By Sophie Girardini, LLM student International Human Rights Law, University of Groningen, sophie.girardini hotmail.com  

Growing up in Italy, my knowledge on sex, contraception and sexually transmitted infections (STIs) was limited and worrying. During an exchange year to a more Southern school, I realized the magnitude of the problem. Sentences like “masturbation is bad for your health”, “tampons will make you sick” or “you can never get pregnant when you are on your period” were heard daily.

Already in 1947, Italy declared in its Constitution to protect “health” as a basic right of the individual and as an interest of the community.[i] Since then, the country has ratified several regional and international treaties promising to uphold the right to health for all.[ii] By ratifying, amongst others, the International Covenant of Economic Social and Cultural Rights (ICESCR) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) the country accepted its positive obligations to realise the right to health progressively. According to the Committee on Economic, Social and Cultural Rights (CESCR), access to sexual health education (SHE) is part of the right to health, laid down in Article 12 ICESCR.[iii] By not making SHE mandatory and failing to include it in the formal school curriculum, Italy fails to guarantee health information accessibility and thereby acts in violation of Article 12 ICESCR.[iv]

Lack of access to SHE

The lacking SHE in Italy is concerning. According to a study conducted at four Italian universities, the lack of knowledge on reproductive health is far-reaching among young adults: the length of the female menstrual cycle or the length of survival of sperm in the womb was known only to 40% of university students, while the most fertile interval within a woman’s period was known only to 55% of interviewees.[v] The study demonstrated that students from Southern universities were consistently and significantly less knowledgeable on these matters.[vi] While a total of 39 SHE projects are currently active in Italy on a voluntary basis, these are not geographically distributed equally: eight of the 20 Italian regions have no programme in place, with the South of Italy considerably lacking projects.[vii] The existing discrepancy between North and South shows a lack of effective national health strategy and inequality between regions due to no appropriate prioritisation and funding.[viii]

International and regional human rights violations

States have obligations under Article 12 ICESCR to provide education and access to information concerning the main health problems in the community, including methods of preventing and controlling them.[ix] Satisfying these minimum essential levels of the Convention rights qualifies as a core obligation for states and has immediate effect and priority. A failure to reach those standards amounts to a violation of the right to health.[x] Accordingly, the lack of SHE promotion and planning in Italy, with the country performing far below the European average and large discrepancies between regions, can be considered a violation of the right to health.[xi] Italy is not equitably distributing its health information services, has no action plan on the matter and does not ensure that all individuals have access to comprehensive education and information on sexual and reproductive health.[xii]

Within the system of the Council of Europe (CoE), there has been more concrete criticism. The Group of Experts on Action against Violence against Women and Domestic Violence (GREVIO), the Monitoring Mechanism of the the Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention), lamented in its 2020 report that the Italian initiative to prepare national guidelines was stopped due to growing resistance to SHE and the stigmatisation of those partaking in it, channelled by disinformation campaigns.[xiii] The body urged authorities to finalise and implement national guidelines, underlining the importance of knowledge on the right to physical integrity, absence of freely given consent, and the definition of sexual violence in accordance with Article 36 of the Istanbul Convention.[xiv]

Additionally, the European Committee of Social Rights (ESCR), the monitoring body of the European Social Charter (ESC), and the European Court of Human Rights (ECtHR), the court that interprets the European Convention on Human Rights, have both had the opportunity to stress the importance of sex education as well.[xv] For instance, the ESCR explicitly criticised Croatia for not providing sex education in a non-discriminatory manner when it comes to sexual orientation.[xvi] As Croatia was criticised for the content and form of its sex-education, Italy’s lack of mandatory sex-education in general could arguably be considered an even more far-reaching violation as some Italian adolescents have no access to SHE at all.

Women and girls are most affected

Unsurprisingly, the lack of consistent and mandatory SHE in Italy and the deriving lack of knowledge puts especially girls and women at risk. While women of all ages in Italy experience undesired pregnancies, girls between the ages of 15 to 24 are most affected by them.[xvii] As abortions in certain regions are still dependant on the possibility of “conscientious objection” by doctors, SHE is especially important in preventing unwanted pregnancies in the first place. SHE is required to provide women and girls with the necessary tools to protect themselves from, among other things, STDs, in particular HIV/AIDS, as well as support them in family planning.[xviii]

The special vulnerability of women and girls when it comes to sexual and reproductive health causes Italy to additionally violate its positive obligations under the CEDAW.[xix] There, Articles 16 (1) (e) and 10 (h) guarantee women’s equal rights in deciding “on the number and spacing of their children”, as well as “access to […] information and advice on family planning.”[xx] In 2017, the CEDAW Committee urged Italy to prioritise SHE and recommended to finalize and implement national guidelines in line with the Standards for Sexuality Education in Europe developed by the World Health Organization Regional Office for Europe and the Federal Centre for Health Education of Germany.[xxi]

The road ahead

Italy, falling far behind the European average with a political landscape sceptical of SHE, hinders the fulfilment of the right to health and achieving comprehensive SHE.[xxii] It is therefore crucial to continue upholding the international pressure for Italy to implement and standardize SHE programs in schools in a mandatory and immediate manner. Italy must stop violating its regional, international and constitutional obligations on the right to health and move forward into a more informed future.

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[i] Italian Constitution (adopted on 22 December 1947) Art 32.

[ii] International Covenant on Economic Social and Cultural Rights (adopted 1966, entered into force 1976) 993 UNTS 3 (ICESCR) Art 12; Convention on the Rights of the Child (adopted 20 November 1989) UNGA Res 44/25 (CRC) Art 24; Convention on the Elimination of All Forms of Discrimination Against Women (adopted 18 December 1979, entered into force 3 September 1981) 1249 UNTS 13 (CEDAW) Art 10 (h).

[iii] Committee on Economic, Social and Cultural Rights (CESCR) ‘General Comment 14: The Right to the Highest Attainable Standard of Health (Art. 12)’ 11 August 2000, UN Doc E/C.12/2000/4, para 11.

[iv] Committee on Economic, Social and Cultural Rights (CESCR) ‘General Comment 22: on the right to sexual and reproductive health (Art. 12) 2 May 2016, UN Doc E/C.12/GC/22, para 15, 18.

[v] Luca Cegolon et al ‘Birth control knowledge among freshmen of four Italian universities’ (2020) 10 Sci Rep 1.

[vi] ibid.

[vii] Alice Chinelli et al ‘Sexuality education in Italy 2016-2020: a national survey investigating coverage, content and evaluation of school-based educational activities’ (2022) Sex Education https://www.tandfonline.com/doi/full/10.1080/14681811.2022.2134104 accessed on 18 Mai 2023.

[viii] Toni Cappelletti ‘Sexual education in the school setting: an overview of the Italian situation’ (2022) 32(3) European Journal of Public Health 589; Iole Fontana, ‘Mapping Sex and Relationship Education (SRE) in Italy’ (GenPol, 22 October 2018) https://gen-pol.org/2018/10/mapping-sex-and-relationship-education-sre-in-italy/ accessed on 18 Mai 2023.

[ix] CESCR GC 14 (n iii) para 44 (d).

[x] ibid para 43, 49, 52, 53.

[xi] In the EU SHE is non-mandatory next to Italy in only 5 other countries: in Bulgaria, Cyprus, Lithuania, Poland and Romania; Natalie Picken ‘Sexuality education across the European Union: an overview’ (Publications Office of the European Union 2020); see also UNESCO ‘Global Education Monitoring Report: Comprehensive sexuality education (CSE) country profiles’ (2023) ED/GEM/MRT/2023/CSE/1; Cappelletti (n vii).

[xii] CESCR GC 14 (n iii) para 43 (e) and (f); CESCR GC 22 (n iv) para 49 (b) and (f).

[xiii] Group of Experts on Action against Violence against Women and Domestic Violence (GREVIO) ‘GREVIO’s Baseline Evaluation Report on legislative and other measures giving effect to the provisions of the Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence (Istanbul Convention) Italy’ 13 January 2020, GREVIO/Inf (2019)18.

[xiv] Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention) (adopted 11 May 2011, entered into force 1 August 2014) Art 36.

[xv] Dojan and Others v Germany (ECtHR, 13 September 2011) App no 319/08; AR and LR v Switzerland (ECtHR, 19 December 2017) App no 22338/15.

[xvi] International Centre for the Legal Protection of Human Rights (INTERIGHTS) v. Croatia (ECSR, 30 March 2009) Complaint No 45/2007.

[xvii] Jonathan Marc Bearak and others, ‘Country-Specific Estimates of Unintended Pregnancy and Abortion Incidence: A Global Comparative Analysis of Levels in 2015–2019’ (2022) 7(3) BMJ Global Health; World Health Organisation (WHO) ‘Factsheet on Adolescent Pregnancy’ https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy accessed on 18 Mai 2023

[xviii] Committee on Economic, Social and Cultural Rights (CESCR) ‘Concluding Observations Italy’ 7 December 2022, UN Doc E/C.12/ITA/CO/6.

[xix] UN Committee on the Elimination of Discrimination Against Women (CEDAW) ‘General Recommendation 24: Article 12 of the Convention (women and health)’ 1999, UN Doc A/54/38/Rev.1, chap. I; United Nations Fourth World Conference on Women, Beijing Declaration and Platform for Action (adopted 27 October 1995).

[xx] CEDAW (n ii) Art 10 (h) and 16 (1)(e).

[xxi] Committee on the Elimination of Discrimination against Women (CEDAW) ‘Concluding Observations Italy’ 24 July 2017, UN Doc CEDAW/C/ITA/CO/7 para 35(c) and 36(c); WHO Regional Office for Europe and BZgA German Federal Centre for Health Education ‘Standards on Sexual Education in Europe: A framework for policy makers, educational and health authorities and specialists’ 2010.

[xxii] UNGA ‘Transforming our world: the 2030 Agenda for Sustainable Development’ 21 October 2015, UN Doc A/RES/70/1, Goal 3.7.