128. Acceptability means that healthcare facilities and services must respect medical ethics and culturally appropriate standards. They also must include a gender approach, as well as take into consideration the patient’s living conditions,124 and they must be designed to maintain confidentiality and improve the health of the people they treat. 125 With regard to sexual and reproductive health, respect for the privacy and confidentiality of health information are crucial and form part of States’ basic obligations to respect this right.126 At the same time, to ensure the availability of sexual and reproductive health services, States must ensure that providers and medical staff are duly qualified and trained specifically to provide care for women and girls.127 The Inter-American Court has also found that “a failure to provide legal protections to ensure that reproductive health is taken into consideration can severely undermine autonomy and reproductive freedom."128 Likewise, the lack of information and the existence of certain practices, attitudes, and stereotypes—in families and communities as well as from the staff working in healthcare facilities—can function as barriers that prevent women from accessing sexual and reproductive health services and impact their decision on whether to seek medical care or health information in a timely fashion.129 129. The IACHR recalls that the organization and structure of health services and women’s knowledge of the medical care services available and the protection of their right to health are essential for safeguarding that right.130 The Commission has pointed to the need to encourage policies that propose specific prevention and healthcare measures in maternal health and making adequate health care services available to women, especially poor women, as well as reproductive health information and assistance programs, including dissemination measures and campaigns on the government’s obligations and the rights of women in this area.131 In this regard, States must adopt measures to eliminate preventable risks and harm faced by women in the area of sexual and reproductive health, to include not only medical treatment and care that address the needs and interests specific to women, but also the elimination of stereotypical roles and concepts that affect the enjoyment of the right to health. 130. In this case, the Commission observes that the doctor who attended Manuela reported her on February 27, 2008, stating that her having given birth appeared to have been “the result of committing a crime." Additionally, the doctor gave a statement to the police on February 28, 2008, in which she revealed information from a clinical examination of the alleged victim, including that the patient “did not provide information that matched the clinical diagnosis,” that “on examination of her, the emergence of an umbilical cord of about 40cm in length was observed, cleanly cut and with a perianal tear,” and that “the patient’s placenta was observed to be calcified.” 131. Additionally, on February 29, 2008, the Director of the Hospital Nacional San Francisco Gotera sent, at the request of the Office of the Public Prosecutor of Morazán, a summary of Manuela's medical records that contained the alleged victim’s personal medical history including “first menstrual period at 13 years old, began having sexual relations at 22 years old, no family planning methods, no sexually-transmitted diseases, last pap smear five years ago, patient says pregnancy is the result of infidelity." 132. The Commission underscores that this constituted a restriction on the right to privacy and raises a tension between that right and the duty to report. An evaluation of proportionality must therefore be made to determine if the restriction was acceptable under the Convention. To do so, the IACHR will take the Inter-American Court, Case of Poblete Vilches et al. v. Chile. Merits, Reparations, and Costs. Judgment of March 8, 2018. Series C No. 349, párr.121. 125 Committee on Economic, Social and Cultural Rights, General Comment 14 (2000) "The right to the highest attainable standard of health, para. 12. 126 Committee on Economic, Social and Cultural Rights, General Comment 22 (2016) “On the right to sexual and reproductive health,” paras. 40 and 49(d). 127 Committee on Economic, Social and Cultural Rights, General Comment 22 (2016) “On the right to sexual and reproductive health,” paras. 13, 25-29. 128 Inter-American Court. Case of Artavia Murillo et al. (in vitro fertilization) v. Costa Rica. Preliminary Objections, Merits, Reparations, and Costs. Judgment of November 28, 2012. Series C No. 257. párr.147 129 IACHR. Access to Maternal Health Services from a Human Rights Perspective (June 7, 2010), paras. 29 and 33 130 IACHR, Report of the Inter-American Commission on Human Rights on the Status of Women in the Americas, OEA/Ser.L/V/II.100, Doc. 17, October 13, 1998. 131 IACHR. Access to Maternal Health Services from a Human Rights Perspective (June 7, 2010), para. 43 124 24