66 such as this one. 210. In this regard, the Court deems it pertinent that the laws of the States should include clear definitions of what constitutes informed consent. Also, States “should monitor public and private health centers, including hospitals and clinics, which perform sterilization procedures so as to ensure that fully informed consent is being given by the patient before any sterilization procedure is carried out, with the appropriate sanctions in place in the event of a breach.” 279 In addition, Article 22 of the UNESCO Universal Declaration on Bioethics and Human Rights (supra para. 176) refers to the obligation of States to take all appropriate measures to give effect to the principles set out in the Declaration in accordance with international human rights law, which includes informed consent. The Court considers that, in cases of non-consensual or involuntary sterilization, measures to prevent such procedures are of vital importance because, although the creation of mechanisms for access to justice allows rights to be guaranteed, this cannot ensure in all cases the full restoration of the reproductive capacity, which has been lost owing to the surgical procedure. 211. The Court notes that, at the time of the facts, July 1, 2000, the regulations on informed consent in relation to surgical procedures for female sterilization in Bolivia were included in two specific norms: Bolivian Health Standard NB–SNS–04–97 (“Voluntary surgical contraception for women at high reproductive risk”),280 adopted by the National Health Secretariat in August 1997 (hereinafter “the 1997 Bolivian standard”), and Bolivian Health Standard MSPS-98 (“Voluntary surgical contraception. Bilateral tubal occlusion in reproductive risks”),281 adopted by the Ministry of Health and Social Services in November 1998 (hereinafter “the 1998 Bolivian standard”). 212. Under the 1997 Bolivian standard, the purpose of voluntary surgical contraception for women was to reduce the cases of death due to high-risk reproductive factors,282 and it was addressed at women of child-bearing age, with an active sexual life, who had a high reproductive risk and desired a permanent contraceptive method. The 1997 Bolivian standard indicated that surgical contraception was a voluntary procedure that required the patient’s prior consent, after being fully informed of the sterilization procedure, its consequences, and other methods of contraception and their characteristics, using simple language, by trained personnel, to ensure that the information received had been understood. This standard defined informed consent in cases of sterilization as “the decision of the user to undergo a voluntary surgical sterilization after having been fully informed of the procedure and its consequences,”283 and, to this end, she had to sign an informed consent form, which constituted the legal authorization for the procedure. The standard specifically established that it should be ensured that “when obtaining the informed consent, the user is not subject to coercion or to physical or emotional factors that could affect her ability to take a careful and well-considered Cf. UN, Committee for the Elimination of Discrimination against Women, Concluding observations with regard to Slovakia, CEDAW/C/SVK/CO/4, July 2008, para. 31. 279 Cf. Bolivian Health standards NB–SNS–04–97 (“Voluntary surgical contraception for women at high reproductive risk”), adopted by Secretariat Resolution No. 0/408 of August 4, 1997 (file of the procedure before the Commission, volume III, folios 887 to 898). 280 Cf. Bolivian Health standards MSPS-98 (“Voluntary surgical contraception. Bilateral tubal occlusion in reproductive risks”), approved by Ministerial Resolution No. 0517 of November 17, 1998 (file of the procedure before the Commission, volume I, folios 186 to 200). 281 The 1997 Bolivian standards defined high reproductive risk as the “probability that both the woman of child-bearing age, and also her potential fetus, might experience injury or death if she became pregnant.” Cf. Bolivian Health standards NB–SNS–04–97, p. 17. The standards contained a list of medical reasons for sterilization, including: pulmonary diseases which limited the respiratory capacity; severe rupture of the uterus, and a third caesarean section with three living offspring. It also listed “paridad satisfecha” which referred to cases of women who requested sterilization provided they had had five vaginal births with living offspring and were over 35 years of age (file of the procedure before the Commission, volume III, folios 892 to 895). 282 283 Bolivian Health standards NB–SNS–04–97, p. 27 (file of the procedure before the Commission, volume III, folio 898).