The United Nations Convention on the Rights of the Child1 is a critically important and highly relevant document for practitioners concerned with domestic and international child health and well-being. In this age of best practices and evidence-based medicine, the Convention is the basic blueprint for describing, assessing, and promoting infant, child, and adolescent health in the most holistic sense of the word. However, most health professionals in the United States are not familiar with the Convention or its successful use as a tool for informed advocacy throughout the world.
The Convention has it origins in article 25 of the Universal Declaration of Human Rights,2 which states that every person has a right to "a standard of living adequate for the health and wellbeing of himself and his family, including food, clothing, housing, and medical care and necessary social services ... Motherhood and childhood are entitled to special care and assistance. All children ... shall enjoy the same social protection." Article 12 of the International Covenant on Economic, Social, and Cultural Rights3 echoes this principal with an even stronger statement that focuses on the right to the enjoyment of the highest attainable standard of physical and mental health. It states that making "provisions for the healthy development of the child" is necessary for optimal child health and makes clear that access to healthcare is a critical prerequisite.
After a decade of in-depth discussions and negotiations involving multiple governmental, non-governmental, religious, health, legal, and educational agencies and organizations, the Convention was entered into force on September 2, 1990. With its 191 signatories, the Convention has received the most universal support of any UN Convention to date. Only two countries are missing - Somalia and the United States.
The Convention is unique in its integration of civil, political, economic, social, and cultural rights. Instead of a hierarchy of rights, it demonstrates the interdependence of rights, acknowledging that they are of equal importance, each one reliant on the others for full expression and realization of human existence. The Convention also recognizes children as human beings deserving respect, dignity, and rights. It demonstrates a preferential option for vulnerable children - whether they be poor and living in rural Appalachia, street children in Latin America, or refugees in the Sudan - and stales that governments should distribute resources with this in mind.
A number of the Convention's articles hold special relevance for health professionals. Article 24 clearly declares that every child has a right to the enjoyment of the highest attainable standard of health and access to healthcare facilities. It unequivocally states that governments should endeavor to make healthcare universally available. Article 27 states that every child has a right to an adequate standard of living, speaking to the environmental factors (eg, housing, food, income) that affect a child's health. Article 2 states that governments shall respect and ensure the rights set forth to each child within their jurisdiction without discrimination of any kind, irrespective of the child's or his or her parent's or legal guardian's race, color, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth, or other status. Nations must not only actively protect children from discrimination, but they also must refrain from actions that may have a discriminatory effect on some children.
The Convention describes the overall responsibility that governments must have towards all children. They are required to undertake all appropriate legislative, administrative, and other measures to implement the Convention, and they must use the maximum amount of available resources to support the overall rationale, which is to ensure to the maximum extent possible the survival and development of the child.1 The Convention charges governments to act on the principle of nondiscrimination, identify vulnerable groups, and take affirmative action to redress inequities.
US INVOLVEMENT IN THE CONVENTION
A number of articles address the role governments should play in supporting parents. Notably, the United States joined the unanimous vote for the Convention at the General Assembly on November 20, 1989. It also made a commitment at the World Summit for Children in 1991 to "work to promote the earliest possible ratification and implementation of the Convention on the Rights of the Child,"4 and signed the Convention on February 5, 1995. However, despite proclamations in support of this document and being a signatory, the US has yet to ratify the Convention.5 Ratification is important because with it come specific responsibilities of implementation. It also conveys a message to the rest of the world mat the US is committed to protecting and promoting children's rights.
Among the reasons ratification has not occurred are legal arguments, including that it is not enforceable, that it would challenge the US Constitution, and that US laws already do a good job of protecting children. There also is fear that it threatens parental rights, although the preamble and 10 articles of the Convention clearly state and support parents' rights to raise their children. Further, there is concern that it promotes abortion - the language in the document is neutral on this topic - and that certain actions of the US government, most notably the execution of minors, would be prohibited if the US ratified the Convention.
In general, there are widespread misconceptions regarding UNCRCs intent, provisions, and potential affect. However, the logic and international appeal of the Convention as the "standard of care" for children makes it a useful instrument for change on behalf of US children. As the Convention gains increasing currency internationally, the failure of the US to live up to standards codified in the Convention becomes even starker.
INTERNATIONAL AND DOMESTIC ADVOCACY
The purposeful international process that generated the specific articles of the Convention not only provides legal guidance but also some political legitimacy. In Sweden, Brazil, Norway, and Belgium, the Convention is viewed as an active policy document to be used in budgetary decision-making at all levels of government.6 Other legislative or administrative endeavors internationally include integration of the Convention into the national legislation in the Democratic Republic of the Congo and Ethiopia, establishment of child parliaments and child courts in India, and formation of ombudsman offices in Zambia and Rwanda. From the perspective of advocacy, the Convention has been used to outlaw female genital mutilation in Burkina Faso, Senegal, Togo, and other African countries; protect Gypsies in Romania, children with disabilities in Iran, and child laborers in Thailand;6 and combat sexual exploitation of children worldwide.7
In Uganda, children are learning about the Convention and using theater to engage their audiences in exploring the issue of child sexual abuse.8 Numerous nongovernmental organizations are collaborating with governments to address distinct child rights concerns.9 An organization based in New York, NY, recently used the language of the Convention to address how New York and federal welfare reform policies violate the right to food and what steps need to be taken to strengthen the US Food Stamp Program and make it accessible to those who need it.10 Another US-based nonprofit organization has filed a brief with the InterAmerican Commission on Human Rights, charging that US policies and specifically welfare reform violate the economic human rights of its poor.11
Notably, US courts have referred to provisions of the Convention. In Batista ? Batista, the court cited article 12 of the Convention in support of its decision that a 1 5-year-old girl's views and concerns should be heard.7 Additionally, many US state constitutions contain language regarding care for the less affluent, and several states have used international law for interpreting their state statutes as pertains to education and minimum standard of living.12
The Convention should have a special resonance for pediatricians and others who have both the capacity and responsibility to care for children. A basic tenet of pediatric practice is to advocate for the best interests of the child. According to the Convention, this does not mean that a child's interests will always prevail; rather, it allows for child interests to be considered and given equal weight to competing interests. The pediatric community could benefit in this regard by using a human rights perspective to inform the public debate on children's issues. Pediatricians use growth charts in their daily practices to compare a child's growth to norms for his or her particular age and gender. One may think of the Convention as the growth chart for children's interests, a template by which child advocates can measure progress in promoting the health and well-being of children.
1. Convention on the Rights of the Child. United Nations General Assembly Resolution 44/25. November 20, 1989. Available at: http://www.unhchr.en/html/menu3/b/k2crc.ht m. Accessed August 3, 2004.
2. Universal Declaration of Human Rights. United Nations General Assembly Resolution 217 A (??). December 10, 1948 Available at: http://www.unhchr.ch/udhr/lang/eng.htm. Accessed September 9, 2004.
3. Committee on Economic, Social and Cultural Rights. International Covenant on Economic, Social and Cultural Rights, GA res. Office of the High Commissioner for Human Rights; 1966. 2200A (XXI), 21 UNGAOR Supp. (No. 16) at 49, UN Doc A/6316 (1966), 993 UNTS 3, entered into force Jan. 3, 1976. Available at: http://wwwl.umn.edu/humanrts/instree/b2esc.htm. Accessed August 3, 2004.
4. America's Children Falling Behind: The United States ana the Convention on the Rights of the Child. Washington, DC: Children's Defense Fund; 1992.
5. Haggerty RF. The convention on the rights of the child: it's time for the United States to ratify. Pediatrics. 1994;94(5):746-747.
6. Newell P. Making Governments Work for Children. Presented at: 10th Anniversary of the Convention on the Rights of the Child Commemorative Meeting: Achievements and Challenges. September 30-October 1, 1999; Geneva, Switzerland. Available at: http://www.unhchr.ch/html/menu2/6/roupre3. htm. Accessed August 3, 2004.
7. Rios-Kohn R. The Convention on the Rights of the Child: progress and challenges. Georgetown Journal on Poverty Law and Policy. 1998:5(2): 139.
8. Shrosbree A. These rights are mine. Footsteps. March 2004,58:16.
9. Price-Cohen C. Implementing the UN Convention on the Rights of the Child. Whittier Law Review. 1999:21:95.
10. Hunger is No Accident: New York and Federal Welfare Policies Violate the Human Right to Food. New York, NY: New York City Welfare Reform and Human Rights Documentation Project; 2000.
11. Honkala C, Butts J; Poor People's Economic Human Rights Campaign; et al. Petition in the Inter-American Commission on Human Rights. October 1, 1999. Available at: http://www.kwru.org/updates/IACpetition.pd f. Accessed September 9, 2004.
12. Ramsey S, Braveman D. Let them starve: government's obligation to children in poverty. Temple Law Review. 1995;68:1607.