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WOMEN'S LINKAGE CAUCUS

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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 it is determined by the social, political and economic context of their lives as well as by biology. However, health and wellbeing elude the majority of women. [amend & retain: (delete: The) A major] barrier for women to the achievement of the highest attainable standard of health is inequality, both between men and women and [retain: among women]. In national and international forums, women have emphasised 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 [retain: 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 [retain: gender] bias in the health system and by the provision of inadequate and inappropriate medical services to women.

94. Women's rights to the enjoyment to 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, [retain: 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 and inadequate access to safe water, all sanitation facilities and fuel supplies, particularly in rural and poor urban areas, and deficient housing conditions, overburden women and their families and have a negative effect on their health. Good health is essential to leading a productive and fulfilling life [retain: 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 childbearing 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. [amend & retain: 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 information, privacy, confidentiality, respect and informed consent is often not considered, (delete: taking into account the parent's responsibilities)] Adolescent girls are both biologically and psychosocially more vulnerable than boys to sexual abuse, violence and prostitution, and to the consequences of [retain: unprotected] [delete: premature] sexual relations. The trend towards early sexual experience, combined with a lack of information and services, increases the risk of [retain: unwanted] and too early pregnancy, HIV infection and other sexually transmitted diseases, as well as [retain: 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's. Young men are often not educated to respect [retain: women's self determination] and to share responsibility with women in matters of sexuality and reproduction.

96. [retain: 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 whether to engage in sexual relations, and 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 aims to enhance life and personal relations and does not merely involve counselling and care related to reproduction and sexually transmitted diseases.]

97. [amend & retain: 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 and to have access to the education, information and means to do so safely and in a context of mutual respect. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the physical integrity of the human body, whether that of woman or man, require mutual consent and (delete: willingness to accept) shared responsibility for (delete: 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.** [retain: 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. [retain: Most of these deaths, health problems, and injuries are preventable, [amend & retain: through improved access to adequate reproductive health-care services including safe and effective family planning (delete: methods) safe abortion and emergency obstetric care] [retain: 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.] [amend & retain: These problems and means should be addressed on the basis of the report of the International Conference on Population and Development (delete: with particular reference to paras.[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 [amend & retain: sexual and reproductive rights, including the right to have the information and means to exercise those rights] severely limits their opportunities in public and private life, including opportunities for education, economic and political empowerment. [amend & retain: The ability of women to control their own fertility and sexuality 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.

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 [retain: and adolescent girls often do not have the power to insist on safe sex practices] [delete: 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 the social vulnerability and the unequal power relationships between women and men [retain: 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 [retain: 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 [retain: gender] perspective.

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

101. Mental disorders related to [delete: alienation][retain: 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 labor 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.

104. The quality of women's health-care is often deficient in various ways, depending on local circumstances. [retain: 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 medication of women's life events is common, leading to unnecessary surgical intervention and inappropriate medication.

105. Statistical data on health often are not systematically collected, disaggregated and analyzed by age, sex and socio-economic status and [retain: race and ethnicity] 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, sideeffects and effectiveness [retain: including contraceptices] 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.[Increase women's full access throughout the life cycle to appropriate, affordable andquality health-care and related services]

Strategic objective C.1.Increase women's access throughout the life cycle to appropriate free or affordable and good quality health-care and related information and services*