Enough of the ‘Snake Oil’: Applying a Business and Human Rights Lens to the Sexual and Reproductive Wellness Industry

Abstract The female sexual and reproductive wellness industry is flourishing, valued at around US$4.5trn globally. Heavily focused on the female reproductive life cycle, products are marketed to women and girls from puberty through to the menopausal years, with medically unsubstantiated claims that can fail to deliver on promises made and leave damaging physical and psychological side-effects. In this article we ask: do the harms caused by the sexual and reproductive wellness industry fall within the boundaries of business and human rights (BHR) scholarship? We establish the landscape of the industry, identify human rights relating to sexual and reproductive healthcare and education, and use BHR literature to make the case that the industry should be placed on the BHR research agenda so that the various tools used in BHR such as the law, corporate governance, and the weight of public consciousness, can be applied to encourage appropriate regulation of this industry.


I. Introduction
This article examines the highly successful industry of marketing and selling non-medicinal remedies for women's sexual and reproductive health. 1 The industry focuses on the female reproductive years from puberty through to menopause. It includes health-related products that promise to address women's sexual and reproductive concerns. However, these products can, and often do, fail to perform the promised function. In worst-case scenarios, they can cause damaging medical or psychological side-effects.
We use the 'Sexual and Reproductive Wellness Industry' (the industry) as an umbrella term to capture the kaleidoscope of businesses (large and small) operating within the field. This industry has received relatively little attention in the business and human rights (BHR) field. To the extent that sexual and reproductive wellness products are discussed, such scrutiny tends to focus on individual products or companies rather than on the industry as a whole. This is a problem because the industry is largely unregulated. As a result, it is able to target consumers with inappropriate marketing practices selling unnecessary or potentially harmful products. In this article, we propose that the industry should fall within the boundaries of the BHR scholarship as it has significant human rights implications that need to be addressed.
To be clear, this article is not advocating for modern medical and pharmaceutical interventions to the detriment of traditional or alternative medicine. We recognize the benefits of holistic approaches to health and the diverse cultural understandings of health that exist in communities around the world.
We identify the research agenda for this topic as requiring a fourfold approach: (1) to establish the landscape of the industry and use case studies to illuminate the legal and ethical problems within the industry; (2) to examine human rights principles to demonstrate the impact of an unregulated industry on human rights relating to access to sexual and reproductive healthcare and education; (3) to make the case that the sale and harmful marketing practices of the industry fall within the boundaries of the BHR scholarship; and (4) to engage in dialogue with interested parties and present a framework of solutions. We intend to address the first three objectives in this article and to open the fourth objectivethe development of a framework of solutionsto the wider BHR community.
The article proceeds as follows. Part II establishes the landscape of the industry by identifying the wider wellness economy and distinguishing how neoliberal understandings of wellness are connected to female sexual and reproductive health, with a focus on personal responsibility, lack of regulation and privatized healthcare. To further cement our mapping of the industry, we then use several examples to illustrate the scope of existing products and companies and to identify four concerning dynamics present in the industry. Part III identifies human rights norms on sexual and reproductive health framed through the right to health and the right to education. Part IV uses a BHR framework to support the case that the industry in its current under-and unregulated form is harmful to the human rights of women and girls and, as such, should be more comprehensively addressed by the BHR community. Part V concludes by pointing towards a further BHR research agenda.

Wellness
Wellness has become a buzzword. 2 The origins and history of wellness practices span ancient and traditional approaches to health from across the globe. 3 Wellness has been defined as the 'active pursuit of activities, choices and lifestyles that lead to a state of holistic health'. 4 The term refers to proactively optimizing physical, mental, emotional (and often spiritual) 5 well-being as a whole, rather than just relying solely on curative strategies. It is a noticeably 2 Anna Kirkland, 'What is Wellness Now?' (2014) 39 imprecise and malleable ideal, 6 encapsulating vast areas of personal and social life. This is 'no small part of its marketing appeal.' 7 Wellness encompasses interests such as fitness, nutrition and personal care. The wellness economy has exploded, valued at US$4.5trn globally in 2018. 8 Although data on the industry as a whole are scarce, its growth has been attributed to many varied factors, including the promotion of 'clean eating', 9 digital and viral marketing, 10 the increasing privatization and cost of healthcare (particularly in the United States of America (USA)), 11 and the rise and personalization of wellness technology. 12 Despite its permeation in everyday life, as an area of research, wellness has been largely overlooked in BHR scholarship. 13 However, wellness culture, and in particular the commodification and promotion of wellness, is contested and problematic. Critical health and media studies scholarship has linked the pursuit of wellness or 'healthism' 14 to the neoliberal ideal of the 'enterprising' individual. 15 The commodification of everyday life and focus on individual responsibility has shaped how people think about themselves, including their bodies, sexuality and wellbeing, 16 emphasizing 'consumer citizenship, personal responsibility and individual empowerment.' 17 Drawing on the concept of governmentality, 18 critical feminist health studies understand the body as a disciplinary site in and of itself, where neoliberal governance is enacted through hyper-individualized self-regulation and surveillance. 19 Wellness is then perceived as the result of 'good choices made by morally autonomous and efficacious citizens'. 20 Those who do not participate in this pursuit are viewed as leading mismanaged lives. 21 Self-improvement becomes both a moral responsibility for the individual, and a never-ending task. 22 Various aspects of the wellness economy have also faced criticism for the promotion of 'diet culture', 23 ableism, 24 racism, 25 the co-option and distortion of traditional practices for profit, 26 wellness as a form of social control, 27 and the encouragement of an unattainable and often unaffordable lifestyle, reserved for a largely white and elite consumer base. 28 Perhaps the most fundamental and underlying criticism is the wellness industry's lack of evidence-based approaches to health, which include the frequent blending of scientific language with pseudoscientific practices that aim to tackle nebulous symptoms such as 'inflammation', 'toxins' or 'free radicals'. 29 Crucially, it is women who are most often the targets of wellness product marketing.

Adverse Health Outcomes in Women
'Women's bodies have been (and continue to be) a site of struggle for definition and control.' 30 The medical research gender gap means that less is known about women's bodies and health relative to men. 31 Studies demonstrate that the implicit gender bias in medicine and medical research harms women, particularly women of colour. 32  mainstream healthcare is lower in women than in men, a gap that has continued to expand. 33 Iniquities can be particularly pronounced when it comes to sexual and reproductive healthcare. Almost 4.3 billion people of reproductive age have inadequate sexual and reproductive health services, 34 and a disproportionate burden of sexual and reproductive ill-health falls on women and girls. 35 According to the 2018 Guttmacher-Lancet Commission on reproductive health and rights, 200 million women globally have an unmet need for modern contraception and more than 45 million women receive inadequate or no antenatal care. 36 Recent scandals concerning large pharmaceutical companies have also brought some of the harmful practices in conventional sexual and reproductive healthcare into sharp relief. Manufacturers of transvaginal mesh implants used in pelvic reconstructive surgery have been sued by women alleging serious health complications. 37 Similarly, the Essure implant, a contraceptive manufactured by Bayer and marketed as a permanent, less invasive contraceptive solution, was taken off the market in 2018 after a global outcry from women who suffered devastating long-term side-effects. 38 Bayer was also the subject of several class-action lawsuits. 39 These cases exemplify the dangers of unsafe marketing practices, inadequate regulation, and corporate influence over female sexual and reproductive healthcare.
Compounding these issues is the educational and cultural context of sexual and reproductive health. While a woman's right to sexual and reproductive health forms an intrinsic part of international human rights law 40further unpacked in Part III of this paper there remain extensive disparities between sexual and reproductive health education for women, which vary from country to country (and even from school to school within countries), 41 leaving inequitable knowledge gaps regarding women's health that wellness businesses step in to fill.
Studies have found that women overwhelmingly report normative body discontent, including concerning their genitalia. 42 Patriarchal structures, which simultaneously stigmatize and objectify the female body and its sexual and reproductive functionsas exemplified by the concealment of menstruation, 43 taboos surrounding female sexual pleasure or the idea that female genitalia are unclean 44remain prevalent. 45

The Sexual and Reproductive Wellness Industry
With this context in mind, we turn to the female sexual and reproductive wellness industry. 46 Critical feminist health scholarship extends the discussion on how the neoliberal 'enterprising self' is enacted and regulated through the eternal pursuit of wellness (as discussed above), to look specifically at the impact of this on the female sexual and reproductive body. In her work, Jane Ussher builds on earlier feminist theorizing to argue that the reproductive body is seen as both central to the performance of normative femininity and as an embodied pathology. 47 Folded in with and concealed by the surveillance and regulation of the sexual and reproductive self, 48 is the development of the postfeminist rhetoric of choice and empowerment and the popularization of 'commodity feminism'. 49 Here, the ability of women to make choices and to be empowered is demonstrated through their participation in the market economy. Feminist ideals of body positivity and self-care, traditionally understood as emancipatory and collectivist acts, 50 are commodified and individualized. 51 Rosalind Gill maintains that the discourse of empowerment is highly marketable, inviting women to 'purchase everything from bras to coffee as a sign of their power and independence'. 52 Indeed, this has become central to how wellness is marketed to women, 53 with products like rejuvenation injections claiming to 'empower the vagina'. 54 43  . 44 Braun and Wilkinson, note 30. 45 Vandenburg and Braun, note 16. 46 Although there are also products available which target male sexual and reproductive healthparticularly those geared at erectile functionthe focus of this piece is on products directed at women. 47  In this way, the industry has co-opted both the fears around women's sexual health and fertility, and the emancipatory principles that sought to liberate women from their sexual and reproductive roles. As Morgan succinctly contends, 'The tacit suggestion that we are not loving ourselves enough unless we spend the money to try to give our vulvas the tone and luminosity of a cheekbone or a shoulder is, surely, a phenomenon worthy of great concern.' 55 Given the expansive definition of wellness, products in the industry are extensive. They range from 'Femtech', 56 hygiene products, sexual health products, beauty products and cosmetic genital treatments. These products cater to (and to some extent, help to control) every stage of a woman's reproductive life cycle, including fertility-enhancing, ante-natal, postpartum and menopause treatments. Many centre on the use of eco-friendly materials, such as menstrual cups, organic tampons and CBD lubrication. 57 Others boast holistic benefits like detoxing and purification. 58 Retailers range from individual sellers on e-commerce platforms such as Etsy, to large, international lifestyle and wellness brands. 59 Typically, products in this industry are classified as cosmetic rather than medical devices or pharmaceuticalseven though many of them are meant for internal usemeaning that companies are largely unregulated. 60 In addition to the control and commodity aspects of the industry discussed above, the misinformation produced by the industry has significant human rights implications. We discuss these below with reference to specific examples.

Industry Examples
As the contours of the industry are rather amorphous, we draw on three illustrative examples -Goop's Jade Egg, LadyCare's Menopause Magnets and Goddess Detox's Vaginal Detox Pearls. The three products were chosen because they provide axiomatic examples of the types of products and companies at play and how these can harm women and girls throughout their reproductive life cycle. All of the products have been under investigation for false advertising in different domestic jurisdictions, where approaches to the regulation of deceptive marketing vary. Using these examples as a guide, we then identify dynamics of the industry that are of particular concern in a BHR context.

Goop's Jade Egg
Goop's Jade Egg (or 'Yoni' Egg) is perhaps the most infamous of the industry products. in the United Kingdom (UK) as capable of harnessing 'the power of energy work, crystal healing, and a Kegel-like physical practice.' 61 Both Goop Inc. and the Egg have been the subject of fierce criticism. Goop has a history of marketing strategies that co-opt or distort scientific language and combine evidence with folklore and anecdotes in a way that is difficult to regulate. 62 Goop contends that it is careful to avoid making statements of medical fact, instead emphasizing that its purpose as a wellness lifestyle company is to 'ask questions' about conventional approaches to women's health and well-being. 63 It claims to compile and offer a variety of alternative information about, and solutions for, sexual and reproductive health, allowing consumers to draw their own conclusions. 64 This approach combines the neoliberal ideal of female empowerment and choice rhetoric 65 while highlighting that women's sexual and reproductive issues have been overlooked by conventional healthcare: 'Our primary place is in addressing people, women in particular, who are tired of feeling less-than-great, who are looking for solutionsthese women are not hypochondriacs, and they should not be dismissed or marginalized.' 66 The Jade Egg was previously advertised online as having the ability to 'balance hormones, regulate menstrual cycles, prevent uterine prolapse, and increase bladder control'. 67 This generated a strong backlash in the media and healthcare. 68 Medical practitioners have repeatedly stated that aside from the Egg's implausible claims on its impact on genital health, 69 its use might also be harmful. 70 In 2018, Goop settled a case with the California Food, Drug and Medical Device Task Force, where the company was ordered to pay US$145,000, and refund customers for the Egg and another deceptively marketed product. 71 Perhaps most significantly of all, Goop was also precluded from making or disseminating deceptive claims and statements about any of its products for five years. 72

LadyCare's Menopause Magnet
LadyCare's Menopause Magnet is a UK£45 device that relies on magnet therapy to treat symptoms of perimenopause and menopause. It is designed to clip into underwear and to be worn every day for at least three months. 73 Magnet therapy is reportedly a billion-dollar industry, 74 with little evidence-based science to back up curative claims. 75 The LadyCare Magnet is advertised as proven to reduce or eliminate menopause symptoms (such as hot flashes, night sweats, weight gain and mood swings) in 'over 71 percent of women', by 'restoring balance' in the automatic nervous system. 76 The efficacy of these claims has been frequently contested, most recently by the UK's Advertising Standards Agency, which decided that advertising the Magnet in such a misleading manner breached the Code of Non-Broadcast Advertising and Direct & Promotional Marketing. 77 While LadyCare contended that their website described the outcome of clinical trials and reported observations, they produced no evidence to that effect. 78 The Magnets continue to be sold online, with many of the original claims intact.

Goddess Detox Vaginal Detox Pearls
Goddess Inc.'s Detox Pearls are US$33 herbal vaginal suppositories, which work to aid 'overall womb health' by expelling contents that may be 'working against the womb and vagina'. 79 These products form part of a wider trend of 'vaginal steaming' using the application of herbs and heat. 80 The practice has similarities to other home remedies, 81 but has been rapidly commercialized, with contemporary products often promoted to treat serious medical conditions like uterine prolapse. 82 Apart from the fact that the vagina does not require detoxing, 83 the use of steaming products has in some cases led to significant harm, causing second-degree burns. 84 The list of the Goddess Detox Pearls' supposed benefits ranges from increasing libido and fertility, to 'detoxing a consumer's ex-partner'. 85 In 2019, Canada's public health department barred the sale of the Pearls due to their deceptive marketing practices. 86 Concerns over the Pearls' purported trauma-healing properties were also raised by the Canadian Women's Foundation, who stated that: 'Healing and cleansing "aids" that make claims ungrounded in research can mislead people, create confusions and compound vulnerability. It causes even more harm to survivors of violence.' 87 In 2020, a class-action lawsuit was filed in Florida against Goddess Inc., claiming that the Pearls' marketing and advertising were false and misleading. The claimants also contend that some of the listed ingredients have not been established as safe for internal use, exposing consumers to the risk of significant bodily harm. 88 They further argue that claiming the product can treat infertility is unlawful, as infertility is a medical condition, and treatment of such a condition must be approved by a federal agency, the United States Food and Drug Association. 89

Marketing Practices of Concern
From the above examples, we can delineate several features of the marketing practices employed by companies in the industry which are of particular concern from a human rights perspective and arguably therefore also of interest to the BHR field.
First, product advertisement is often infused with a combination of scientific language and holistic vocabulary. In the above cases, language such as 'Kegel-like', 'detoxifying' and 'restoring balance to the automatic nervous system' through magnetic fields is used. These phrases are a form of 'scienceploitation' that can 'mislead the public and make it difficult to discern real science from marketing claims that merely reference scientific-sounding terminology.' 90 Second, marketing practices directly exploit the lack of understanding and dismissal of women's bodies in conventional healthcare, manipulating perennial misogynistic beliefs about female bodies as 'unclean' and in need of constant surveillance, for profit. 91 It perpetuates false information in the form of pseudoscientific health myths (dressed up as 'wellness'), which have the potential to directly harm women. They prey on shame and body insecurities and encourage personal hyper-surveillance of genitalia to control anything that might be perceived as 'abnormal', with each product resting on the assumption that women's sexual and reproductive organs require fixing. The three products discussed above are indicative of a harmful trend in the industry, particularly as unsubstantiated marketing claims may be relied upon by people making health-related decisions when they are advertised by those who have a commercial interest in profiting from misinformation, and when those interests are not properly regulated.
Finally, the growth of digital marketing practices via social media provides an effective vehicle for marketing sexual and reproductive wellness products, given the potential for both a wide reach and targeted advertisements. 92 91 Vandenburg and Braun, note 16. 92 The spread of misinformation via digital platforms, particularly in relation to health during the COVID-19 pandemic, is a growing human rights concern; see UN Department of Global Communications, 'UN Tackles celebrity endorsements has been advantageous for the marketing of misinformation online, 93 where the consumer seeks to buy into a certain lifestyle, rather than assessing whether the product itself is effective or safe. 94 For example, Goopowned by actor and guru, Gwyneth Paltrowis built on the aspirational and very marketable ideal that buying Goop's products is akin to owning Paltrow's lifestyle and that of her influential (white and wealthy) friends. 95 LadyCare has also used celebrity endorsements, 96 and The Goddess Detox heavily relies on marketing via social media, touting numerous positive consumer product reviews. 97 In spotlighting these three industry products, and exploring common features that are of particular concern, we pave the way for Parts III and IV below, which highlight the right to sexual and reproductive health and the potential for using a BHR framework to observe, prevent and remedy some of these harms in the industry.

Sexual and Reproductive Health
This article demonstrates that states are failing to respect, protect and facilitate the right to health for women and girls. 98 One outcome of this failure is that businesses are given freedom to define the boundaries of female sexual and reproductive health and wellness without any real accountability for the harms that they might cause. Neoliberal regulatory approaches have created unequal health and educational systems that provide fertile ground for the predatory corporate marketing of sexual and reproductive wellness products. 99 These are human rights issues that must be addressed by states and by businesses.
Sexual and reproductive health rights (SRHR) includes 'The right to have control over and decide freely and responsibly on matters relating to sexuality, including sexual and reproductive health, free of coercion, discrimination and violence … and the right to attain the highest standard of sexual and reproductive health.' 100 States have obligations under international human rights law to respect, protect and fulfil the SRHR of women and girls. The global health community has also developed professional standards and ethical codes that support medical practitioners taking a proactive role in safeguarding access to health information and in countering misinformation. 101 While SRHR apply to everyone, the realization of these rights for women and girls is of particular importance due to their centrality for the achievement of gender equality. 102 As noted in Part II of this paper, women and girls during their reproductive years form the demographic most at risk of being targeted by businesses in the female wellness industry.
In 2010, the Committee on the Elimination of All Forms of Discrimination Against Women (CEDAW) issued General Recommendation (No. 28) 103 on the core obligations of states parties under the Convention noting that 'Article 2 is not limited to the prohibition of discrimination against women caused directly or indirectly by States parties. Article 2 also imposes a due diligence obligation to prevent discrimination by private actors.' 104 States parties are obliged, inter alia, to regulate the 'activities of private actors with regard to education, employment and health policies'. 105 States parties are further obliged to 'promote the equal rights of girls since girls … are more vulnerable to discrimination in such areas as access to basic education … and States shall pay attention to the specific needs of (adolescent) girls by providing education on sexual and reproductive health'. 106 SRHR are therefore well-established human rights norms that entail obligations for states and responsibilities for non-state actors, including businesses, to ensure that they are respected and protected without any discrimination.

Right to Health
The right to health is recognized in several key international treaties, including the International Covenant on Economic, Social and Cultural Rights (CESCR). 107 General Comment No. 14 on Article 12 of CESCR recognizes the gender gap in healthcare by advising states that they should 'integrate a gender-based perspective in their health-related policies, planning, programmes and research in order to promote better health for both women and men.' 108 The general comment clarifies that to remove discrimination against women, 'there is a need to develop and implement a comprehensive national strategy for promoting women's right to health throughout their life … [t]he realization of women's right to health requires the removal of all barriers interfering with access to health services, education and information including in the area of sexual and reproductive health.' 109 In 2016, in response to its observed violations of SRHR, the CESCR Committee issued its interpretive General Comment (No. 22), clarifying that SRHR are an 'integral' part of the right to health. 110 Women and girls are highlighted particularly because of their reproductive capacities 111 and, as demonstrated in Part II, it is especially because of these capacities that an industry has developed to tap into the associated special needs of women. For there to be gender parity in sexual and reproductive health, 'the health needs of women, different from those of men' 112 must be considered and this applies to protection from harmful products aimed at women due to their sexual and reproductive biology. The CESCR Committee reminds states of their obligation to ensure 'to the maximum of their available resources, with a view to achieving progressively the full realization of the right to sexual and reproductive health … [s]uch steps should … [use] all appropriate means, particularly including, but not limited to, the adoption of legislative and budgetary measures.' 113 In this context, we argue that manufacturers of goods or services relating to women's sexual and reproductive health should be subject to appropriate regulation and accountability frameworks.
The highest attainable standard of sexual and reproductive health can only be realized through equal access to public health services. The risk that someone will self-diagnose and self-treat increases in healthcare systems rooted in neoliberal approaches and increases again when the complaint relates to sexual and reproductive health where there is stigma and a lack of education surrounding what is 'normal'. Consequently, access to healthcare is connected to the right to education and it is for this reason that to fully realize health rights we must also consider rights to education and information so that women and girls are able to make informed choices about their SRHR.

Right to Education
Education is recognized as a human right in numerous international and regional instruments. 114 The Convention on the Elimination of Discrimination Against Women (CEDAW) interpretation of education is particularly important because of historical gender discrimination against girls. Article 10(h) stipulates that states must ensure that there is '[a]ccess to specific educational information to help to ensure the health and well-being of families, including information and advice on family planning.' 115 In 2017, the CEDAW Committee issued General Recommendation No. 36 on girls' and women's right to education which states that '[a]s a human right, education enhances the enjoyment of other human rights and freedoms, yields significant development benefits [and] facilitates gender equality'. 116 The CESCR Committee interprets the determinants of SRHR as including access to 'healthrelated education and information'. 117 Information 'related to sexual and reproductive health care should be accessible to all individuals and groups without discrimination and free from barriers'. 118 All 'individuals and groups, including adolescents and youth, have the right to evidence-based information on all aspects of sexual and reproductive health'. 119 States are under an obligation to ensure that SRHR is 'evidence-based and scientifically and medically appropriate and up-to-date.' 120 As was highlighted in Part I, there is a gap in medical research, knowledge and understanding of women's bodies relative to men's bodies. 121 One critical contributor to this dearth of understanding is the lack of a cohesive international approach to sexual and reproductive health education. Differences occur from country to country and even from school to school within a single country. 122 A global review undertaken by UNESCO in 2015 states that core elements of comprehensive sexuality education (CSE) 'share certain similarities: CSE's firm grounding in human rightsincluding the rights of the child, and the empowerment of children and young peopleand a reflection of the broad concept of sexuality as a natural part of human development.' 123 The report also notes that 'young people are increasingly demanding their right to sexuality education'. 124 Furthermore, the report recognizes the commitments that various governments have made and the increasing political will to 'scale up delivery of CSE' with partnerships between governmental departments of health and education. 125 In sum, while there has been increased political will to respond to the need for more effective sexual and reproductive education, there is too great a variation in terms of the content, methods of delivery and quality of teaching. An issue that is considered within the review and that is the subject of future research, is how prevalent the interference by groups with cultural or religious agendas is concerning sexual and reproductive health educationspecifically concerning the female reproductive life cycle.
The sexual and reproductive wellness industry would lose much of its power if young people had access via their primary and secondary school curricula to evidence-based learning about puberty, fertility (and the issues surrounding it, including infertility), what happens to the body when an individual becomes pregnant, delivers a baby, has a miscarriage/abortion, or transitions to another sex, and the slow cessation to the end of the menstrual life cycle beginning with perimenopause and ending with the menopause, inclusive of the myriad of experiences which accompany these stages. Women and girls would be less vulnerable to industry marketing around sexual and reproductive wellness if the same empowering curriculum was taught to everyone.
In Part II of this article we demonstrated that the industry is dangerously unregulated or under-regulated in various jurisdictions, with legal cases being brought concerning unsubstantiated claims and possible harms to sexual and reproductive health. Furthermore, the industry is rife with misinformation. In this section, we have demonstrated that there is a human right to access to sexual and reproductive health care and education without discrimination that states have positive obligations to respect, protect and fulfil. In the following concluding parts of the paper, we will make the case for including the industry in the BHR agenda.

IV. Application of the Business and Human Rights Framework to Sexual and Reproductive Health and Education Rights
This article forms part of a larger scoping project undertaken by the author team to determine the future research agenda to address the harms caused to women and girls by the marketing of products that interfere with sexual and reproductive healthcare and education. As part of this, we considered various fields that intersect with business, law and ethics as the optimal paradigm within which to frame and ultimately examine the issue. This was narrowed to the field of BHR.
BHR was born of the desire to hold businesses accountable for both individual and collective harmful effects to people and to prevent or mitigate such harms by building a framework of expectations that are grounded in a specific core set of human rights obligations. 126 The development of the BHR scholarship included the need to elevate the responsibility and role of non-state actors to work along with states to protect the rights embodied in human rights treaties. BHR is the appropriate framework, therefore, to use when the rights of a person, or group of people, are being harmed.
In 2019, the United Nations Working Group on BHR (UNWG) adopted a report on the 'gender dimension' of the United Nations Guiding Principles on Business and Human Rights (UNGPs). 127 This report highlights shortcomings vis-à-vis gender in current state and business measures to implement the UNGPs 128 and identifies concrete measures that might be taken by both states and businesses in discharging their respective responsibilities under the UNGPs relating to gender equality. 129 As outlined above, the sexual and reproductive wellness industry is highly gendered, selling products almost exclusively to women and girls that directly impact their sexual and reproductive health. Business enterprises in this industry have capitalized on the neoliberal approaches to healthcare and education gaps that exist in many countries resulting in the commodification of the female reproductive life cycle. These harmful marketing practices are addressed by the UNWG, which notes that: 'Business enterprises should not perpetuate gender stereotypes or objectify and sexualize women's bodies in any process, including sales and marketing, related to their products or services' (emphasis added). 130 'Sales and marketing' is thus clearly identified as a gendered human rights issue. Furthermore, UNGP 13 states that the business responsibility to respect human rights involves avoiding adverse human rights impacts, addressing these if they occur, and preventing or mitigating abuses 'directly linked to their operations'. 131 These responsibilities are currently being ignored by the industry which must be integrated within the BHR agenda to ensure that states, businesses and rights-holders are aware of SRHR and that these rights are respected, protected, and if abused, access to remedy is provided.
This article has described three examples of how the industry has created, and profited from, stereotypes about the bodies of women and girls. It must be noted, however, that there are many other instances where business enterprises across a range of retail fields target female bodies with products that are unnecessary and harmful and where long-term impacts are unknown. The UNWG draws attention to these forms of sales and marketing as a BHR issue of importance when applying the UNGPs through a gender lens. The predatory marketing of unnecessary or harmful products by business enterprises must be further examined to better understand why so many products and marketing strategies go unregulated and how this can be addressed at both the international and domestic levels. The future research agenda should consider the best approaches for the effective regulation of businesses operating in the sphere of sexual and reproductive health, for example, domestic consumer protection laws could be useful vehicles of response to regulating the industry at the domestic level.

V. Conclusion
In this article, we have established that harmful marketing or unnecessary products aimed at the female reproductive cycle is a BHR issue but also that there is much work still to be done. By applying a gender analysis to the sexual and reproductive wellness industry, we have demonstrated that states and businesses are failing in their responsibilities to women and girls concerning the protection of their rights to sexual and reproductive health. Coupled with deficient education about sexual and reproductive health, business enterprises are profiting, often in predatory and harmful ways.
To contextualize these issues within BHR, we have demonstrated that a growing sexual and reproductive wellness industry exists; products sold within this industry overwhelmingly target women and girls who are aged within the female fertility life cycle years; these products are largely unregulated both in labelling (claims made) and in how they are marketed (including increasing problems with online advertising); the international human rights framework is unequivocal that sexual and reproductive healthcare and education are human rights that should be protected without discrimination; and the BHR framework places responsibility on both states and businesses to respect and protect human rights. Consequently, businesses have responsibilities to respect such human rights, and states have a protective duty to regulate the industry in domestic legislation to ensure that sexual and reproductive rights are not being abused and if they are, access to remedy must be provided.
Upon this basis, we suggest that the future BHR research agenda includes: (1) further study on the advertising and marketing practices of all industries selling and marketing products that are highly gendered (for example, cosmetics or dietary supplements), and this research should foreground social media and online practices; (2) research on the laws concerning the packaging and labelling of products within the industry; (3) study into the effects on women and girls of the marketing of products that fall under the definition of the industry; (4) a review of extant research on advertising as a source of information in a public health context, situated within a review of World Trade Organisation rules; 132 (5) research into best practice for embedding into domestic law the guidance provided by the UNWG relating to gender and marketing to assist states to develop effective regulatory tools; and (6) scholars are encouraged to research cultural influences on sexual and reproductive healthcare and education across the areas identified in this article and beyond as necessary.
We hope that fellow BHR scholars will join the conversation and collaborate to use the tools of law, corporate governance and the weight of public consciousness to assist us in moving the regulation of the sexual and reproductive wellness industry to the fore of the BHR agenda.