and advancement of women, for the purpose of guaranteeing them the exercise and enjoyment of human rights and fundamental freedoms on a basis of equality with men. Article 4 1. Adoption by States Parties of temporary special measures aimed at accelerating de facto equality between men and women shall not be considered discrimination as defined in the present Convention, but shall in no way entail as a consequence the maintenance of unequal or separate standards; these measures shall be discontinued when the objectives of equality of opportunity and treatment have been achieved. 2. Adoption by States Parties of special measures, including those measures contained in the present Convention, aimed at protecting maternity shall not be considered discriminatory. 251. The peremptory legal principle of the equal and effective protection of the law and nondiscrimination signifies that States must refrain from creating discriminatory regulations or regulations that have discriminatory effects on different groups of the population when exercising their rights.404 Accordingly, if a norm or practice that appears to be neutral has particularly negative repercussions on a person or group with specific characteristics, this should be considered indirect discrimination.405 252. The Court has recognized that the liberty and autonomy of women in the area of sexual and reproductive health has historically been limited, restricted or annulled based on negative and prejudicial gender stereotypes.406 This was because, socially and cultural, men have been assigned a dominant role in the adoption of decisions concerning a woman’s body and women are seen, quintessentially, as a reproductive being.407 Nevertheless, women have the “right to receive dignified and respectful reproductive health care services and obstetric care, free from discrimination and any violence.”408 253. This Court also considers that various structural disadvantages coalesced in Manuela and had an impact on her victimization. In particular, the Court underscores that Manuela was a poor illiterate woman who lived in a rural area. If the discrimination that has been alleged in this case is verified, these factors of vulnerability or sources of discrimination would have coalesced intersectionally, increasing the presumed victim’s comparative disadvantages and causing a specific form of discrimination due to the confluence of all those factors. 409 Moreover, the Court stresses that those factors of discrimination coincide with the profile of most of the women who have been tried for abortion or aggravated homicide in El Salvador; they have little or no income, hardly any schooling, and reside in rural or marginal urban areas (supra para. 46). 254. The Court considers that the ambiguity of the laws on the medical professional secrecy and the reporting obligation that exists in El Salvador disproportionately affects women Cf. Case of the Yean and Bosico Girls v. Dominican Republic. Judgment of September 8, 2005. Series C No. 130, para. 141, and Case of Artavia Murillo et al. (In vitro fertilization) v. Costa Rica, supra, para. 286. 404 Cf. Case of Artavia Murillo et al. (In vitro fertilization) v. Costa Rica, supra, para. 286. See also, Committee for the Elimination of Discrimination against Women, General recommendation No. 25 on temporary special measures (2004), footnote 1: “Indirect discrimination against women may occur when laws, policies and programmes are based on seemingly gender-neutral criteria which in their actual effect have a detrimental impact on women. 405 406 Case of I.V. v. Bolivia, supra, para. 143. 407 Case of I.V. v. Bolivia, supra, para. 143. Report of the Special Rapporteur on violence against women, its causes and consequences on a human rightsbased approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence. UN Doc. A/74/137, July 11, 2019, para. 76. 408 Case of the Workers of the Fireworks Factory of Santo Antônio de Jesus and their families v. Brazil, supra, para. 191. 409 71