29 August 2016, The Netherlands

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29 August 2016, The Netherlands

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Freedom of choice in obstetric care not guaranteed

The submitting parties signal that many NGO’s have expressed their concern to the Minister of Health, Welfare and Sport over the intention to change the system of reimbursement for obstetric care.204 Those changes will lead to restrictions of the freedom of choice of pregnant women with regard to primary obstetric care for giving birth at home. It will also give rise to regional variations in treatment since health care insurers can then decide which midwife, doctor or gynaecologist is to be reimbursed and which one is not. Institutions’ financial policy must never interfere with women’s right to decide where, how and from whom they accept obstetric care.

Recommendation 42:

The submitting parties recommend the Committee to ask the Dutch government how it plans to safeguard pregnant women’s autonomy and freedom of choice regarding obstetric care.

  1. Restrictions to access to reproductive health care

According to the government, by way of Ministry of Health (VWS) and the Health Care Inspectorat (IGZ) family doctors (general practitioners) and pharmacies are criminally liable in case they provide for a medical abortion for early unwanted pregnancies.205

This hinders the access to quality and accessible health care particularly for vulnerable groups of women,206 such as women in limiting social conditions (unfree situation), undocumented women and women who live in rural areas which often live far away from the authorized clinics. Undocumented women are altogether excluded from affordable abortion services, even by the national system established for medical care for incompetent documented in life.207

The Health Minister has announced to amend the current abortion law to include family doctors as abortion care providers. On the other hand, the amendments include many new thresholds and obstacles by criminalizing early medical abortion and unnecessary license-requirements and excessive bureaucratic burdens for family doctors who want to provide early abortion care.

Recommendation 43:

The submitting parties recommend the Committee to:

  • call upon the Dutch government to not undertake retrogressive steps while safeguarding accessible early abortion care and decriminalize abortion care;

  • urge the Dutch government to make abortion care accessible to all women regardless of status.

  1. Right to Health, Curaçao (ISLA Refinery)(& art. 6 ICESCR)

The submitting parties are pleased to note that in the Sixth Periodic Report the Dutch government reaffirmed its commitment to take steps to promote the right to work in Curacao, for example by agreeing protocols with major companies on the island such as the ISLA Refinery.208 However, the Dutch government does not address the environmental and possibly work place related health issues with regard to ISLA Refinery. In particular, major newspapers have covered the severe pollution emanating from this (Venezuelan-owned) refinery, in great excess of Dutch environmental standards, i.e. reportedly up to more than 15 times acceptable emission standards.209 Actually, in 2010, the Joint Court of Justice already decided that ISLA is obliged to limit its contribution to the emission for sulfur dioxide, which it currently consistently exceeds.210 However, this is not enforced.

Over the past year, the Dutch Parliament has pressured the government for concerted action, since new problems have emerged, referring to the great threats to health (eg asthma, cancer) and life of inhabitants. In February 2016, Dutch Parliament adopted a motion that condemns the poor governance on the Island of this issue, and requires the Dutch government to ensure that pollution is maximally reduced within three months,211 Yet, considering that the costs of effective adaption are likely very high, the question is what efforts will be truly undertaken to secure the right to health of Curacao inhabitants.212

Recommendation 44:

The submitting parties recommend the Committee to ask the Dutch government what concrete measures it is taking to ensure that the right to health is guaranteed for the citizens of Curacao, especially protection against harmful substances in and out of the workplace.

  1. Right to Health and Air Pollution Levels in the Netherlands (Friends of the Earth – air pollution case)

Despite some improvements, the right to health of people in the Netherlands, especially in urban areas, continues to be severely compromised by prevailing and prolonged exposure to ambient air pollution, in contravention of European and international safety levels for acceptable pollution rates. To illustrate, in the Netherlands about 3-5% of the total burden of disease is caused by air pollution.213 Recent studies also reveal that in 40% of Amsterdam city streets, levels of NO2 are higher than allowed per European clean air regulations.214 In August 2016, Friends of the Earth Netherlands therefore launched a law suit against the Dutch state to require the State to take further measures in this regard, and to ensure within half a year, compliance with relevant air pollution regulation, including also particularly the WHO Air Quality Guidelines.215

From a perspective of the ICESCR, submitting parties concur with the perspective that clean air, in line with international regulations on air pollution, can be claimed as part of the right to health.216 The WHO considers ‘clean air to be a basic requirement for human health and well-being’.217 The Committee also makes several clear references to environmental hygiene and the impacts of (air) pollution on health, including ‘the prevention and reduction of the population’s exposure to harmful substances such as radiation and harmful chemicals or other detrimental environmental conditions that directly or indirectly impact upon human health’.218 Moreover states ‘should refrain from unlawfully polluting air’ and ‘should formulate and implement national policies aimed at reducing and eliminating pollution of air, water and soil, including pollution by heavy metals such as lead from gasoline’.219 Finally, ‘the failure to enact or enforce laws to prevent the pollution of water, air and soil by extractive and manufacturing industries’ is a violation of the obligation to protect the right to health.220 Also the WHO points out the severe health effects due to exposure to ambient air pollution, and has drafted international guidelines on air pollution.221 A particular concern of Friends of the Earth in its lawsuit is that WHO guidelines are two times stricter than the EU regulations.222 They propose therefore that EU regulations are not sufficiently protective in guaranteeing clean air for Dutch citizens, and that the Netherlands should strive to meet the higher WHO Guidelines to protect the right to the highest attainable standard of health for its citizens effectively.

Recommendation 45:

The submitting parties recommend the Committee to require the Government to take immediate and concrete actions on air pollution, e.g. through various regulatory measures, particularly with the aim of ensuring that as a minimum form of protection the most stringent international safety levels for air pollution and health (i.e. the WHO Guidelines) are met.

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  • Restrictions to access to reproductive health care
  • Right to Health, Curaçao (ISLA Refinery)( art. 6 ICESCR)
  • Right to Health and Air Pollution Levels in the Netherlands (Friends of the Earth – air pollution case)

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