An enlightening and invaluable guide.

Reproductive Health and Human Rights: Integrating Medicine, Ethics and Law Rebecca J. Cook, Bernard M. Dickens and Mahmoud E. Fathalla (Oxford University Press, 2003, 554pp) ISBN: 0199241333, $29.95

TO BE ASKED TO PASS COMment on the work of three eminent scholars of reproductive and sexual health and human rights is somewhat intimidating. However, one of this book's great pleasures is that it is not intimidating and can be used and enjoyed on several different levels.

The book does exactly what it says that it will do. It integrates the medical, ethical, legal and human rights aspects of reproductive and sexual health and, in so doing, provides advocates, lawyers, health care workers--in fact anybody who has an interest in human rights and reproductive health--with a complete reference manual for the advancement of reproductive and sexual health. The authors achieve their goal and the manner in which they do makes the subject matter accessible to those who may not be medics, philosophers, lawyers or specialists in human rights.

People are affected throughout their lives by their access to reproductive and sexual health and rights--and this may not be the case with other areas of health. We are affected by the circumstances in which we are conceived, by the health of our mothers, by the social circumstances of those who bring us up, by our gender and sexual preferences, CATHERINE FORDE is a horrister and on the hoard of the Irish Family Planning Association. by whether we have healthy sexual lives and relationships, by our access to contraception, abortion, education and freedom from discrimination. "The different needs in reproductive health are not isolated from each other. They are simultaneous or consecutive, related needs." As human beings we are sexual beings. The authors emphasize the importance of reproductive health in our lives and, in particular, in the lives of women.

THE BOOK IS STRUCTURED LIKE A set of building blocks. The first block provides us with a general introduction to all aspects of reproductive and sexual health, such as the social factors that arc fundamental to the well being of women and, hence, of society in general. It sets out the rational foundation on which the principles of human rights are based and does so with particular reference to sexual and reproductive health and rights. Much of this section is very philosophical, but nevertheless, it also reminds the reader of some very important, clear and simple truths: "Improving reproductive and sexual health needs action beyond the health sector. The noble task of reproducing our species has not brought societal rewards to women. On the contrary, it has often led to their subordination.... Reproductive health is often compromised not because of lack of medical knowledge, but because of infringements on women's human rights. Powerlessness of women is a serious health hazard." (p33)

The next block gives an analysis of health care systems and the provision of services within them. The next two blocks deal with bioethics, ethics and the law, ethics and human rights and the application of legal principles to reproductive health. With this thoughtful background, the book then moves to the last block--the human rights principles applicable to reproductive and sexual health and to the practical application of those principles to the advancement of reproductive and sexual health. Having built up our knowledge, we are given an opportunity to see how those principles can be applied to everyday situations.

The second section of the book is made up of case studies, and in each the medical, ethical and human rights principles are applied to provide a discussion of and solution to each problem the authors present. Examples include the application of those principles to the problems which can arise, for example, when an adolescent girl seeks sexual and reproductive health care or the responsibilities a doctor has when a woman seeks a test to determine the sex of her child when the doctor knows that, if the fetus is female, the woman will abort that fetus. While the authors state that the case studies have particular reference to "resource-poor settings," I consider them to be relevant to any setting.

THERE ARE THOUGHT-PROVOKING remarks throughout. I particularly liked, "The emergence of a concept of reproductive health that is of secular origin, requiring implementation by pragmatic legal rules that measure the validity of such laws by their practical consequences, present a special challenge to religious authorities. They are not accustomed to being held accountable to civil societies for the effect of pronouncements they make." (p98) I enjoyed the discussion on the futility of trying to use the criminal law to regulate and control morality and there are many chapters that I look forward to re-reading.

The authors elucidate all the basic principles that lead to the development of rights. They go behind the norms of human rights and discuss the ethical basis from which they grew and will continue to grow. Reproductive Health and Human Rights stimulates, educates, advocates and provides practical assistance. This book will be invaluable to all advocates of reproductive and sexual health and rights whether they be volunteers in family planning associations, health care work ers or politicians. This book will assist them on many different levels and will do so whether they wish to know how to use human rights to advocate for change or how to deal with everyday problems.