools in certain areas or for certain populations, is a violation of the availability and accessibility of this fundamental right.47 UN human rights treaty bodies have found violations of the acceptability of education where education is not provided in an appropriate language,48 or where the curriculum fails to include education programs on the culture of ethnic, linguistic, or religious minority groups.49 As the right to education is also guaranteed to traditionally excluded groups such as minorities, children with disabilities, and children in detention, States must ensure that schooling options can be adapted to meet their unique needs.

Freedom from Abuse, Torture and Ill-Treatment

All children have a right to health and to be free from violence, abuse and neglect, yet each year, millions of children are victims of violence, abuse, and neglect, with far-reaching harm to their physical and mental health and development. Children in every country in the world are threatened by violence, where it is often socially approved, and frequently legal and State sanctioned.50 In 2006, the UN conducted the first global study on all forms of violence against children in various settings: family, school, alternative care institutions, detention centers and communities. It found that States often fail to take sufficient measures to protect children from domestic violence, corporal punishment, and/or other forms of abuse and neglect, and that such maltreatment is often justified by adults as “tradition” or “disguised as ‘discipline.’”51

Though accurate statistics are hard to ascertain, the UN study estimated that there were 53,000 childhood homicides in 2006.52 Child deaths from maltreatment only represent a small fraction of the problem of child abuse and neglect, with some international studies having shown that, in some parts of the world, between a quarter and a half of all children report severe and frequent physical abuse.53 In 2002, 150 million young girls suffered forced sexual intercourse or other forms of sexual violence.54 And among their peers, children with disabilities are particularly vulnerable to abuse and neglect.

Preventing such abuse and violence against all children is a positive obligation of States. Article 19 of the CRC instructs, “States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.” Children have a right to increased protection from maltreatment given the vulnerabilities inherent in their age and dependence on adults for care and security. As such, in cases of abuse, the child explicitly “has the right to the protection of the law against such interference or attacks.”

The CRC Committee considers the absence of legislation protecting children from domestic violence to be a violation of the obligation of States under Article 19. State Parties are often called to implement legislation that criminalizes domestic violence,55 and absolutely prohibits corporal punishment in all settings. In General Comment 8, the CRC Committee emphasizes that “eliminating violent and humiliating punishment of children, through law reform and other necessary measures, is an immediate and unqualified obligation of States parties.”56

Preventing physical and psychological abuse and violence against children has rightfully become a key priority of the international community, particularly as such maltreatment is associated with risk factors and risk-taking behaviors later in life.57 According to some studies, these include “violent victimization and the perpetration of violence, depression, smoking, obesity, high-risk sexual behaviours, unintended pregnancy, and alcohol and drug use. Such risk factors and behaviors can lead to some of the principal causes of death, disease and disability: as heart disease, sexually transmitted diseases, cancer, and suicide.”58

Freedom from Economic or Sexual Exploitation

Children have the right to be protected from any form of exploitation that may harm their physical, mental, and social development and interfere with their right to education. There are an estimated 250 million child laborers globally. Worldwide, approximately 1.2 million children and adolescents are trafficked for economic and sexual exploitation each year.59 States are responsible for ensuring that children are not exposed to hazardous circumstances that may jeopardize their health, safety, and well-being. The CRC devotes several articles to preventing exploitation, with Article 32 protecting the child from economic exploitation, Article 34 protecting children from sexual exploitation, Article 35 providing protection from trafficking, and Article 36 protecting children against all other forms of exploitation. Where children are recruited into dangerous industries, where minimal ages of employment are lower than ages of compulsory schooling, or where limited action is taken by States to prosecute child traffickers, States are failing to uphold their international human rights obligations.60

Children belonging to vulnerable groups are often at heightened risk for exploitation. As such, human rights treaty bodies as well as various independent experts frequently call on States to improve living conditions, educational opportunities, and vocational training programs for such young people so as to mitigate the potential that they may be forced (either directly or indirectly) into dangerous economic or sexual circumstances.61 States are given some measure of flexibility in determining minimum age of employment,62 and both scholars and human rights mechanisms recognize subjectivity in the term “exploitative” and the need to balance regulations with the child’s right to participation and decision-making.63 However, freedom from sexual abuse and exploitation is clearly and fully protected and recent international instruments have established further measures that States should undertake in order to guarantee the protection of all children, and especially those at heightened risk, from any sexual exploitation and all worst forms of child labor.

In 1999, the International Labour Organization, a specialized UN agency responsible for setting and monitoring international labor standards, adopted the Convention Concerning the Prohibition and Immediate Action for the Elimination of the Worst Forms of Child Labour. The Convention seeks urgent and effective measures to eliminate slavery, child prostitution, child involvement in illicit activities, and any work that is likely to harm the health, safety, or morals of children.64 Children are further protected against exploitation by the Optional Protocol on the sale of children, child prostitution and child pornography (OPSC), which entered into force in 2002. The OPSC criminalizes specific acts relating to the sale of children, child prostitution and child pornography, including attempt and complicity. It lays down minimum standards for protecting child victims in criminal justice processes and recognizes the right of victims to seek compensation.65

In spite of these efforts, exploitation of children continues to exist on a massive scale, and though child labor is a complex issue, the potential costs of denying children’s rights to protection from exploitation are enormous and unacceptable.66 In addition to the harm intrinsic to economic and sexual exploitation, children can suffer long-term social, emotional, and cognitive impairments, as well as behaviors that cause disease, injury and social problems.67 States are encouraged to take deliberate and swift action to put in place legislative and policy measures that explicitly identifies and prohibits the exploitation of children, and also to employ a holistic framework that aims to guarantee the safe upbringing, well-being, and development of all children.

Freedom from Harmful Traditional Practices

Children are protected under international human rights law from harmful cultural traditions, and all practices that can have a negative affect on their health and well-being. For example, according to a WHO estimate, between 100 and 140 million girls and women in the world have undergone some form of female genital mutilation (FGM).68 Though “harmful traditional practices” is a term most frequently associated with FGM and other practices targeting young girls such as forced marriages and preferential treatment of sons, there are many other harmful practices against both boys and girls.69 The international community has been historically wary to intervene to prevent harmful traditional practices, viewing such practices as culturally sensitive issues. However, there has been noticeable progress in human rights protection against value or belief-based practices that have an undeniably harmful impact on the child or adolescent victim. The WHO writes:

It is unacceptable that the international community remain passive in the name of a distorted vision of multiculturalism. Human behaviors and cultural values…have meaning and fulfill a function for those who practice them. However, culture is not static but it is in constant flux, adapting and reforming. People will change their behavior when they understand the hazards and indignity of harmful practices and when they realize that it is possible to give up harmful practices without giving up meaningful aspects of their culture.70

A human rights perspective towards harmful traditional practices affirms the rights of children to physical and mental integrity, freedom from discrimination on the basis of age of gender, and to the highest standard of health. Thus, states are required under the CRC, CEDAW, and the International Covenant on Civil and Political Rights (ICCPR) to take action to end such harmful traditional practices. The corresponding human rights treaty bodies hold States accountable for taking measures to prevent such practices and guarantee that culture is not used as a justification for the violation of the health and human rights of children.71

What are human rights-based approaches for upholding the health rights of children?

A basic principle of child rights, as guaranteed by the CRC is to secure the best interest of the child. According to Article 3 of the CRC, the best interest of the child is to be a ‘primary consideration’ in all actions regarding children. The principle thus underlines all human rights-based approaches for the promotion and protection of children’s health rights. The best interests of the child are to guide the implementation of the CRC by State Parties, including all “legislative, administrative and other measures” necessary to realize the human rights of children and adolescents.72 The following list includes objectives and initiatives that support a child-centered, human rights-based approach that serves to prevent and/or defend against some of the violations detailed in the section above.73

Ensuring Early Childhood Survival, Development and Well-being

Given that most children74 under 5 die from one or more of five common (and treatable) conditions – diarrheal dehydration, measles, respiratory infections, malaria, or malnutrition, continuing and comprehensive efforts must be made by States to prevent such deaths. Communication of health information to families and care takers is an underlying premise of effective health interventions, particularly to secure the well being of young children. “Communication is vital: conveying to parents the key information about how to manage diarrhoea at home – or how to recognize pneumonia or malaria and seek timely care from someone with medical training – will save many children’s lives.”75 For example, some of the most effective initiatives to reduce malnutrition were those that enabled “families to understand the causes of malnutrition and to take informed action to address them,” including the promotion of breast feeding, and addressing key micronutrient deficiencies.76

Eliminating Barriers to Education and Maximum Development

Education is also critical to the development of communities, and thus eliminating the cultural, social and economic barriers to education for girls and other vulnerable children (including poor children, children living in remote locations, children with disabilities, and children belonging to minority groups) must be a priority of any child-centered education program. However, simply eliminating barriers is insufficient; States must use strategic planning to ensure realistic progress. For example, eliminating school fees as required by the CRC has made significant impact in access to primary education for children in Eastern/Southern Africa,77 where enrollment increased significantly; however, ensuring sustainable and quality education demands acquiring the funds to provide adequate accommodations, supplies, and teachers to these newly enrolled students.

Meaningful Participation of Young People in Decisions Affecting Their Health

A programming approach78 that is guided by the CRC should create conditions that allow families with children and children themselves to participate more fully in community life and in the development of policies that affect them. Consultation with children should make explicit efforts to include vulnerable children and their families, including children of minority groups, poor children, disabled children, and girls, generally. The goal is not just to increase participation of children in decision making and health promotion but to ensure their meaningful participation. “If programmes are to meet the health needs of children it is vital that they are given some ownership of the programmes by having a voice in planning, implementing and monitoring programme activities.”79

Supporting Parents and Strengthening Families

The CRC clearly emphasizes the obligation of governments to support parents and families in their duties as the primary caregivers and protectors of children. Under Article 3, paragraph 2, “States Parties undertake to ensure the child such protection and care as is necessary for his or her well-being, taking into account the rights and duties of his or her parents, legal guardians, or other individuals legally responsible for him or her, and, to this end, shall take all appropriate legislative and administrative measures.” Families have the most potential to protect children and also empower young people with tools and strategies to protect themselves. The need to strengthen family life and support families (particularly those in challenging situations) must therefore be a priority at every stage of intervention and programming. Parents and families should be provided with opportunities (such as trainings and accessible social services) to develop the skills and identify the resources they need to understand and meet their children’s needs and protect them from harm.

Creating National Plans of Action to Ensure the Well-being of Children

In 2002, 180 countries gathered to develop an ambitious ten-year action plan called “A World Fit for Children” (WFFC). Grounded in the principles set forth in the CRC, the WFFC agenda called on all participating countries to create national plans of action (NPAs) that effectively integrated international legal standards and secured the rights of children. Where they are not in place, national strategies are often recommended by the CRC Committee and require such elements as:

  1. Time-bound, measurable goals for improving protection of child rights;
  2. Cooperation between government and civil society, including children;
  3. Child-centered budgets and adequate resources allocation;
  4. Communication and campaigns that inform the general public of child rights;
  5. Regular monitoring of the situation of children at the national level and engagement with the UN human rights monitoring mechanisms.80

A comprehensive approach to child protection and development, ensures that both the root causes and consequences of violations of child rights are considered and meaningfully addressed.

Reshaping National Laws for the Protection of Children’s Health Rights

Countries around the world have undertaken reforms to bring their national legislation into closer conformity with the principles and provisions of the CRC. Such efforts that better safeguard the health rights of children include: laws to protect children from discrimination; laws to protect against domestic violence and prohibit corporal punishment; laws prohibiting forced marriage and raising the legal marriage age; and labor laws prohibiting the involvement of children in hazardous employment and other worst forms of child labor.81 However, changing the law alone is insufficient to guarantee protection if efforts are not made to address the underlying social contexts that require such legislation. Thus, programs committed to achieving substantial changes in the legislative protection of the health and human rights of children must also ensure that children, parents, communities, and enforcement officials are trained and made aware of new regulations and the human rights that warrant such protection.

Notes

1 To date, 193 State Parties have ratified the CRC. The United States of America and Somalia have signed but not ratified the Convention; for the status of signatures, ratifications, and accessions, see: United Nations General Assembly (UNGA), Convention of Rights of the Child (1989). http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&lang=en.

2 UN General Assembly, Geneva Declaration on the Rights of the Child, G.A. Res. 1386 (XIV), 14 U.N. GAOR Supp. (No. 16) at 19 UN Doc. 1/4354. U.N. GAOR Supp. (No. 16) at 19, U.N. Doc. A/4354, art. 4. www.unicef.org/lac/spbarbados/Legal/global/General/declaration_child1959.pdf.

3 UN Office of the High Commissioner of Human Rights (OHCHR) and World Health Organization (WHO), The Right to Health, Fact Sheet No. 31. www.ohchr.org/Documents/Publications/Factsheet31.pdf.

4 UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 14, para. 45, in Nolan A, Yamin AE and Meier BM, Submission on the Content of a Future General Comment on the Right of the Child to the Enjoyment of the Highest Attainable Standard of Health (art. 24) (OHCHR). http://www2.ohchr.org/english/bodies/crc/callsubmissionsCRC_received.htm.

5 UN Office of the High Commissioner of Human Rights, “Committee on the Rights of the Child – General Comments.” http://www2.ohchr.org/english/bodies/crc/comments.htm.

6 A particular country’s laws may define majority at an earlier age. To date, 193 State Parties have ratified the CRC. The United States of America and Somalia have signed but not ratified the Convention. UN General Assembly, Convention on the Rights of the Child (CRC), G.A. Res. 44/25, annex, 44 U.N. GAOR Supp. (No. 49) at 167, U.N. Doc. A/44/49 (1989); 28 I.L.M. 1448 (1989). www.ohchr.org/english/law/crc.htm.

7 World Health Organization, The second decade: improving adolescent health and development (2001). www.who.int/maternal_child_adolescent/documents/frh_adh_98_18/en/index.html.

8 UN Committee on the Rights of the Child (CRC Committee), General Comment No. 4: Adolescent health and development in the context of the Convention on the Rights of the Child, CRC/GC/2003/4 (2004). http://tb.ohchr.org/default.aspx?Symbol=CRC/GC/2003/4.

9 Nolan A, Yamin AE and Meier BM, Submission on the Content of a Future General Comment on the Right of the Child to the Enjoyment of the Highest Attainable Standard of Health (art. 24) (OHCHR). http://www2.ohchr.org/english/bodies/crc/callsubmissionsCRC_received.htm.

10 Nolan A, “The Child’s Right to Health and the Courts,” in Harrington J and Stuttaford M, eds., Global Health and Human Rights: Legal and Philosophical Perspectives (London: Routledge, 2010).

11 Ibid.

12 Ibid.

13 Ezer T, “A Positive Right to Protection for Children,” Yale Human Rights and Development Law Journal 7 (2004): 1-2.

14 Nolan A, “The Child’s Right to Health and the Courts,” in Harrington J and Stuttaford M, eds., Global Health and Human Rights: Legal and Philosophical Perspectives (London: Routledge, 2010).

15 Nolan A, Yamin AE and Meier BM, Submission on the Content of a Future General Comment on the Right of the Child to the Enjoyment of the Highest Attainable Standard of Health (art. 24) (OHCHR). http://www2.ohchr.org/english/bodies/crc/callsubmissionsCRC_received.htm.

16 Zeldin W, “Children’s Rights: International Laws,” Law Library of Congress. www.loc.gov/law/help/child-rights/international-law.php#f9. citing Van Bueren, G, The International Law on the Rights of the Child (Dordrecht/Boston/London, Martinus Nijhoff Publishers, 1995).

17 UN Committee on the Rights of the Child, General Comment No. 12: The right of the child to be heard, CRC/C/GC/12 (2009). http://www2.ohchr.org/english/bodies/crc/comments.htm.

18 UNICEF, State of the World’s Children 2012: Children in an Urban World (2012): 83. www.unicef.org/sowc2012/fullreport.php.

19 UNICEF, “Reduce Child Mortality,” Millennium Development Goals. www.unicef.org/mdg/childmortality.html.

20 Walker SP et al, “Inequality in early childhood: risk and protective factors for early child development,” The Lancet 378 (2011): 1325–38.

21 Sawyer S et al, “Adolescence: a foundation for future health,” The Lancet 379 (2012): 1630–40; Gore FM et al, “Global burden of diseases in young people aged 10–24 years: a systematic analysis,” The Lancet 377 (2011): 2093–102.

22 UN Inter-Agency and Expert Group on MDG Indicators, The Millennium Development Goals Report (2010). www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdf#page=28.

23 UN Committee on the Rights of the Child, General Comment No. 7: Implementing Child Rights in Early Childhood, CRC/C/GC/7/Rev.1 (2006).

24 UN Inter-agency Group for Child Mortality Estimation, Levels & Trends in Child Mortality, Report 2011 (2011). www.who.int/maternal_child_adolescent/documents/childmortality_booklet_2011.pdf.

25 Nolan A, “The Child’s Right to Health and the Courts” in J Harrington and M Stuttaford, eds., Global Health and Human Rights: Legal and Philosophical Perspectives (Routledge, 2010): 135-162. www.routledge.com/books/details/9780415479387.

26 Viner RM et al, “Adolescence and the social determinants of health,” The Lancet 379 (2012): 1641–52.

27 UN Committee on the Rights of the Child, Concluding Observations (COs) on Costa Rica – CRC/C/CRI/CO/4, para. 29 (2011); Panama CRC/C/PAN/CO/3-4, para. 54 (2011).

28 UN Committee on the Rights of the Child, Concluding Observations on Argentina, CRC/C/ARG/CO/3-4, para. 57 (2010); Egypt, CRC/C/EGY/CO/3-4, para. 62 (2011); and Bukina Faso, CRC/C/BFA/CO/3-4, para. 54 (2010).

29 Noting discrimination against Roma children in Bulgaria, Serbia, and Italy in particular with regard to access to education, health care and housing. UN Committee on the Rights of the Child, CRC/C/SR.1318, para. 24 (2008); CRC/C/SRB/CO/1, para. 25( 2008); CRC/C/ITA/CO/3-4, para. 24 (2012).

30 Calling on Panama to ensure that indigenous and Afro-Panamanian girls and boys receive health services and education adapted to their culture, history and languages. CRC Committee, Concluding Observations on Panama, CRC/C/PAN/CO/3-4, para. 81 (2011).

31 UN Committee on the Rights of the Child, General Comment No. 7: Implementing Child Rights in Early Childhood, CRC/C/GC/7/Rev.1 (2006). On examining the gender discrimination against girls and incidence of child marriage, prostitution, and sexual abuse in India: Singh K and Kapur D, “Law, Violence and the Girl Child,” Health and Human Rights Journal 5, no. 2 (2001). www.hhrjournal.org/archives-pdf/4065363.pdf.bannered.pdf.

32 UN Committee on the Rights of the Child, General Comment No. 5: General Measures of Implementation of the Convention on the Rights of the Child, arts. 4, 42, and 44; para. 6, CRC/GC/2003/5 (2003).

33 UN Office of the High Commissioner for Human Rights, Manual on Human Rights Reporting (1997): 427. www.ohchr.org/Documents/Publications/manualhrren.pdf.

34 UN Committee on the Rights of the Child, General Comment No. 7: Implementing Child Rights in Early Childhood, CRC/C/GC/7/Rev.1 (2006). http://www2.ohchr.org/english/bodies/crc/comments.htm.

35 Convention on the Rights of the Child, art 5. See also Viner RM et al, “Adolescence and the social determinants of health,” The Lancet 379 (2012): 1641–52.

36 UN Committee on the Rights of the Child, General Comment No. 12: The right of the child to be heard, CRC/C/GC/12 (2009). http://www2.ohchr.org/english/bodies/crc/comments.htm.

37 UN Committee on the Rights of the Child, General Comment No. 4: Adolescent Health, CRC/C/GC/4 (2003). http://www2.ohchr.org/english/bodies/crc/comments.htm.

38 Convention on the Rights of the Child, arts. 24, 13, and 17.

39 UNICEF, Progress for Children: A report card on adolescents (2012). www.childinfo.org/files/PFC2012_A_report_card_on_adolescents.pdf.

40 World Health Organization, “Treatment of children living with HIV.” www.who.int/hiv/topics/paediatric/en/index.html.

41 UNAIDS, International Guidelines on HIV/AIDS and Human Rights: 2006 Consolidated Version (2006). http://data.unaids.org/Publications/IRC-pub07/jc1252-internguidelines_en.pdf.

42 UNICEF, “Basic Education and Gender Equality: The Big Picture.” www.unicef.org/education/bege_59826.html.

43 UNICEF, “Basic Education and Gender Equality: Introduction.” www.unicef.org/education/index_1.php.

44 Right to Education Project, “Right to Education Indicators.” www.right-to-education.org/node/860; the 4A framework was developed by Katarina Tomaševski, the former UN Special Rapporteur on the right to education.

45 de Beco G, Right to Education Indicator based on the 4 A framework: Concept Paper, (The Right to Education Project, 2009). www.right-to-education.org/sites/r2e.gn.apc.org/files/Concept%20Paper.pdf.

46 Convention on the Rights of the Child, art. 28; International Covenant on Economic, Social and Cultural Rights, arts. 13 and 14.

47 UN Committee on the Rights of the Child, Concluding Observations on Panama, CRC/C/PAN/CO/3-4, para. 62 (a) (2011).

48 Committee on the Elimination of Racial Discrimination (CERD), Concluding Observations on Norway, CERD/C/NOR/CO/19-20 (2011); Denmark, CERD/C/DNK/CO/18-19 (2010); Vietnam, CERD/C/VNM/CO/10-14 (2012).

49 UN Committee on the Rights of the Child, Concluding Observations on Costa Rica, CRC/C/CRI/CO/4 , paras. 67, 69 (2011).

50 UN General Assembly, Report of the independent expert for the United Nations study on violence against children, A/61/299 (2006).

51 Ibid. at 5.

52 Ki-Moon B, Children and the Millennium Development Goals: Progress towards a World Fit for Children (UNICEF, 2006): 53. www.unicef.org/publications/files/Children_and_the_MDGs.pdf.

53 World Health Organization and International Society for Prevention of Child Abuse and Neglect, Preventing Child Maltreatment: A guide to taking action and generating evidence (2006). http://c.ymcdn.com/sites/www.ispcan.org/resource/resmgr/docs/preventing_child_maltreatmen.pdf.

54 Ki-Moon B, Children and the Millennium Development Goals, 59.

55 UN Committee on the Rights of the Child, Concluding Observations on Algeria, CRC/C/DZA/CO/3-4 , para. 45 (2012), and Burkina Faso, CRC/C/BFA/CO/3-4, para. 50 (2010).

56 UN Committee on the Rights of the Child, General Comment No. 8: The right of the child to protection from corporal punishment and other cruel or degrading forms of punishment, CRC/C/GC/8, arts. 19; 28, para. 2; and 37, inter alia (2006).

57 Kydd JW, “Preventing Child Maltreatment: An Integrated Multisectoral Approach,” Health and Human Rights Journal 6, no. 2 (2003).

58 World Health Organization and International Society for Prevention of Child Abuse and Neglect. Preventing Child Maltreatment: A guide to taking action and generating evidence (2006). http://c.ymcdn.com/sites/www.ispcan.org/resource/resmgr/docs/preventing_child_maltreatmen.pdf.

59 International Labour Organization (ILO), A Future Without Child Labour: Global Report (2002).

60 UN Committee on the Rights of the Child, inter alia Concluding Observations on Burkina Faso CRC/C/BFA/CO/3-4, para. 68 (2010); Singapore CRC/C/SGP/CO/2-3, para. 62 (2010), para. 62; see also CESCR, Concluding Observations on Sri Lanka E/C.12/LKA/CO/2-4 (2010).

61 UN General Assembly, Recommendations of the Special Rapporteur on the Sale of Children, Child Prostitution and Child Pornography on Greece, E/CN.4/2006/67/Add.3 (2006) and the United Arab Emirates, A/HRC/16/57/Add.2 (2010).

62 International Labour Organization, Convention No. 138 related to the minimum age of employment, art 7(1) (1973, entry into force 19 June 1967).

63 For discussion on the subjectivity of “exploitation” and the challenge of defining child labour within a human rights context, see Parker DL and Bachman S, “Economic Exploitation and the Health of Children: Towards a Rights-Oriented Public Health Approach,” Health and Human Rights Journal 5, no. 2 (2001).

64 International Labour Organization, Convention No. 182 on the Worst Forms of Child Labour, (1999, entry into force on 19 Nov 2000). www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID:312327.

65 Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography, G.A. Res. 54/263, Annex II, 54 U.N. GAOR Supp. (No. 49) at 6, U.N. Doc. A/54/49, Vol. III (2000, entry into force 18 January 2002). http://www2.ohchr.org/english/law/crc-sale.htm.

66 UN Study on Violence against Children, Chapter 6: Violence against children in places of work. www.unicef.org/violencestudy/6.%20World%20Report%20on%20Violence%20against%20Children.pdf.

67 UN Study on Violence against Children, Chapter 1: An end to violence against children. www.unicef.org/violencestudy/1.%20World%20Report%20on%20Violence%20against%20Children.pdf.

68 UN Study on Violence against Children, Chapter 3: Violence Against Children in the Home and the Family, p. 60. www.unicef.org/violencestudy/3.%20World%20Report%20on%20Violence%20against%20Children.pdf.

69 For a list of harmful traditional practices, see UN Committee on the Rights of the Child, General Comment No. 13 The right of the child to freedom from all forms of violence, CRC/C/GC/13, art 29 (2011).

70 World Health Organization, Female Genital Mutilation: A Joint WHO/UNICEF/UNFPA Statement (1996).

71 Convention on the Rights of the Child, art 24; Convention on the Elimination of Discrimination against Women (CEDAW), arts 5, 16; and International Covenant on Civil and Political Rights, art 7.

72 Convention on the Rights of the Child, art 4.

73 UNICEF, A World Fit for Children (2002). www.unicef.org/specialsession/wffc/resource.html.

74 UN Committee on the Rights of the Child, General Comment No. 7 Implementing child rights in early childhood (2005) CRC/C/GC/7/Rev. 1. (20 September 2006).

75 Annan K, We the Children: Meeting the promises of the World Summit for Children (UNICEF, 2001): 26. www.unicef.org/specialsession/about/sgreport-pdf/sgreport_adapted_eng.pdf.

76 Ibid.

77 UNICEF, Progress for Children: A report card on gender parity and primary education. (2005). www.childinfo.org/files/PFC05n2en.pdf.

78 UNICEF, “Child and youth participation resource guide, Participation in programme areas.” www.unicef.org/adolescence/cypguide/index_health.html.

79 Child-to-Child Trust, New directions for child-to-child: Ideas and experiences from a consultation meeting held in Cambridge, England in March 2002 (2003): 29. www.child-to-child.org/publications/c2creport2002.pdf.

80 UNICEF, “Follow-up: National plans of action,” United Nations Special Session on Children 8-10 May 2002. www.unicef.org/specialsession/followup_npa/index.html; National Children’s Alliance, The National Children’s Alliance and A Rights Based Approach: Setting the Context for Discussion and Action (2003). www.nationalchildrensalliance.com/nca/pubs/2003/National_Plan_of_Action.pdf.

81 Annan K, We the Children: Meeting the promises of the World Summit for Children (UNICEF, 2001): 76. www.unicef.org/specialsession/about/sgreport-pdf/sgreport_adapted_eng.pdf.