A/HRC/33/57 colonization that permit or enable abuse.40 The health-related impacts of violence against women include injuries, sexually transmitted infections, gynaecological problems, mental illness and substance dependence. Violence against women also affects children exposed to such violence, who experience higher rates of morbidity and mortality.41 64. These challenges can be overcome in partnership with indigenous peoples. For example, community maternity wards, maternal houses and waiting homes have reduced perinatal risk in Guatemala and Peru.42 Involvement and further training of traditional midwives in modern health-care delivery approaches may reduce maternal morbidity and mortality, while also improving service acceptability. States should consider opportunities for South-South cooperation concerning sexual and reproductive health, in particular in relation to intercultural standards (E/2013/43-E/C.19/2013/25). 65. In many indigenous communities, birth rates remain significantly higher compared with the national average, partly reflecting the value indigenous communities place on motherhood and childbearing. These views can occasionally clash with prevailing beliefs in mainstream medicine regarding, for instance, birth practices and contraception. The perceived conflict between the rights of indigenous peoples and the rights of women, however, is often illusory. The elimination of customary law or practices that violate women’s rights, such as forced marriage and domestic violence, has long been sought by many indigenous peoples. Other practices that are traditional or preferred by indigenous peoples should not be prohibited by States; instead, dialogue on pregnancy spacing, contraceptive use and parenting should be conducted in a culturally sensitive manner. 66. States must do more to address gender-based violence. Indigenous women and girls frequently have no effective legal remedies for such acts. In certain jurisdictions, violence perpetrated against women by State officials such as police officers and military or paramilitary forces occurs. In such cases, women experience a two-fold rights violation: firstly, through the experience of violence and, secondly, through the lack of redress from the very mechanism that has perpetrated the violence. States must take steps to prevent such violence and ensure that acceptable mechanisms to provide redress for such violations are available and accessible to all women. B. Health of indigenous persons with disabilities 67. Indigenous persons experience higher rates of disability globally compared to the general population. Barriers such as multiple forms of discrimination, poverty, systemic and physical barriers and violence contribute to the lack of full enjoyment of their human rights. The Convention on the Rights of Persons with Disabilities recognizes the right to health (art. 25) and the difficult conditions faced by persons with disabilities who are subject to multiple or aggravated forms of discrimination, including indigenous persons with disabilities (preamble). 68. Indigenous children with disabilities face physical, systemic and attitudinal barriers that impede the realization of their rights to education, accessible services and disabilityrelated rehabilitation programmes. Too often, indigenous children with disabilities face 40 41 42 Ellen Gabriel, presentation to the Expert Seminar on Indigenous Peoples and the Right to Health. World Health Organization, “Violence against women: intimate partner and sexual violence against women”, factsheet No. 239 (January 2016). Available from: www.who.int/mediacentre/factsheets/fs239/en/. United Nations Population Fund and the Spanish Agency for International Development Cooperation, “Promoting equality, recognizing diversity: case stories in intercultural sexual and reproductive health among indigenous peoples” (Panama, August, 2010). 17