Draft Platform for Action
C. Inequalities in access to health 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[*]

[* The implementation of the actions to be taken contained in the section on health are the sovereign right of each country, consistent with national laws and development priorities, with full respect for the various religious and ethical values and cultural backgrounds of its people and in conformity with universally recognized international human rights.] [The section on health is especially guided by the principles contained in chapter II of the Programme of Action of the International Conference on Population and Development, in particular the introductory paragraphs.]

Actions to be taken

107. By Governments, [in collaboration with non-governmental organizations and employers and with the support of international institutions]:

(a) Support and implement [their commitments] [the commitments made] [to the report of the International Conference on Population and Development] [in the Programme of Action of the International Conference on Population and Development, taking into account the reservations and declarations made in that document] and the Copenhagen Declaration on Social Development and Programme of Action of the World Summit for Social Development 14/ and relevant international agreements, to meet the health needs of girls and women of all ages;

(b) Reaffirm the right to the enjoyment of the highest attainable standards of physical and mental health, protect and promote the attainment of this right for women and girls and incorporate it in national legislation, for example; review existing legislation, including health legislation, as well as policies, where necessary, to reflect a commitment to women's health and to ensure that they meet the changing roles and responsibilities of women wherever they reside;

(c) Design and implement, in cooperation with women and community-based organizations, gender-sensitive health programmes, including decentralized health services, that address the needs of women throughout their lives and take into account their multiple roles and responsibilities, the demands on their time, the special needs of rural women and women with disabilities and the diversity of women's needs arising from age, socio-economic and cultural differences, among others, and include women, especially local and indigenous women, in the identification and planning of health-care priorities and programmes; [and remove all barriers to women's health services] [and provide the widest possible access to a broad range of health-care services];

(d) [Allow women access to social security systems in equality with men throughout the whole life cycle;]

(e) Provide more accessible, available and affordable primary health- care services of high quality, including [sexual and reproductive health care as well as family planning information and services] and giving particular attention to maternal and emergency obstetric care [as contained in the report of the International Conference on Population and Development] [as agreed in the Programme of Action of the International Conference on Population and Development];

(f) Redesign health information, services and training for health workers, so they are [gender] sensitive and reflect the user's perspectives with regard to interpersonal and communications skills and the user's right to privacy and confidentiality. [recognizing the rights, duties and responsibilities of parents and other persons legally responsible for children, and consistent with the Convention on the Rights of the Child] These services, information and training should adopt a holistic approach [as defined by WHO];

(g) [Ensure that all health services and workers conform to human rights and to ethical, professional and gender-sensitive standards in the delivery of women's health services aimed at ensuring responsible, voluntary and informed consent.] [Develop, implement and disseminate widely codes of ethics in this regard.] [Nothing, however, in the present Platform for Action is intended to require any health professional or health facility to provide (or refer for) services to which they have objections on the basis of religious belief or moral conviction as a violation of conscience];

(h) [Take all appropriate measures to eliminate harmful, medically unnecessary or coercive medical interventions, as well as inappropriate medication and over-medication of women. All women should be fully informed of their options, including likely benefits and potential side effects;]

(First alternative)

[Ensure that women are fully informed by properly trained personnel orally, and in writing where appropriate, of the potential dangers, side effects and contraindications as well as the likely benefits of their health-care options, including medication and any surgical interventions, among others; all appropriate measures should be taken to eliminate harmful, medically unnecessary or coercive medical interventions, as well as inappropriate medication and over- medication of women; ensure that immunization is provided to women and girls according to established ethical medical standards;]

(Second alternative)

[Ensure that before medication is prescribed, mechanical devices inserted or sterilization performed, women are examined by a physician, who must give them full information, orally and in writing, on the potential dangers, side effects and contraindications of all the available methods of family planning; ensure that immunization of women and girls does not include experimental drugs, vaccines or abortifacients;]

(i) Strengthen and reorient health services, particularly primary health care, in order to ensure universal access to quality health services for women and girls, [recognizing the rights, duties and responsibilities of parents and other persons legally responsible for children and consistent with the Convention on the Rights of the Child] to reduce ill health and maternal morbidity and to achieve worldwide the agreed-upon goal of reducing maternal mortality by at least 50 per cent of the 1990 levels by the year 2000 and a further one half by the year 2015; ensure that the necessary services are available at each level of the health system; and make reproductive health care accessible, through the primary health-care system, to all individuals of appropriate ages as soon as possible and no later than the year 2015;

(j) [Recognize and deal with the health impact of unsafe abortion as a major public health concern, as agreed in the Programme of Action of the International Conference on Population and Development;]

[Paragraph 8.25 of the Programme of Action of the International Conference on Population and Development states: "In no case should abortion be promoted as a method of family planning. All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women's health, to deal with the health impact of unsafe abortion 15/ as a major public health concern and to reduce the recourse to abortion through expanded and improved family-planning services. Prevention of unwanted pregnancies must always be given the highest priority and every attempt should be made to eliminate the need for abortion.

Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling. Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process. In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family-planning services should be offered promptly, which will also help to avoid repeat abortions."]

(k) [Consider reviewing laws containing punitive measures against women who have undergone illegal abortions;]

(l) Give particular attention to the needs of girls [taking into account the rights, duties and responsibilities of parents and other persons legally responsible for children and consistent with the Convention on the Rights of the Child] especially the promotion of healthy behaviour, including physical activities; take specific measures for closing the gender gaps in morbidity and mortality where girls are disadvantaged, while achieving internationally approved goals for the reduction of infant and child mortality - specifically, by the year 2000, the reduction of mortality rates of infants and children under five years of age by one third of the 1990 level, or 50 to 70 per 1,000 live births, whichever is less; by the year 2015 an infant mortality rate below 35 per 1,000 live births and an under-five mortality rate below 45 per 1,000;

(m) Ensure that girls [taking into account the rights, duties and responsibilities of parents and other persons legally responsible for children and consistent with the Convention on the Rights of the Child] have continuing access to necessary health and nutrition information and services as they mature, to facilitate a healthful transition from childhood to adulthood;

(n) Develop information, programmes and services to assist women to understand and adapt to changes associated with ageing; and to address and treat the health needs of older women, paying particular attention to those who are physically or psychologically dependent;

(o) Ensure that girls and women of all ages with any form of disability receive supportive services;

(p) Formulate special policies, design programmes and enact the legislation necessary to alleviate and eliminate environmental and occupational health hazards associated with work in the home, in the workplace and elsewhere [with special attention to pregnant and lactating women]; (q) Integrate mental health services into primary health care systems or other appropriate levels, develop supportive programmes and train primary health workers to recognize and care for girls and women of all ages who have experienced any form of violence especially domestic violence, sexual abuse or other abuse resulting from armed and non-armed conflict;

(r) Promote public information on the benefits of breast-feeding; examine ways and means of implementing fully the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes, and enable mothers to breast-feed their infants by providing legal, economic, practical and emotional support;

(s) Establish mechanisms to support and involve non-governmental organizations, particularly women's organizations, professional groups and other bodies working to improve the health of girls and women, in government policy-making, programme design, as appropriate, and implementation within the health sector and related sectors at all levels;

(t) Support non-governmental organizations working on women's health and help develop networks aimed at improving coordination and collaboration between all sectors that affect health;

(u) Rationalize drug procurement and ensure a reliable, continuous supply of high-quality pharmaceutical, [contraceptive] and other supplies and equipment, [using the WHO Model List of Essential Drugs as a guide;] and ensure the safety of drugs and devices through national regulatory drug approval processes;

(v) Provide improved access to appropriate treatment and rehabilitation services for women substance abusers and their families;

(w) Promote and ensure household and national food security, as appropriate, and implement programmes aimed at improving the nutritional status of all girls and women by implementing the commitments made in the Plan of Action on Nutrition of the International Conference on Nutrition 16/ including a reduction worldwide of severe and moderate malnutrition among children under the age of five by one half of 1990 levels by the year 2000, giving special attention to the gender gap in nutrition, and a reduction in iron deficiency anaemia in girls and women by one third of the 1990 levels by the year 2000; (x) Ensure the availability of and universal access to safe drinking water and sanitation and put in place effective public distribution systems as soon as possible;

(y) Ensure full and equal access to health care infrastructure and services for indigenous women.


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