Draft Platform for Action
C. Inequalities in access to health and related services

91. Women have the right to the enjoyment of the highest attainable standard of physical and mental health. The enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social and physical well-being, and is determined by the social, political and economic context of their lives, as well as by biology. However, health and well-being elude the majority of women. [The major] barrier for women to the achievement of the highest attainable standard of health is inequality, both between men and women and [among women]. In national and international forums, women have emphasized that to attain optimal health throughout the life cycle, equality, including the sharing of family responsibilities, development and peace are necessary conditions.

92. Women have different and unequal access to and use of basic health resources, including primary health services for the prevention and treatment of childhood diseases, malnutrition, anaemia, diarrhoeal diseases, communicable diseases, malaria and other tropical diseases and tuberculosis, among others. Women also have different and unequal opportunities for the protection, promotion and maintenance of their health. In many developing countries, the lack of emergency obstetric services is also of particular concern. Health policies and programmes often perpetuate [gender] stereotypes and fail to consider socio-economic disparities and other differences among women and may not fully take account of the lack of autonomy of women regarding their health. Women's health is also affected by [gender] bias in the health system and by the provision of inadequate and inappropriate medical services to women.

93. In many countries, in particular developing and least-developed countries, [structural adjustment,] [the deterioration of public health systems, a decrease in public health spending and, in some cases, increasing privatization of health-care systems without appropriate guarantees of universal access] further reduce health-care availability. This situation not only directly affects the health of girls and women, but also places disproportionate responsibilities on women, whose multiple roles, including their roles within the family and the community, are often not acknowledged; hence they do not receive the necessary social, psychological and economic support.

94. Women's right to the enjoyment of the highest standard of health must be secured throughout the whole life cycle in equality with men. Women are affected by many of the same health conditions as men, but women experience them differently. The prevalence among women of poverty and economic dependence, their experience of violence, negative attitudes towards women and girls, discrimination due to race and other forms of discrimination, [the limited power many women have over their sexual and reproductive lives] and lack of influence in decision-making are social realities which have an adverse impact on their health. Lack of and inequitable distribution of food for girls and women in the household, inadequate access to safe water, sanitation facilities and fuel supplies, particularly in rural and poor urban areas, and deficient housing conditions, all overburden women and their families and have a negative effect on their health. Good health is essential to leading a productive and fulfilling life [and the right of all women to control their own fertility is basic to their empowerment].

95. Discrimination against girls, often resulting from son preference, in access to nutrition and health-care services endangers their current and future health and well-being. Conditions that force girls into early marriage, pregnancy and child-bearing and subject them to harmful practices, such as female genital mutilation, pose grave health risks. Adolescent girls need, but too often do not have, access to necessary health and nutrition services as they mature. [Counselling and access to sexual and reproductive health information and services for adolescents are still inadequate or lacking completely, and a young woman's right to privacy, confidentiality, respect and informed consent is often not considered, taking into account the parents' responsibilities] Adolescent girls are both biologically and psychosocially more vulnerable than boys to sexual abuse, violence and prostitution, and to the consequences of [unprotected] [premature] sexual relations. The trend towards early sexual experience, combined with a lack of information and services, increases the risk of [unwanted] and too early pregnancy, HIV infection and other sexually transmitted diseases, as well as [unsafe abortions]. Early child-bearing continues to be an impediment to improvements in the educational, economic and social status of women in all parts of the world. Overall, for young women early marriage and early motherhood can severely curtail educational and employment opportunities and are likely to have a long-term, adverse impact on the quality of their lives and the lives of their children. Young men are often not educated to respect [women's self-determination] and to share responsibility with women in matters of sexuality and reproduction.

96. [Reproductive health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents. Sexual health enhances life and personal relations, and does not merely involve counselling and care related to reproduction and sexually transmitted diseases.]

97. [Sexual rights include the individual's right to have control over and decide freely on matters related to her or his sexuality, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the physical integrity of the human body, require mutual consent and willingness to accept responsibility for the consequences of sexual behaviour.]

*98. Further, women are subject to particular health risks due to inadequate responsiveness and lack of services to meet health needs related to sexuality and reproduction. Complications related to pregnancy and childbirth are among the leading causes of mortality and morbidity of women of reproductive age in many parts of the developing world. Similar problems exist to a certain degree in some countries with economies in transition. [Unsafe abortions] threaten the lives of a large number of women, representing a grave public health problem as it is primarily the poorest and youngest who take the highest risk. [Most of these deaths, health problems and injuries are preventable, [through improved access to adequate health-care services including safe and effective family planning methods and emergency obstetric care] [recognizing the right of women and men to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.] [These problems and means should be addressed on the basis of the report of the International Conference on Population and Development, with particular reference to paragraphs [1.15], [7.1], 7.2, 7.3, 7.6 and 8.25, among others, of the Programme of Action of the Conference. 13/]

In most countries, the neglect of women's [reproductive rights] severely limits their opportunities in public and private life, including opportunities for education and economic and political empowerment. [The ability of women to control their own fertility forms an important basis for the enjoyment of other rights.] Shared responsibility between women and men in matters related to sexual and reproductive behaviour is also essential to improving women's health.

* The placement of the paragraph has not yet been determined.

99. HIV/AIDS and other sexually transmitted diseases, the transmission of which is sometimes a consequence of sexual violence, are having a devastating effect on women's health, particularly the health of adolescent girls and young women. Women [and adolescent girls often do not have the power to insist on safe sex practices] [are not able to insist on responsible sexual behaviour on the part of their partners] and have little access to information and services for prevention and treatment. Women, who represent half of all adults newly infected with HIV/AIDS and other sexually transmitted diseases, have emphasized that social vulnerability and the unequal power relationships between women and men [are obstacles to negotiating safe sex], in their efforts to control the spread of sexually transmitted diseases. The consequences of HIV/AIDS reach beyond women's health to their role as [mothers,] caregivers and their contribution to the economic support of their families. The social, developmental and health consequences of HIV/AIDS and other sexually transmitted diseases need to be seen from a [gender] perspective.

100. Sexual and [gender-based] violence, including physical and psychological abuse, trafficking in women and girls, other forms of abuse [and prostitution] place girls and women at high risk of physical and mental trauma, disease [and unwanted pregnancy]. Such situations often deter women from using health and other services.

101. Mental disorders related to [alienation][marginalization], powerlessness and poverty, along with overwork and stress and the growing incidence of domestic violence as well as substance abuse are among other health issues of growing concern to women. Women throughout the world, especially young women, are increasing their use of tobacco with serious effects on their health and that of their children. Occupational health issues are also growing in importance, as a large number of women work in low-paid jobs either in the formal or the informal labour market under tedious and unhealthy conditions and the number is rising. Cancers of the breast and cervix and other cancers of the reproductive system as well as infertility affect growing numbers of women and may be preventable, or curable, if detected early.

102. With the increase in life expectancy and the growing numbers of older women, their health concerns require particular attention. The long-term health prospects of women are influenced by changes at menopause, which, in combination with life-long conditions and other factors, such as poor nutrition and lack of physical activity, may increase the risk of cardiovascular disease and osteoporosis. Other diseases of ageing and the interrelationships of ageing and disability among women also need particular attention.

103. Women, like men, particularly in rural areas and poor urban areas, are increasingly exposed to environmental health hazards owing to environmental catastrophes and degradation. Women have a different susceptibility to various environmental hazards, contaminants and substances and they suffer different consequences from exposure to them.

104. The quality of women's health care is often deficient in various ways, depending on local circumstances. [Women are frequently not treated with respect, nor are they guaranteed privacy and confidentiality, nor do they always receive full information about the options and services available.] Furthermore, in some countries, over-medicating women's life events is common, leading to unnecessary surgical intervention and inappropriate medication.

105. Statistical data on health are often not systematically collected, disaggregated and analysed by age, sex and socio-economic status, and [race and ethnicity] [and other relevant variables] among others. Recent and reliable data on mortality and morbidity of women and conditions and diseases particularly affecting women are not available in many countries. Relatively little is known about how social and economic factors affect the health of girls and women of all ages, about the provision of health services to girls and women and the patterns of their use of such services, and about the value of disease prevention and health promotion programmes for women. Subjects of importance to women's health have not been adequately researched and women's health research often lacks funding. Medical research, on heart disease for example, and epidemiological studies in many countries are often based solely on men; they are not gender specific. Clinical trials involving women to establish basic information about dosage, side-effects and effectiveness [including contraceptives] are noticeably absent and do not always conform to ethical standards for research and testing. Many drug therapy protocols and other medical treatments and interventions administered to women are based on research on men without any investigation and adjustment for gender differences.

106. In addressing inequalities in health status and unequal access to and inadequate health care services between women and men, Governments and other actors should promote an active and visible policy of mainstreaming a gender perspective in all policies and programmes, so that, before decisions are taken, an analysis is made of the effects for women and men, respectively.

[Increase women's full access throughout the life cycle to appropriate, affordable and quality health care and related services]

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