III. CONCLUDING OBSERVATIONS, CONTINUED

CERD

•	Croatia, CERD, A/57/18 (2002) 24 at para. 97.

97. The Committee expresses concern at the continued practice of segregation of Roma children within the educational system and at the reports of discrimination against the Roma regarding access to employment, health, political representation and citizenship rights. The Committee recommends that the State party pay particular attention to the situation of the Roma and take effective measures to prevent the segregation of Roma children within the educational system...The Committee also encourages the State party to reinforce its efforts to train and recruit Roma teachers and to prevent discrimination against the Roma in access to employment, health, political representation and citizenship rights.

•	Lithuania, CERD, A/57/18 (2002) 35 at paras. 173 and 176.

173. The Committee notes with concern that, despite the adoption of a programme for the integration of the Roma into Lithuanian society for 2000-2004, the Roma experience difficulties in enjoying their fundamental rights in the fields of housing, health, employment and education, and are the subject of prejudicial attitudes. In this regard, the Committee wishes to draw the attention of the State party to general recommendation XXVII on discrimination against Roma...

...

176. The Committee is further concerned about xenophobic tendencies towards Chechen asylum-seekers and refugees and requests the State party to take preventive and educational measures in this regard. The Committee recommends that the State party ensure the enjoyment of social rights, particularly to adequate housing and health, to all asylum-seekers and refugees in need without regard to their legal status.

•	Fiji, CERD, A/58/18 (2003) 25 at para. 93.

93. The Committee takes note of information on the growing rate of suicide among Indo-Fijians, and recommends that the State party conduct research into the causes of this phenomenon and keep the Committee informed.

•	Ghana, CERD, A/58/18 (2003) 30 at paras. 107 and 114.

107. The Committee appreciates the approach adopted by the State party that seeks to respect the customs and traditions of various ethnic groups on its territory, while at the same time enhancing the enjoyment of human rights for all. It further notes that, under article 26 of the Constitution, which protects cultural rights, customary practices which dehumanize or are injurious to the physical and mental well-being of a person are prohibited.

...

114. While noting the legislative and other measures adopted to eradicate practices that are harmful to the health and dignity of women, the Committee is concerned that some practices, in particular female genital mutilation, degrading treatment of widows and the Trokosi system, still occur, and wishes to be further informed of their ethnic dimensions. The Committee encourages the State party to continue its efforts in this field and refers the State party to its general recommendation XXV (56) of 20 March 2000 on gender-related dimensions of racial discrimination.

•	Saudi Arabia, CERD, A/58/18 (2003) 41 at para. 206.

206. The Committee welcomes the recent initiative to include non-Saudis in a health insurance system...

•	Albania, CERD, A/58/18 (2003) 53 at para. 315.

315. The Committee is concerned about information relating to discrimination against the Roma in respect of access to education, health, hygiene, housing, employment, and sufficient and adequate food and water.

The Committee recommends that the State party intensify its efforts on behalf of the Roma minority, in accordance with general recommendation XXVII...

•	Bolivia, CERD, A/58/18 (2003) 58 at para. 341.

341. The Committee notes the lack of information regarding the Afro-Bolivian community which, according to the information received, accounts for around 31,000 individuals situated at the lower end of the socio-economic scale and who face severe disadvantages in health, life expectancy, education, income, literacy, employment and housing. The Committee further notes that there are no specific provisions making reference to this group in the domestic legislation.

The Committee recommends that the State party adopt measures with a view to ensuring to members of the Afro-Bolivian community the full enjoyment of the rights enumerated in article 5 of the Convention...

•	United Kingdom of Great Britain and Northern Ireland, CERD, A/58/18 (2003) 88 at paras. 542 and 543.

542. The Committee expresses concern about the discrimination faced by Roma/Gypsies/Travellers that is reflected, inter alia, in their higher child mortality rate, exclusion from schools, shorter life expectancy, poor housing conditions, lack of available camping sites, high unemployment rate and limited access to health services.

The Committee draws the attention of the State party to its general recommendation XXVII on discrimination against Roma and recommends that the State party develop further appropriate modalities of communication and dialogue between Roma/Gypsy/Traveller communities and central authorities. It also recommends that the State party adopt national strategies and programmes with a view to improving the situation of the Roma/Gypsies/Travellers against discrimination by State bodies, persons or organizations.

543. The Committee reiterates its concern that besides the Roma/Gypsy/Traveller populations, certain other minority groups or individuals belonging to them experience discrimination in the areas of employment, education, housing and health.

The Committee urges the State party to continue taking affirmative measures in accordance with article 2, paragraph 2, of the Convention to ensure equal opportunities for full enjoyment of their economic, social and cultural rights...

•	Spain, CERD, A/59/18 (2004) 32 at para. 167.

167. The Committee...notes with satisfaction the extensive measures taken in the social, economic, cultural and other spheres in connection with the Gypsy community, including inter alia:

(a) The further implementation of the Gypsy Development Programme, aimed at promoting access for members of the Gypsy community - on terms of equality with the rest of the population - to public education, health, housing, employment;

(b) The National Plan of Action for Social Inclusion identifying the Gypsy community as a specific beneficiary group;

...

•	Suriname, CERD, A/59/18 (2004) 36 at para. 194.

194. The Committee notes with concern complaints by indigenous and tribal peoples in the interior about the deleterious effects of natural-resource exploitation on their environment, health and culture. It regrets that the State party does not seem to have attached the highest priority to dealing with the problem of mercury contamination in parts of the interior.

The Committee wishes to point out that development objectives are no justification for encroachments on human rights, and that along with the right to exploit natural resources there are specific, concomitant obligations towards the local population; it recommends adoption by the State party of a legislative framework that clearly sets forth the broad principles governing the exploitation of the land, including the obligation to abide by strict environmental standards. It recommends the State party to set up an independent body to conduct environmental impact surveys before any operating licenses are issued, and to conduct health and safety checks on small-scale and industrial gold-mining.

•	Argentina, CERD, A/59/18 (2004) 45 at para. 235.

235. The Committee welcomes the entry into force of Immigration Law No. 25871 in January 2004, which replaces the former Immigration Law No. 22439, and provides, inter alia, for the following:

...

(b) Migrants' access to basic rights such as education and health irrespective of their migration status;

...

•	Slovakia, CERD, A/59/18 (2004) 70 at para. 388.

388. The Committee is alarmed at the critical health situation of some Roma communities, which is largely a consequence of their poor living conditions.

The Committee recommends that the State party continue to implement programmes and projects in the field of health for Roma, bearing in mind their disadvantaged situation resulting from extreme poverty and low levels of education; to this end, the Committee encourages the State party to take further measures to address the issues of drinking water supplies and sewage disposal systems in Roma settlements.

•	Bahrain, CERD, A/60/18 (2005) 22 at paras. 84 and 86.

84. The Committee remains concerned at the situation of migrant workers, in particular regarding their enjoyment of economic, social and cultural rights.

In light of article 5 (e) (i) and of general recommendation XXX on non-citizens, the Committee urges the State party to take all necessary measures to extend full protection from racial discrimination to all migrant workers and remove obstacles that prevent the enjoyment of economic, social and cultural rights by these workers, notably in the areas of education, housing, employment and health...

...

86. The Committee notes with concern the reportedly disparate treatment of and discrimination faced by members of some groups, in particular the Shia, that may be distinguishable by virtue of their tribal or national origin, descent, culture or language; the Committee is especially concerned about apparently disparate opportunities that are afforded to such groups.

The Committee recommends that the State party ensure that everyone, without distinction as to race, colour, or national or ethnic origin, enjoys the rights to work and to health and social security, adequate housing and education in accordance with article 5 (e) (i), (iii), (iv) and (v) of the Convention.

•	Ireland, CERD, A/60/18 (2005) 30 at para. 145.

145. While noting the efforts made so far by the State party with regard to the situation of members of the Traveller community in the field of health, housing, employment and education, the Committee remains concerned about the effectiveness of policies and measures in these areas (art. 5 (e)).

The Committee recommends to the State party that it intensify its efforts to fully implement the recommendations of the Task Force on the Traveller community, and that all necessary measures be taken urgently to improve access by Travellers to all levels of education, their employment rates as well as their access to health services and to accommodation suitable to their lifestyle.

ICCPR

•	Hungary, ICCPR, A/57/40 vol. I (2002) 60 at para. 80(11).

(11) The Committee is concerned at the high maternal mortality rate in Hungary and the fact that the State party does not provide sufficient support for family planning through effective means of contraception.

The State party should take steps to protect women's life and health, through more effective family planning and contraception (article 6 of the Covenant).

•	Suriname, ICCPR, A/59/40 vol. I (2004) 43 at para. 69(21).

(21) The Committee...notes allegations that mercury has been released into the environment in the vicinity of such communities, which continues to threaten the life, health and environment of indigenous and tribal peoples...

...The State party should take the necessary steps to prevent mercury poisoning of waters, and thereby of inhabitants, in the interior of the State party's territory.

•	Albania, ICCPR, A/60/40 vol. I (2004) 25 at para. 82(14).

(14) The Committee is concerned about the high rate of infant mortality and of abortion and the apparent lack of family planning and social care in some parts of the State party (arts. 6, 24 and 26).

The State party should take steps to ensure that abortion is not used as a method of family planning and take appropriate measures to reduce infant mortality.

•	Yemen, ICCPR, A/60/40 vol. I (2005) 65 at para. 91(21).

(21) The Committee...is...concerned about marriages of under-age children contracted by their guardians. This practice jeopardizes the effectiveness of the consent given by spouses, their right to education and, in the case of girls, their right to health (arts. 3, 23 and 24).

The State party should raise the minimum age of marriage and ensure that it is respected in practice.

ICESCR

•	Colombia, ICESCR, E/2002/22 (2001) 110 at paras. 773, 775, 794 and 796.

773. The Committee is deeply concerned about the current low status of women's sexual and reproductive health rights and in particular about the increased incidence of illegal abortions. The Committee is also concerned about the high infant and child mortality, especially in the rural areas.

...

775. The Committee is concerned about the reduction of State subsidies for health care which makes access to health care even more difficult, particularly in the rural areas where health care coverage is already significantly more limited than in urban areas. The Committee also notes that women and indigenous groups are adversely affected by this reduction in subsidies.

...

794. ...The Committee recommends that the State party implement vigorously its national sexual and reproductive health programme.

...

796. The Committee urges the State party to allocate a higher percentage of its GDP to the health sector and to ensure that its system of subsidies does not discriminate against the most disadvantaged and marginalized groups.

•	Algeria, ICESCR, E/2002/22 (2001) 116 at paras. 821, 824, 826, 840 and 843.

821. The Committee is deeply concerned about the serious problem of poverty, as well as the decline in the standard of living and the increase in poverty-related diseases. The Committee expresses its profound concern about the inadequacy of measures being taken to combat this problem.

...

824. The Committee expresses its concern about the ineffectiveness of programmes to reduce the maternal and infant mortality rate in the State party.

...

826. The Committee notes with concern the data in the UNDP Human Development Report, 2001 that indicates a significant decrease in public spending on health and education in the 1990s, as a percentage of both GNP and GDP, and relative to military expenditure, which more than doubled as a percentage of GDP.

...

840. The Committee urges the State party to take all necessary measures in order to lower maternal and infant mortality rates and to ensure that all forms of health services are available to women and men, especially in rural areas, in particular reproductive health services.

...

843. The Committee recommends that the State party increase its expenditures for health and education...

•	France, ICESCR, E/2002/22 (2001) 121 at paras. 853 and 877.

853. The Committee welcomes the State party's recent efforts to address the problem of social exclusion in the State party, inter alia, by the adoption of Framework Law No. 98-657 of 29 July 1998 to combat social exclusion, particularly targeting the right to work, the right to housing and the right to health.

...

877. The Committee recommends that the State party undertake urgent steps to address the problem of job insecurity, as well as the serious problem of suicides related to it...

•	Czech Republic, ICESCR, E/2003/22 (2002) 25 at para. 106.

106. The Committee encourages the State party to adopt a comprehensive National Health Strategy.

•	Trinidad and Tobago, ICESCR, E/2003/22 (2002) 45 at para. 273.

273. The Committee notes that the State party, in answering questions about specific programmes devoted to reducing and preventing infant mortality and maternal mortality, as well as teenage pregnancies and back-street abortions, did not provide disaggregated data on a comparative basis which would put the Committee in the position to ask focused questions as to how the delineated health programmes have actually been put into practice.

•	Slovakia, ICESCR, E/2003/22 (2002) 50 at paras. 322 and 336.

322. The Committee is deeply concerned about the high rate of tobacco smoking as well as the high level of alcohol consumption among adults.

...

336. The Committee calls upon the State party to adopt effective measures, including public awareness campaigns, to reduce tobacco smoking and alcohol consumption.

•	Poland, ICESCR, E/2003/22 (2002) 54 at paras. 352, 364 and 386.

352. The Committee notes with appreciation the initiatives undertaken by the State party to reduce alcohol consumption and tobacco smoking in the country, including the recent ban on the selling of alcohol to minors and on the promotion and advertising of tobacco products.

...

364. The Committee expresses its concern that the relatively high incidence of child labour in rural areas, as acknowledged by the State party's delegation, has a negative impact on children's health and on their right to education.

...

386. The Committee...recommends the adoption of legislation in order to regulate child labour in rural areas in such a way that the right to health and right to education of working children are fully protected.

•	Solomon Islands, ICESCR, E/2003/22 (2002) 65 at paras. 460, 461, 473 and 474.

460. The Committee is concerned that malnutrition, especially among young people, is widespread, despite the fact that food supplies are available in almost sufficient quantities in all parts of the country.

461. The Committee is also concerned that many communities in the State party do not have access to safe drinking water and proper sanitation facilities, which poses severe health risks to them.

...

473. The Committee...urges the State party to address the problem of malnutrition, including through seeking assistance from international organizations.

474. The Committee urges the State party to seek international cooperation and assistance with a view to ensuring access to safe drinking water and adequate sanitation systems for all rural and urban communities.

•	Estonia, ICESCR, E/2003/22 (2002) 68 at para. 537.

537. The Committee...recommends that the State party strictly enforce the domestic and international standards for environmental protection, so as to prevent harmful effects on the health of the population in Estonia.

•	Brazil, ICESCR, E/2004/22 (2003) 28 at paras. 119, 127 and 151.

119. The Committee welcomes the creation within the State party of independent special rapporteurs responsible for monitoring economic, social and cultural rights, particularly the right to food, to health and to education.

...

127. The Committee is concerned about the widespread and deeply rooted discrimination against Afro-Brazilians, indigenous peoples and minority groups such as Gypsies and the Quilombo communities.

...

151. The Committee urges the State party to take all effective measures to prohibit discrimination on the basis of race, colour, ethnic origin or sex in all fields of economic, social and cultural life. It further recommends that the State party undertake urgent measures to ensure equal opportunity for Afro-Brazilians, indigenous peoples and minority groups such as Gypsies and the Quilombo communities, especially in the fields of employment, health and education...

•	New Zealand, ICESCR, E/2004/22 (2003) 35 at paras. 191 and 206.

191. The Committee notes with concern that despite improvements in some health indicators, the general health situation of the indigenous Maori people continues to be worse than that of other segments of the population in the State party. In particular, the Committee is concerned that the life expectancy of Maoris is significantly lower than the national average.

...

206. The Committee requests the State party to adopt effective measures to improve the health situation of the indigenous Maori people.

•	Iceland, ICESCR, E/2004/22 (2003) 39 at paras. 229 and 239.

229. The Committee expresses its concern about the high level of alcohol and drug consumption in the State party, in particular among young people.

...

239. The Committee calls upon the State party to take effective measures to address the high level of alcohol and drug consumption, particularly among young people.

•	Republic of Moldova, ICESCR, E/2004/22 (2003) 49 at paras. 314, 317, 318, 336, 339 and 340.

314. The Committee is concerned about the deterioration of the public health system and notes with regret that conditions in hospitals, especially psychiatric hospitals, are inadequate.

...

317. The Committee is concerned about the continuing high level of infant and maternal mortality. It is also concerned that the number of abortions remains high (15.6 per 1,000 women of fertile age in 2002), notwithstanding the ongoing programmes in the area of reproductive health.

318. The Committee is concerned that drug abuse is a serious problem in the State party, with the number of drug addicts having more than doubled in the last five years despite the establishment of an interdepartmental commission to fight drug addiction in 2000 and the launching of a programme to fight drug addiction and the drugs business in the period 2003-2004.

...

336. The Committee recommends that the State party take effective measures to ensure the quality, affordability and accessibility of health services, especially in rural areas. In this respect, the Committee draws the attention of the State party to its general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12 of the Covenant)...

...

339. The Committee urges the State party to reinforce its efforts to reduce infant and maternal mortality by increasing health coverage for women and children. The Committee calls upon the State party to strengthen efforts to promote awareness of sexual and reproductive health, safe contraceptive methods and the health risk of using abortion as a method of birth control...

340. The Committee calls on the State party to ensure the effective implementation of programmes to prevent and combat drug abuse, especially among young people...

•	Yemen, ICESCR, E/2004/22 (2003) 55 at paras. 358, 365, 366, 377, 384 and 385.

358. The Committee is concerned about the high rate of infant and maternal mortality and the insufficient availability of health services, especially for women in rural areas. The Committee is also concerned about the lack of a comprehensive sexual and reproductive health programme in the State party.

...

365. The Committee is deeply concerned about the persistent consumption of khat, especially when up to about 50 per cent of household incomes are allocated to its consumption.

366. The Committee is concerned about the high level of tobacco consumption in the State party, especially among youth.

...

377. The Committee urges the State party to increase its efforts to reduce the rate of infant and maternal mortality by providing adequate access to health services and vaccination programmes, especially for women and children in rural areas. The Committee urges the State party to adopt and implement a national sexual and reproductive health programme.

...

384. The Committee urges the State party to take effective measures to combat the widespread consumption of khat and to conduct further studies on the health and economic implications of its consumption.

385. The Committee recommends that the State party undertake immediate measures to implement the national work plan for tobacco control recently developed by the Ministry of Health.

•	Guatemala, ICESCR, E/2004/22 (2003) 59 at paras. 417, 418, 435 and 436.

417. The Committee is concerned about the current state of sexual and reproductive health of women and that the incidence of child and maternal mortality is relatively high.

418. The Committee is alarmed about the increasing level of drug addiction in the State party, especially among young people.

...

435. The Committee recommends that the State party take measures to reduce child and maternal mortality, and in particular intensify the implementation of its national programme on reproductive health, provide further assistance and training to midwives, organize educational campaigns regarding women's sexual and reproductive health, and include such subjects in the school curricula.

436. The Committee urges the State party to undertake effective measures to combat drug addiction, such as awareness-raising campaigns and educational activities.

•	Russian Federation, ICESCR, E/2004/22 (2003) 64 at paras. 473, 474, 476-478, 501, 502 and 504-506.

473. The Committee is concerned about the general deterioration of the level of availability and accessibility of health care in the State party. The Committee also notes with concern that hospitals and clinics in poor regions often do not stock all essential drugs, and that, despite the constitutional guarantee of free medical care, many health clinics charge fees for their services and request patients to purchase medicaments. Furthermore, the Committee is concerned about the poor health status of northern indigenous peoples, the life expectancy of whom is estimated to be 15-20 years lower than the national average.

474. The Committee notes that the State party lacks federal legislation on the rights of patients concerning, inter alia, professional ethics and redress for medical errors.

...

476. The Committee notes with concern the sharp increase in the HIV-infection rate during the last three years, the increasing incidence of HIV contracted through heterosexual contacts, and the increasing number of children born of HIV-positive mothers.

477. The Committee is concerned about the high levels of infant and maternal mortality in the State party. It also notes with concern that unsafe abortion remains a main cause of maternal mortality.

478. The Committee remains concerned about the spread of drug addiction in the State party.

...

501. The Committee calls upon the State party to ensure that the ongoing reform of the health sector will improve the quality of, and equitable access to, health services in all regions of the country. The State party should also take effective measures to improve the health status of indigenous peoples in the regions of the Far North.

502. The Committee recommends that the State party address the matter of patients' rights...

...

504. The Committee, in line with its general comment No. 14 (2000) on the right to the highest attainable standard of health (art. 12 of the Covenant), calls upon the State party to take urgent measures to stop the spread of HIV/AIDS. The State party should ensure that all persons know about the disease and how to protect themselves, including through sex education in schools, and that methods of protection are available at affordable prices. Moreover, awareness-raising campaigns should aim at preventing discrimination against HIV-positive people.

505. The Committee urges the State party to reinforce its efforts to reduce infant and maternal mortality. The State party should promote awareness of safe contraceptive methods and ensure that abortions are carried out under adequate medical and sanitary conditions.

506. The Committee recommends that the State party ensure the effective implementation of programmes to prevent and combat drug abuse, targeted at young people and the worst affected regions of the country...

•	Lithuania, ICESCR, E/2005/22 (2004) 18 at paras. 92, 93, 114 and 115.

92. The Committee is concerned about the high suicide rate in the State party, particularly among the rural population.

93. The Committee is concerned about the high mortality rate due to alcohol and tobacco abuse, particularly among men.

...

114. The Committee recommends that the State party undertake a study of the root causes of suicide in the State party and strengthen its efforts under the National Suicide Prevention Programme to reduce the suicide rate.

115. The Committee recommends that the State party ensure the effective implementation of programmes to combat tobacco smoking and alcoholism...

•	Greece, ICESCR, E/2005/22 (2004) 23 at paras. 131, 145 and 167.

131. While acknowledging the State party's efforts to promote the social integration of Greek Roma, the Committee remains deeply concerned about the persistent discrimination against Roma people in the fields of housing, health and education...

...

145. The Committee notes with concern that the State party has one of the highest tobacco and alcohol consumption rates in Europe, in particular, among minors.

...

167. The Committee recommends that the State party strictly enforce the prohibition of smoking in public areas and of the sale of strong alcoholic beverages to minors, adopt effective measures against "subtle" forms of tobacco and alcohol advertisement, in addition to existing restrictions, and intensify its efforts in the field of anti-smoking education and information campaigns.

•	Spain, ICESCR, E/2005/22 (2004) 34 at paras. 232 and 249.

232. The Committee is concerned that, in spite of the existence of a range of programmes at the national and regional levels aimed at improving the situation of the Roma (Gypsy) population, including the Second National Plan of Action for Social Inclusion (2003-2005) and the Gypsy Development Programme, the Roma remain in a vulnerable and marginalized situation in the State party, especially with regard to employment, housing, health and education.

...

249. The Committee encourages the State party to continue and strengthen its efforts to address the situation of the Roma population, increasing at the same time the involvement of Roma associations in the planning and implementation of such programmes...

•	Ecuador, ICESCR, E/2005/22 (2004) 39 at paras. 277-279, 295, 296, 300-302, 320 and 321.

277. The Committee is concerned that, despite the legal framework in place and the growing influence of indigenous grassroots community groups, indigenous people continue to suffer discrimination, particularly with regard to employment, housing, health and education.

278. The Committee is concerned that, although the Constitution recognizes the rights of indigenous communities to hold property communally and to be consulted before natural resources are exploited in community territories, these rights have regretfully not been fully implemented in practice. The Committee is deeply concerned that natural extracting concessions have been granted to international companies without the full consent of the communities concerned. The Committee is also concerned about the negative health and environmental impacts of natural resource extracting companies' activities at the expense of the exercise of land and culture rights of the affected indigenous communities and the equilibrium of the ecosystem.

279. The Committee is deeply concerned about the de facto discrimination against the Afro-Ecuadorian population in all spheres of life....

...

295. The Committee is concerned about the low coverage, quality and insufficient financial resources available to the health system. The Committee notes that, despite improvements, the maternal mortality rate remains high. The Committee expresses concern about the increasingly high rate of teenage pregnancies.

296. The Committee is concerned about the enjoyment of the right to health by all people in the State party and particularly with regard to access to generic medicine.

...

300. The Committee recommends that the State party take effective and practical steps to ensure effective protection of indigenous people against discrimination in many fields, especially with regard to employment, housing, health and education...

301. The Committee strongly urges the State party to ensure that indigenous people participate in decisions affecting their lives. The Committee particularly requests that the State party consult and seek the consent of the indigenous people concerned prior to the implementation of natural resources-extracting projects and on public policy affecting them, in accordance with ILO Convention No. 169 (1989) concerning Indigenous and Tribal Peoples in Independent Countries. The Committee strongly recommends that the State party implement legislative and administrative measures to avoid violations by transnational countries of environmental laws.

302. The Committee urges the State party to undertake immediate steps to ensure equal opportunities for Afro-Ecuadorians, particularly with regard to employment, housing, health and education...

...

320. The Committee urges the State party to allocate a higher percentage of GDP to the health sector. The Committee also recommends the State party to continue with its prevention and care efforts in the field of health by providing sexual and reproductive health services, particularly to women and young people.

321. The Committee strongly urges the State party to conduct an assessment of the effect of international trade rules on the right to health for all and to make extensive use of the flexibility clauses permitted in the WTO Agreement on Trade-related Aspects of Intellectual Property Rights (the TRIPS Agreement) in order to ensure access to generic medicine and more broadly the enjoyment of the right to health for everyone in Ecuador.

•	Denmark, ICESCR, E/2005/22 (2004) 49 at paras. 396 and 409.

396. The Committee is concerned about the high rate of illicit drug consumption and alcohol abuse in the State party, and about the conditions of those who suffer from mental illnesses caused by such consumption and abuse.

...

409. The Committee recommends that the State party continue taking measures for the effective implementation of programmes to prevent the consumption of illicit substances, tobacco smoking and alcohol abuse...

•	Azerbaijan, ICESCR, E/2005/22 (2004) 59 at paras. 497 and 523.

497. The Committee is concerned that according to Azerbaijan Figures 2004 published by the State Statistical Committee, the illicit preparation, storage and sale of narcotics has been on the rise since 1995 and that 2,049 cases were registered in 2003.

...

523. The Committee urges the State party to take effective measures to decrease the availability of illicit drugs in the territory of the State party through, inter alia, combating the root causes...

•	Chile, ICESCR, E/2005/22 (2004) 67 at paras. 554 and 582.

554. The Committee is concerned about the scope of the planned law (on the reorganization of subsidies for industrial disablement and sick leave) which would involve a legislative restriction of the current law, permitting parents a subsidized leave from work to care for children under the age of 1 in the case of serious illness.

...

582. The Committee recommends that the State party review its proposed legislation on the reduction in the parental medical leave benefit system, with a view to ensuring that it will not represent a retrogressive measure affecting the minimum standards of the right to health, as outlined in the Committee's general comment No. 14 (2000) on the right to the highest attainable standard of health (article 12 of the Covenant).

•	China, ICESCR, E/2006/22 (2005) 25 at paras. 164, 167 and 193.

164. The Committee is concerned about the significant number of persons, especially women, who suffer from mental illnesses and about the inadequacy of measures to ensure a decent life for persons suffering from mental illnesses. The Committee is also concerned that, in addition to suffering social stigmatization, persons with mental illnesses often spend a long time in psychiatric facilities, where they live in sub-standard conditions and receive sub-standard treatment and care. The Committee also notes that suicide among women is alarmingly high in the State party.

...

167. The Committee notes with concern the reports regarding the discrimination of ethnic minorities in the State party, in particular in the field of employment, adequate standard of living, health, education and culture. In this regard, the Committee regrets the insufficient information provided by the State party regarding the enjoyment of economic, social and cultural rights enshrined in the Covenant by populations in the ethnic minority areas...

...

193. The Committee recommends that the State party allocate adequate resources and undertake effective measures for the treatment of, and care for, persons with mental illnesses, and to ensure that appropriate standards are established and enforced in psychiatric facilities to prevent maltreatment and neglect of mentally ill patients. The Committee also recommends that the State party conduct a study regarding factors and causes of the high rate of suicide among women...

•	China (Hong Kong Special Administrative Region), ICESCR, E/2006/22 (2005) 34 at paras. 217 and 229.

217. The Committee remains concerned about the public's low level of awareness in the Hong Kong Special Administrative Region of sexual and reproductive health issues. The Committee also regrets that no comprehensive sexual and reproductive health programme exists in the Hong Kong Special Administrative Region and that sexual and reproductive health education is not part of the school curriculum.

...

229. The Committee recommends that the Hong Kong Special Administrative Region develop a comprehensive sexual and reproductive health programme, including a public awareness-raising campaign on safe contraceptive methods. The Committee also calls upon the Hong Kong Special Administrative Region to introduce sexual and reproductive health education in the school curriculum.

•	China (Macao Special Administrative Region), ICESCR, E/2006/22 (2005) 38 at paras. 244 and 254.

244. The Committee is concerned about the high incidence of consumption of illicit drugs in the Macau Special Administrative Region and the ineffective enforcement of the law prohibiting it.

...

254. The Committee recommends that measures be continued and strengthened for the effective implementation of programmes to prevent illicit drug consumption...

•	Serbia and Montenegro, ICESCR, E/2006/22 (2005) 41 at paras. 294 and 321.

294. The Committee deplores the high rates of tobacco consumption and of cardiovascular diseases in Serbia and Montenegro, in particular in the autonomous province of Vojvodina.

...

321. The Committee recommends that the State party intensify its anti-smoking and healthy diet campaigns with a view to combating the causes of cardiovascular diseases.

•	Norway, ICESCR, E/2006/22 (2005) 48 at paras. 348, 366 and 368.

348. The Committee is concerned about the high incidence of eating disorders among adolescents in the State party and about the high incidence of suicide among adolescent boys aged between 15 and 19.

...

366. The Committee encourages the State party to adopt effective measures to address the underlying causes of regional disparities in health indicators.

...

368. The Committee recommends that the State party continue and strengthen the measures taken to implement the coherent strategy developed in 2000 against eating disorders, and also ensure adequate follow-up to the National Plan for Suicide Prevention.

CEDAW

•	Fiji, CEDAW, A/57/38 part I (2002) 9 at paras. 62 and 63.

62. The Committee notes the gains achieved with regard to women's health but is concerned that women in remote islands are adversely affected by maternal and infant mortality. It notes that out-migration of health professionals has led to a decline in health services, and that cervical cancer and circulatory diseases are a major cause of female death. The Committee also notes with concern the growing incidence of sexually transmitted diseases, including HIV/AIDS.

63. The Committee recommends that priority be given to allocating resources for improving health care services for women, including in the remote islands, and combating sexually transmitted diseases, including HIV/AIDS. It encourages the State party to introduce proactive measures and incentives to attract local health professionals to the health services in Fiji.

•	Estonia, CEDAW, A/57/38 part I (2002) 13 at paras. 100, 111 and 112.

100. The Committee recommends that the State party amend its law on statutory rape and bring its law on early marriage into conformity with article 16, paragraph 2, of the Convention, and its own policies on the reproductive health of women and girls. It urges the State party to develop preventive optional welfare programmes to address the problem of teenage pregnancy.

...

111. While recognizing some improvements in the area of health, after a deterioration of the situation in the years following independence, the Committee is concerned with the increase of tuberculosis, sexually transmitted diseases and HIV, as well as with high suicide rates among women. The Committee notes with concern the high rate of abortion among women and the significance of this fact with regard to effective access to family planning methods, including contraceptives, especially among women in rural areas and low incomes.

112. The Committee draws attention to its general recommendation 24 on women and health and recommends that comprehensive research be undertaken into the specific health needs of women, including reproductive health, the financial and organizational strengthening of family planning programmes addressed to women and men and the provision of wide access to contraceptives for all women. The Committee urges the State party to reinforce programmes on sexual education for both girls and boys in order to foster responsible sexual behaviour. It also recommends that structures be established aimed at addressing the mental health problems faced by women, as well as those areas where negative developments have occurred.

•	Iceland, CEDAW, A/57/38 part I (2002) 27 at paras. 251 and 252.

251. The Committee expresses concern at the high level of alcohol consumption among women, and the level of alcohol and drug consumption among young people, including girls.

252. The Committee urges the State party to take measures to address alcohol and drug abuse, especially among women and girls.

•	Suriname, CEDAW, A/57/38 part II (2002) 82 at paras. 65 and 66.

65. The Committee is concerned about the situation of rural women, in particular the indigenous Amerindians and the Maroons, in the coastal plain and in the interior of Suriname, who are disadvantaged by poor infrastructure, limited markets, obstacles in availability and accessibility of agricultural land and agricultural credit, low literacy rates, ignorance of existing regulations, lack of services and environmental pollution. It notes with concern the serious absence of specific policies in all these areas, including on family planning and preventing the spread of sexually transmitted diseases, including HIV...

66. The Committee urges the State party to give full attention to the needs of rural women, including older women, particularly Amerindian and Maroon women, to ensure that they benefit from policies and programmes in all areas, in particular access to health, education, social services and decision-making...

•	Belgium, CEDAW, A/57/38 part II (2002) 95 at paras. 157 and 158.

157. While recognizing the achievements in ensuring women's health, in particular the State party's comprehensive policy to combat HIV/AIDS, the Committee is concerned about the disparities with regard to the health of women throughout the country. It is furthermore concerned about the phenomenon of teenage pregnancy and voluntary termination of pregnancy among women as young as 14.

158. The Committee urges the State party to effect better coordination of its health policy in conformity with the Convention and general recommendation 24 on women and health in all regions of the country. It further calls on the State party to formulate policies, strategies and programmes to prevent early pregnancies, including education campaigns addressed to young men as well as young women.

•	Tunisia, CEDAW, A/57/38 part II (2002) 102 at para. 187.

187. ...The Committee...commends the measures taken to improve women's health, including through the provision of reproductive health services and reduction of maternal and child mortality rates...

•	Zambia, CEDAW, A/57/38 part II (2002) 107 at paras. 242 and 243.

242. While noting that the State party has made progress in addressing the basic health needs of women in Zambia, the Committee expresses concern at the high level of maternal and infant mortality, low life expectancy, very high teenage pregnancies and unsafe abortions and lack of adequate healthcare facilities and family planning services, particularly in the rural areas.

243. The Committee recommends that the State party formulate polices and allocate adequate resources to improve the status of women's health, in particular with regard to maternal and infant mortality. It urges the State party to increase women's access to healthcare and family planning services. It also recommends that national reproductive health programmes be designed and implemented in order to prevent early pregnancy and induced abortions in rural and urban areas.

•	Ukraine, CEDAW, A/57/38 part II (2002) 114 at paras. 289 and 290.

289. The Committee expresses its concern about the status of women's health, especially their reproductive health. The Committee is concerned about the high number of abortions and the fact that the maternal and child mortality rates still remain high. It is also concerned about the undernutrition of women, as well as iodine deficiency and other diseases among women...

290. The Committee draws attention to its general recommendation No. 24 on women and health and recommends comprehensive research into the specific health needs of women, including their reproductive health, the full implementation of a life-cycle approach to women's health, the financial and organizational strengthening of family planning programmes and the provision of wide access to contraceptives for all women and men. The Committee urges the State party to reinforce programmes of sexual and reproductive education for both girls and boys in order to foster responsible sexual behaviour and further discourage abortion as a means of birth control...

•	Denmark, CEDAW, A/57/38 part II (2002) 120 at para. 314.

314. The Committee commends the State party for appointing a Minister for Gender Equality, thereby making gender equality policy a part of the Government's politics and affording a greater potential to directly influence the political decision-making process, and for establishing the Gender Equality Board, comprising a judge and two lawyers with expertise in the areas of gender equality and labour market conditions, respectively, that handles complaints about gender-based discrimination in the labour market, the education, health, social and finance sectors, and in private enterprises.

•	Czech Republic, CEDAW, A/57/38 part III (2002) 157 at paras. 101 and 102.

101. The Committee is concerned about the status of women's health, especially their reproductive health. While recognizing the 60 per cent decrease in abortion since 1994 and the progressive increase in the use of intrauterine and hormonal contraceptives, the Committee is concerned that the current abortion rate may suggest that abortion is still being used as a means of birth control. It is also concerned that voluntary sterilization for women is permitted solely for health reasons. The Committee is concerned about the rate of consumption among women of prescribed sedative and barbiturate drugs.

102. The Committee draws attention to its general recommendation No. 24 on women and health and recommends the collection of data disaggregated by sex as well as comprehensive research into the specific health needs of women, including their reproductive health, the full implementation of a life-cycle approach to women's health, the financial and organizational strengthening of family planning programmes, the provision of wide access to safe and affordable contraceptives for all women and men, and the lifting of the restrictions on voluntary sterilization. The Committee urges the State party to reinforce programmes of sexual and reproductive education for both girls and boys. The Committee calls on the State party to encourage responsible sexual behaviour and further discourage abortion as a means of birth control...

•	Uganda, CEDAW, A/57/38 part III (2002) 164 at paras. 147 and 148.

147. The Committee is concerned about the high rate of teenage pregnancy and its consequences for girls' enjoyment of the rights in the Convention, particularly in the spheres of education and health. It is also concerned at the high rate of maternal mortality among teenage girls, particularly in the rural areas, frequently as a result of clandestine abortion.

148. The Committee recommends that the State party design and implement national health, including reproductive health, programmes to prevent early pregnancies and induced abortions in rural and urban areas. The Committee also urges the State party to reinforce programmes of sexual and reproductive health education for both girls and boys. It also calls on the State party to provide safe and affordable contraceptives.

•	Guatemala, CEDAW, A/57/38 part III (2002) 171 at paras. 196 and 197.

196. ...The Committee is...concerned that the minimum age at which a girl can legally contract matrimony - 14 years - is too low and can impact negatively on their health and impede their education.

197. ...The Committee urges the State party to develop awareness campaigns on the negative implications of early marriage on the health and education of girls.

See also:

•	Yemen, CEDAW, A/57/38 part III (2002) 200 at paras. 394 and 395.

•	Peru, CEDAW, A/57/38 part III (2002) 212 at paras. 488 and 489.

•	Barbados, CEDAW, A/57/38 part III (2002) 177 at para. 223.

223. The Committee congratulates the State party on having achieved a maternal mortality rate of zero.

•	Hungary, CEDAW, A/57/38 part III (2002) 189 at paras. 329 and 330.

329. While noting that abortion rates have fallen in the reporting period, the Committee remains concerned about the high rate of abortion among women, including young women without children, and the possible connection to difficulties in accessing family planning methods and the prohibitive cost of contraceptives, particularly for women with low incomes. The Committee is concerned that the report does not include data on women's general health situation, access to health care or information about the general health policy of the State party, including information on the access to health care of rural women...

330. The Committee draws attention to its general recommendation 24 on women and health and recommends that comprehensive research be undertaken into the specific health needs of women, including reproductive health, HIV/AIDS, the financial and organizational strengthening of family planning programmes addressed to women and men and the provision of wide access to contraceptives for all women. The Committee urges the State party to reinforce programmes on sexual education for both girls and boys. The Committee calls on the State party to take all appropriate measures to foster responsible sexual behaviour and take all appropriate steps to stop the use of abortion as a means of birth control...

•	Yemen, CEDAW, A/57/38 part III (2002) 200 at paras. 396 and 397.

396. The Committee notes with concern the high maternal mortality rates.

397. The Committee recommends that the State party take urgent measures to develop health programmes aimed at reducing the maternal mortality rate and to make contraceptives affordable and accessible.

•	Peru, CEDAW, A/57/38 part III (2002) 212 at paras. 484 and 485.

484. The Committee notes with concern that, in the period covered by the report, mention is made of numerous cases of sterilization of women without prior informed consent, using psychological violence or the promise of financial incentives, thus affecting women's right to decide the number and spacing of their children. The Committee is also concerned that, although the Deputy Defender for Women's Rights and other organs have condemned these practices, those responsible have not been punished.

485. The Committee recommends that all necessary measures should be taken to continue to provide the service of surgical sterilization so as to give women the right of free choice as regards their reproductive health, after they have been duly informed of the medical details and consequences of the operation and have given their consent. The Committee also recommends that a recurrence of these incidents should be avoided in the future. It further recommends that efforts should be continued to bring before the courts the persons responsible for this violation of the right to health.

•	Congo, CEDAW, A/58/38 part I (2003) 29 at paras. 178 and 179.

178. The Committee expresses concern about the situation of rural women, particularly in view of their extreme poverty and lack of access to health, education, credit facilities and community services.

179. The Committee urges the State party to pay special attention to the needs of rural women, ensuring that they participate in decision-making and have full access to education, health services and credit facilities...

•	Canada, CEDAW, A/58/38 part I (2003) 53 at paras. 351 and 352.

351. The Committee is concerned that, within the framework of the 1995 Budget Implementation Act, the transfer of federal funds to the provincial and territorial levels is no longer tied to certain conditions which previously ensured nationwide consistent standards in the areas of health and social welfare. It is also concerned about the negative impact that the new policy has had on the situation of women in a number of jurisdictions.

352. The Committee recommends that the federal Government reconsider those changes in the fiscal arrangements between the federal Government and the provinces and territories so that national standards of a sufficient level are re-established and women will no longer be negatively affected in a disproportionate way in different parts of the State party's territory.

•	Slovenia, CEDAW, A/58/38 part II (2003) 109 at paras. 214 and 215.

214. The Committee is concerned at the high maternal mortality rate in Slovenia.

215. The Committee recommends that the State party take urgent measures to reduce the maternal mortality rate, in consultation with the World Health Organization, as necessary...

•	Japan, CEDAW, A/58/38 part II (2003) 130 at para. 355.

355. The Committee commends the State party for allocating, under the Initiative on Women in Development, approximately 10 per cent of its official development assistance over the last decade for women's education, health and economic and social participation, to a number of developing countries in various parts of the world.

•	New Zealand, CEDAW, A/58/38 part II (2003) 138 at paras. 425 and 426.

425. Taking note of the efforts made by the State party to combat discrimination against refugee and migrant women in New Zealand, the Committee expresses concern at the continuing discrimination suffered by immigrant, refugee and minority women and girls, based on their ethnic background, particularly with respect to education, health, employment, violence against women, and in regard to permanent residence status.

426. The Committee urges the State party to take effective measures to eliminate discrimination against refugee, migrant and minority women and girls, and to strengthen its efforts to combat xenophobia and racism in New Zealand. It also encourages the State party to be more proactive in its measures to prevent discrimination against these women and girls within their communities and in society at large, to combat violence against them and to increase their awareness of the availability of social services and legal remedies, and to provide for their needs with respect to education, employment and health care...

•	Bhutan, CEDAW, A/59/38 part I (2004) 21 at paras. 119 and 120.

119. While recognizing progress made in the area of women's health, the Committee expresses concern about the lack of a holistic and life-cycle approach to women's health.

120. The Committee calls upon the State party to increase the access of women and adolescent girls to affordable health-care services, including reproductive health care, and to increase access to affordable means of family planning for women and men. It also calls upon the State party to step up its efforts to implement awareness-raising campaigns targeting women and men on the importance of family planning and related aspects of women's health and reproductive rights.

•	Kyrgyzstan, CEDAW, A/59/38 part I (2004) 28 at paras. 157 and 158.

157. The Committee is concerned about the status of women's health and the deterioration of the health-care system. It is concerned about the continuing high rates of maternal and infant mortality, anaemia during pregnancy, the still high number of abortions, including among women under the age of 19, underweight girls, the increase in tuberculosis and sexually transmitted diseases among women and the problem of alcoholism and drug addiction among women. The Committee is concerned about the lack of attention to the negative impact on women of the reform of the health-care system, including with respect to the decline in the quality and accessibility of medical services and the closing down of medical institutions, where a majority of workers were women.

158. The Committee recommends that, in accordance with general recommendation 24 on women and health, the State party fully implement a holistic, life cycle approach to women's health. It recommends that the State party strengthen measures to reduce the maternal and infant mortality rates and to address alcoholism and drug addiction among women as well as the spread of tuberculosis and other diseases among women. It urges the State party to reinforce programmes of sexual and reproductive education for both girls and boys to foster responsible sexual behaviour. The Committee urges the State party to maintain access to affordable and adequate health care, to assess the impact on women of the reform of the health-care system and to take remedial action so as to ensure that the reform does not disproportionately disadvantage women.

•	Nepal, CEDAW, A/59/38 part I (2004) 34 at paras. 212 and 213.

212. The Committee is concerned at the status of women's health, particularly rural women. The Committee is concerned that women have a lower life expectancy than men and that there are high maternal and infant mortality rates. It is also concerned that women's health is adversely affected by factors such as early marriage and early pregnancy, inadequate family planning services and illiteracy, which is an obstacle to obtaining and effectively using health-related information. It is further concerned at the lack of research on women's health and data disaggregated by sex.

213. The Committee recommends that the State party take further measures to improve the access of women, particularly rural women, to health-related services and information, including in regard to sexual and reproductive health, in an effort to reduce maternal mortality. It also recommends that programmes and policies be adopted to increase knowledge of and access to contraceptive methods, bearing in mind that family planning should be the responsibility of both partners. It further recommends that sex education be widely promoted, particularly targeting boys and girls, with special attention to the prevention and further control of sexually transmitted diseases and HIV/AIDS. The Committee requests the State party to conduct research on women's health...

•	Belarus, CEDAW, A/59/38 part I (2004) 55 at paras. 355 and 356.

355. The Committee is concerned about the general decline in the status of women's health, as well as the decline in women's access to health services. The Committee is also concerned at the continuing use of abortion as a primary method of birth control, teenage pregnancy, the deterioration of the health of pregnant women and the spread of sexually transmitted diseases, including HIV/AIDS. The Committee is concerned at the continuing negative impact of the Chernobyl disaster on women's health.

356. The Committee recommends the full implementation of a holistic, life cycle approach to women's health, including access to affordable health care, the financial and organizational strengthening of family planning programmes and the provision of wide access to contraceptives for all women and men, in accordance with its general recommendation 24 on women and health. It urges the State party to reinforce programmes of sexual and reproductive education for both girls and boys in order to foster responsible sexual behaviour and further discourage abortion as a means of birth control...

•	Angola, CEDAW, A/59/38 part II (2004) 118 at paras. 162 and 163.

162. While welcoming the priority placed by the State party on the rehabilitation of the health sector, the Committee is concerned about the poor health infrastructure, which results in women's lack of access to health services and their low health status. The Committee is especially concerned about women's low life expectancy, high maternal mortality and morbidity rates, high fertility rates and inadequate family planning services, low rates of contraceptive use and lack of sex education. The Committee is also concerned about trends in HIV/AIDS infection rates of women.

163. The Committee urges the State party to continue its efforts to improve the country's health infrastructure. It calls on the State party to integrate a gender perspective in all health sector reforms, while also ensuring that women's sexual and reproductive health needs are adequately addressed. In particular, the Committee recommends that the State party undertake appropriate measures to improve women's access to health care and health-related services and information, including access for women who live in rural areas. It calls on the State party to improve the availability of sexual and reproductive health services, including family planning information to reduce maternal mortality. It also recommends that programmes and policies be adopted to increase knowledge of and access to affordable contraceptive methods, so that women and men can make informed choices about the number and spacing of children. It further recommends that sex education be widely promoted and targeted at girls and boys, with special attention to the prevention of early pregnancies and the control of sexually transmitted diseases and HIV/AIDS. It also calls on the State party to ensure the effective implementation of its HIV/AIDS law and policies.

•	Bangladesh, CEDAW, A/59/38 part II (2004) 134 at paras. 259 and 260.

259. The Committee is concerned about the impact of the arsenic poisoning of water, which is disproportionately affecting rural women of reproductive age.

260. The Committee urges the State party to put in place measures for ensuring that safe drinking water is available to all, and particularly to affected rural women and their families. The Committee calls on the State party to prepare without delay a plan of action containing preventative and remedial measures, and prioritizing technologies favoured by rural women, their families and local communities that are risk-free, cost-effective and provide alternatives to underground water withdrawal. The Committee recommends that the State party launch an awareness campaign and proactive health, nutrition and social programmes for affected rural women, their families and local communities. The Committee also calls on the State party to encourage all other actors, who directly or indirectly caused the arsenic crisis, to share in the financial burden of compensating the victims.

•	Lao People's Democratic Republic, CEDAW, A/60/38 part I (2005) 16 at paras. 100 and 101.

100. The Committee is concerned that the Lao People's Democratic Republic is increasingly exposed to the danger of HIV/AIDS and other sexually transmitted diseases, in particular around construction sites and along trade routes.

101. The Committee recommends that the State party take all measures necessary to raise awareness among men and women, especially in rural areas, around construction sites and along existing and emerging trade routes, of the risk of HIV/AIDS infection.

•	Croatia, CEDAW, A/60/38 part I (2005) 30 at paras. 196 and 197.

196. The Committee is concerned that Roma women remain in a vulnerable and marginalized situation, especially in regard to education, employment, health and participation in public life and decision-making...

197. The Committee requests the State party to take effective measures to eliminate discrimination against Roma women, both in society at large and within their communities, and to enhance respect for their human rights through effective and proactive measures, including temporary special measures in accordance with article 4, paragraph 1, of the Convention and the Committee's general recommendation 25, and awareness-raising programmes...

•	Paraguay, CEDAW, A/60/38 part I (2005) 44 at paras. 287-290.

287. The Committee remains concerned about the persistent high maternal mortality rates, particularly deaths due to illegal abortions, the limited access of women to health care and family planning programmes and the apparently unmet need for contraceptives.

288. The Committee reiterates the recommendation made in its previous concluding comments and urges the State party to act without delay and implement effective measures to deal with the high maternal mortality rate, to prevent women from having to resort to unsafe abortions and to protect them from the negative effects on their health, in line with the Committee's general recommendation No. 24 on women and health and the Beijing Declaration and Platform for Action. The Committee urges the Government to strengthen the implementation of programmes and policies aimed at providing effective access for women to health-care information and services, in particular regarding reproductive health and affordable contraceptive methods, with the aim of preventing clandestine abortions. It further recommends holding a national consultation with civil society groups, including women's groups, to address the issue of abortion, which is illegal under the current law and is a cause of women's high mortality rates.

289. The Committee remains concerned about...the extensive use of fertilizers and pesticides, which, when improperly used, are harmful to the health of rural women and their families.

290. The Committee...encourages the State party to ensure the participation of rural women in the development of policies aimed at benefiting rural areas and to enhance their access to environmentally sound technologies that are not harmful to their health.

•	Italy, CEDAW, A/60/38 part I (2005) 51 at paras. 332 and 333.

332. The Committee is concerned that certain groups of women, including Roma and migrant women, remain in a vulnerable and marginalized situation, especially in regard to education, employment, health and participation in public life and decision-making...

333. The Committee urges the State party to take effective measures to eliminate discrimination against vulnerable groups of women, including Roma and migrant women, and to enhance respect for their human rights through all available means, including temporary special measures in accordance with article 4, paragraph 1, of the Convention and the Committee's general recommendation 25...

•	Turkey, CEDAW, A/60/38 part I (2005) 58 at paras. 367, 368, 375 and 376.

367. The Committee is strongly concerned about the pervasiveness of patriarchal attitudes and deep-rooted traditional and cultural stereotypes regarding the roles and responsibilities of women and men in society, which continue to cast women in a position of inferiority. It expresses its concern that these attitudes contribute to the perpetuation of violence against women, including in the form of "honour killings", and negatively affect women's enjoyment of their rights in many areas; they also impede the full implementation of the Convention, including in regard to education, employment, health and participation in decision-making...

368. The Committee calls upon the State party to accelerate its efforts to eliminate stereotypical attitudes about the roles and responsibilities of women and men, in conformity with articles 2 (f) and 5 (a) of the Convention, including through awareness-raising and educational campaigns directed at both women and men, to foster a better understanding of and support for equality between women and men at all levels of society. The Committee calls on the State party to monitor carefully the impact of such measures. It recommends that the media be further encouraged to project a positive image of women and of the equal status and responsibilities of women and men in the private and public spheres. The Committee also calls upon the State party to introduce without delay additional measures, in collaboration with civil society organizations, women's groups and community leaders, as well as teachers and the media, to eliminate traditional and cultural practices that discriminate against women in marriage and family relations, taking into account the Committee's general recommendation 21, on equality in marriage and family relations.

...

375. The Committee notes with concern the persistence of high maternal and infant mortality rates in the State party.

376. The Committee recommends that the State party allocate adequate resources to improve the status of women's health, in particular with regard to maternal and infant mortality, and make every effort to increase access to health-care facilities and medical assistance from trained personnel, particularly in rural areas and particularly for post-natal care.

•	Israel, CEDAW, A/60/38 part II (2005) 129 at paras. 255, 256, 259 and 260.

255. While appreciating the progress made in the fields of women's education and health, the Committee is concerned that Israeli Arab women remain in a vulnerable and marginalized situation, especially in regard to education and health...

256. ...The Committee recommends that the State party allocate adequate resources to improve the status of Israeli Arab women's health, in particular with regard to infant mortality...

...

259. The Committee is concerned that Bedouin women living in the Negev desert remain in a vulnerable and marginalized situation, especially in regard to education, employment and health. The Committee is especially concerned about the situation of Bedouin women who live in unrecognized villages with poor housing conditions and limited or no access to water, electricity and sanitation.

260. The Committee requests the State party to take effective measures to eliminate discrimination against Bedouin women and to enhance respect for their human rights through effective and proactive measures, including temporary special measures in accordance with article 4, paragraph 1, of the Convention and the Committee's general recommendation 25, in the fields of education, employment and health...

CAT

•	Zambia, CAT, A/57/44 (2002) 34 at para. 67.

67. While welcoming the Prisons (Amendment) Act which provides for the establishment of open air prisons, the Committee urges the State party to enhance initiatives to reduce overcrowding, increase the use of non-custodial sentences and generally improve detention facilities, especially because of the adverse effects on the health of inmates and prison staff.

•	Cameroon, CAT, A/59/44 (2003) 23 at paras. 40 and 44.

40. The Committee recalls that, in 2000, it found that torture seemed to be a very widespread practice in Cameroon, and expresses concern at reports that this situation still exists. It is troubled by the sharp contradictions between consistent allegations of serious violations of the Convention and the information provided by the State party. In particular, the Committee declares serious concern about:

...

(b) The continued existence of extreme overcrowding in Cameroonian prisons, in which living and hygiene conditions would appear to endanger the health and lives of prisoners and are tantamount to inhuman and degrading treatment. Medical care reportedly has to be paid for, and the separation of men and women is not always ensured in practice. The Committee notes with particular concern the large number of deaths at Douala central prison since the beginning of the year (25 according to the State party, 72 according to non-governmental organizations);

...

44. The Committee urges the State party to take all necessary measures to end the practice of torture on its territory. It recommends that the State party should:

...

(c) Adopt urgent measures to reduce overcrowding in prisons. The State party should enact a law establishing the maximum duration of pre-trial detention, and consider immediately releasing offenders or suspects imprisoned for the first time for petty offences, particularly if they are under 18 years of age; such persons should not be imprisoned until the problem of prison overcrowding has been solved;

(d) Guarantee free medical care in prisons, ensure the right of prisoners to adequate food in practice, and effectively separate men and women;

...

•	Lithuania, CAT, A/59/44 (2003) 52 at para. 108.

108. The Committee welcomes the ongoing efforts by the State party to reform its legal system and revise its legislation in order to safeguard fundamental human rights, including the right not to be subjected to torture and other cruel, inhuman or degrading treatment or punishment, including:

(a) The adoption of a new Criminal Code and Code of Criminal Procedure which prohibit the use of violence, intimidation, degrading treatment or treatment impairing a person's health...

...

•	Finland, CAT, A/60/44 (2005) 32 at para. 71.

71. Amongst the many positive developments, the Committee notes in particular:

...

(f) The amendment of the Mental Health Act, taking into account human rights conventions binding on Finland, in order to strengthen the rights of the patient and staff;

...

CRC

•	Mauritania, CRC, CRC/C/111 (2001) 8 at paras. 64 and 65.

64. The Committee is concerned at the poor situation of maternal, child and the reproductive health and the limited access to health care. In particular, it notes the lack of qualified medical and paramedical staff and the shortage of medicines and equipment in rural areas. It further notes that infant, child and maternal mortality rates, as well as abortion and malnutrition rates, are particularly high in rural areas and in poor urban areas. The Committee also takes note of the low immunization rates and of the resurgence of tuberculosis.

65. In light of article 24 of the Convention, the Committee recommends that the State party:

(a) Allocate appropriate resources and develop comprehensive policies and programmes to improve the health situation of all children without discrimination, in particular by focusing more on primary care and further decentralizing the health care system;

(b) Reduce child mortality and morbidity by providing adequate antenatal and postnatal health care services;

(c) Develop campaigns to inform parents of basic knowledge about child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation; and

(d) Look to international cooperation for the full and efficient implementation of the immunization programme.

•	Kenya, CRC, CRC/C/111 (2001) 21 at paras. 124-127.

124. The Committee notes the efforts of the State party to improve health care for children through, inter alia, the Health Policy Framework, the Expanded Programme on Immunization, and the National Plan of Action for Nutrition. However, the Committee is concerned about the insufficient numbers of trained medical personnel; the high maternal, infant, and under-five mortality rates; the high rate of malnutrition; the increasing incidence of HIV/AIDS; the high incidence of malaria and acute respiratory infections; and poor sanitation and limited access to safe drinking water, especially in rural areas. It is also noted with concern that the State party's cost-sharing policy has limited access to basic health care, especially for poor families.

125. The Committee recommends that the State party allocate appropriate resources to reinforce its policies and programmes to reduce the high rate of malnutrition and improve health care for children. Additionally, the State party should take all effective measures to increase the numbers of trained medical and other health personnel, including traditional healers; facilitate cooperation between trained medical personnel and traditional healers, especially midwives; reduce the incidence of maternal, infant and under-five mortality; prevent and combat malnutrition; increase access to safe drinking water; improve sanitation; and reduce the incidence of malaria and acute respiratory infections. Additionally, the State party should take effective measures to facilitate greater access to health services by, inter alia, abolishing or rationalizing cost sharing in primary health care to reduce the burden on poor families. The Committee encourages the State party to seek technical cooperation for the Integrated Management of Childhood Illnesses and for other measures for child health improvement from, inter alia, WHO and UNICEF.

126. The Committee expresses its concern with respect to the limited availability of programmes and services and the lack of adequate data in the area of adolescent health, including early marriage and pregnancy, HIV/AIDS and sexually transmitted diseases (STDs), abortion, violence, suicide, mental health, and alcohol and substance abuse. The Committee is also concerned at the increasing number of orphans due to HIV/AIDS and at the decrease in expenditure for HIV/AIDS control.

127. The Committee recommends that the State party strengthen adolescent health policies, including reproductive health education. Further, the Committee suggests that a comprehensive and multidisciplinary study be undertaken to assess the extent of adolescent health problems, including the special situation of children infected and/or affected by HIV/AIDS and STDs. Additionally, it is recommended that the State party allocate adequate human and financial resources to increase the number of social workers and psychologists and to develop youth-sensitive care, counselling and rehabilitation facilities for adolescents. It is further recommended that the State party seek technical assistance from, inter alia, UNICEF and WHO.

•	Qatar, CRC, CRC/C/111 (2001) 59 at paras. 295 and 296.

295. The Committee is concerned at the disparities in the enjoyment of economic and social rights, particularly the rights to health and education, experienced by children living in rural areas and non-national children.

296. The Committee recommends that the State party:

(a) Take all necessary measures to ensure that all children within its jurisdiction enjoy all the rights set out in the Convention without discrimination, in accordance with article 2;

(b) Continue to prioritize and target resources and social services for children belonging to the most vulnerable groups;...

...

•	Uzbekistan, CRC, CRC/C/111 (2001) 117 at paras. 576 and 577.

576. In the light of article 24 of the Convention, the Committee expresses its concern at problems of poor access to safe water and food security, exposure to toxic chemicals, and other hazards arising from the Aral Sea disaster, which negatively impact upon the health of children in the Karalpakstan region.

577. In the light of article 24 (c) of the Convention, the Committee recommends that the State party take all appropriate measures, including seeking international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution and contamination of water supplies.

•	Lebanon, CRC, CRC/C/114 (2002) 11 at paras. 83 and 84.

83. The Committee is concerned about the high rate of Palestinian children living below the poverty line, as well as the lack of adequate access by Palestinian children to many basic rights, including health, education and an adequate standard of living, and about the quality of services provided.

84. The Committee reiterates its recommendation ([CRC/C/15/Add.54], para. 40) that the State party, in cooperation with United Nations Relief and Works Agency for Palestine Refugees in the Near East, seek ways of addressing the socio-economic problems among Palestinian children that affect children negatively, including teaching about the Convention in the school and include children in development programmes.

•	Malawi, CRC, CRC/C/114 (2002) 104 at paras. 406 and 407.

406. While welcoming the adoption of the National Programme of Action for the Survival and Development of Children, and noting that the right to life is included in the Constitution, the Committee remains concerned that the programme has not been sufficiently implemented and that the impact of HIV/AIDS, mounting economic challenges and other socio-economic difficulties, as well as traditional practices and witchcraft, continue to threaten the right to life, survival and development of children within the State party.

407. The Committee encourages the State party to reinforce its efforts to provide greater protection and support to children whose right to life, survival and development are unduly threatened by the difficult socio-economic realities of the State. In this connection, the Committee recommends that the State party take the necessary measures to set clear priorities for a new programme of action and take all effective measures to strengthen its technical cooperation with, among others, UNICEF, UNAIDS, UNDP and WHO.

See also:

•	United Republic of Tanzania, CRC, CRC/C/108 (2001) 71 at paras. 382 and 383.

•	Guinea-Bissau, CRC, CRC/C/118 (2002) 12 at paras. 72 and 73.

72. Noting the work undertaken to address female genital mutilation and other harmful practices, including through international cooperation, the Committee remains deeply concerned that:

(a) As indicated in the State party's report, the early marriage of girls - often around the age of 13 or 14 - is common (see report, para.33) and can lead to poor health for girls;

(b) Female genital mutilation is practised widely within certain ethnic groups, especially the Fulas and the Mandinkas;

(c) As indicated in the State party's report (para. 202), traditional food taboos are common and thought to be one cause of malnutrition among children and mothers.

73. The Committee recommends that the State party:

(a) Make every effort to combat practices involving the early marriage of girls, including through the involvement of community leaders and the use of education campaigns;

(b) Continue and strengthen its efforts to end practices of female genital mutilation, for example through legislative prohibition, through the implementation and enforcement of legislation and through public awareness campaigns;

(c) Take steps to end the practise of harmful traditional food taboos by children and mothers;

(d) Strengthening and further supporting the work of the Committee against harmful practices;

(e) Seek cooperation with countries in the region that have positive experience of combating these harmful practices.

•	Niger, CRC, CRC/C/118 (2002) 37 at paras. 177 and 178.

177. While noting the efforts of the State party to prevent and combat harmful traditional practices, the Committee is concerned at the persistence of such practices, including female genital mutilation, the removal of the uvula, early and forced marriages, and forced feeding.

178. The Committee recommends that the State party:

(a) Adopt the bill to prohibit female genital mutilation;

(b) Take legislative and awareness raising measures to prohibit and eradicate all kinds of traditional practices harmful to the health, survival and development of children, boys as well as girls;

(c) Reinforce its sensitization programmes, with the involvement of traditional leaders, practitioners and the general public, to change traditional attitudes and discourage harmful practices, in particular in rural areas;

(d) Find alternative employment for practitioners.

•	Belarus, CRC, CRC/C/118 (2002) 54 at paras. 245 and 246.

245. The Committee notes with concern the persisting negative consequences of the Chernobyl disaster, including the increase of cases among children of various diseases, including cancer, immunological deficiencies and anaemia. It further notes that assistance to people affected by the Chernobyl disaster is strictly humanitarian rather than focused on long-term policies.

246. The Committee recommends that the State party:

(a) Continue to improve the specialized health care provided to children affected by the Chernobyl disaster, including its psychosocial aspect;

(b) Strengthen its efforts at early detection and prevention of diseases related to nuclear contamination;

(c) Focus more on a long-term developmental approach to assistance to people.

•	Argentina, CRC, CRC/C/121 (2002) 8 at paras. 44, 45, 73 and 74.

44. The Committee expresses its concern that budgetary allocations for children are still insufficient to respond to federal, provincial and local priorities for the protection and promotion of children's rights and to overcome and remedy existing disparities between rural and urban areas, as well as within urban areas, in particular Buenos Aires, with respect to public services provided to children. It notes with deep concern that, according to recent statistics mentioned by the State party in its reply to the list of issues, 69.2 per cent of children in Argentina live in poverty, of whom 35.4 per cent live in extreme poverty.

45. In light of article 4 of the Convention, the Committee encourages the State party:

(a) To review economic and social policies and the allocation of resources in the budget with a view to ensuring that the maximum amount of available resources is allocated to promoting and protecting the rights of the child at the federal, regional and local levels, especially in the fields of health, education, social welfare and security, as previously recommended ([CRC/C/15/Add.36], para. 16);

...

73. The Committee notes with deep concern that the increasing rate of malnutrition is affecting, according to the most recent statistics, more than 4 million children, in particular newborn babies and those living in the northern provinces. It further notes that the impact of the economic crisis on children's state of health and nutrition has not yet been assessed.

74. The Committee recommends that the State party:

(a) Undertake a study on child malnutrition and create a comprehensive system of statistics to keep a record of malnutrition cases in order to assess the extent, scope and nature of this phenomenon;

(b) Develop a comprehensive nutritional programme in order to prevent and combat malnutrition;

(c) Seek international cooperation from, among others, UNICEF and the World Health Organization (WHO).

•	Ukraine, CRC, CRC/C/121 (2002) 70 at paras. 348 and 349.

348. The Committee welcomes the information that the State party has moved the families from the areas most affected by the Chernobyl disaster. However, the Committee remains concerned that, as noted in the State party's report, the main factors exerting a harmful impact on children's health (and that of pregnant women) remain the aftermath of the Chernobyl disaster, the high level of chemical pollutants in the atmosphere and food products, and the high level of noise pollution. It further notes that insufficient attention has been given to the long-term health and psycho-social consequences of the Chernobyl disaster.

349. The Committee recommends that the State party:

(a) Continue to improve the specialized health care provided to children affected by the Chernobyl disaster, including its psychosocial aspect;

(b) Strengthen its efforts to detect and prevent diseases related to nuclear contamination;

(c) Focus more on a long-term developmental approach to the assistance given to people through, inter alia, supporting United Nations initiatives in this area;

(d) Take all appropriate measures, including seeking international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution of the environment and food products.

•	Poland, CRC, CRC/C/121 (2002) 120 at paras. 531, 532, 545 and 546.

531. While encouraged that health indicators of children are good and continuously improving, the Committee is nevertheless concerned at the increase in unhealthy behaviours and lifestyle trends, as well as at the low percentage of mothers continuing to breastfeed.

532. The Committee recommends that the State party:

(a) Improve the effectiveness of health promotion and health education programme, in particular by promoting healthy lifestyles among children and young people;

(b) Take steps to encourage and educate mothers on the benefits of exclusive breastfeeding of infants for the first six months and of continued breastfeeding for two years.

...

545. The Committee is concerned that, despite pilot programmes aimed at improving the situation of the Roma in certain provinces, they still suffer from widespread discrimination which has in some instances impeded Romani children's right to education, health and social welfare.

546. The Committee recommends that the State party:

(a) Initiate campaigns at all levels and in all provinces aimed at addressing the negative attitudes towards the Roma in society at large and in particular amongst authorities and professionals providing health, education and other social services;

•	Republic of Korea, CRC, CRC/124 (2003) 24 at paras. 126 and 127.

126. The Committee is encouraged by the very positive health indicators for children. Nevertheless, it is concerned that the proportion of the government budget allocated to health is less than 1 per cent, and that 90 per cent of all health care facilities are privately operated. The Committee is also concerned that the proportion of mothers breastfeeding their children declined significantly during the 1990s, and that the number of adolescents smoking and using amphetamines and other illicit substances is increasing.

127. The Committee recommends that the State party:

(a) Increase to a significant level the funding allocated to health and establish a system of public care facilities so that low-income families may have access to health systems at no cost;

(b) Take steps to encourage and educate mothers on the benefits of exclusive breastfeeding of infants during the first six months and adopt a national code on breastfeeding;

(c) Take effective measures to counteract any negative impact on the employment of women who breastfeed their children;

(d) Undertake a study of adolescent health with a view to developing a comprehensive adolescent health policy that addresses, inter alia, education on HIV/AIDS and other sexually transmitted diseases, the problem of smoking and drug abuse amongst teenagers as well as other relevant issues.

•	Zambia, CRC, CRC/C/132 (2003) 32 at paras. 217 and 218.

217. The Committee notes the launch of the National Education Campaign by the Drug Enforcement Commission but remains concerned at the practice of substance abuse by children, the lack of statistics on this issue and the limited capacities of the specific institutions in the State party to treat drug-addicted children.

218. The Committee recommends that the State party strengthen its efforts to prevent substance abuse by children, giving particular attention to vulnerable groups; make additional efforts to monitor the incidence of substance abuse and to keep accurate statistics on the phenomenon; and develop mechanisms and structures through which assistance, including health and rehabilitative assistance, can be provided to children who abuse substances.

•	Jamaica, CRC, CRC/C/132 (2003) 86 at paras. 434 and 435.

434. The Committee notes with appreciation the State party's considerable achievements in the area of health care and its awareness of and intention to further improve the health situation among children through, inter alia, the adoption of the National Health Services Act, the expansion of health programmes and campaigns and the establishment of a quality assurance programme for the training of health personnel. However, the Committee remains concerned about:

(a) The insufficient number of health personnel, medicines and supplies to meet the needs of sick children;

(b) The problems of environmental degradation within the State party, including air pollution and difficulties accessing safe, clean water in a number of rural and inner-city areas;

(c) The high rates of children and adolescents who are victims of accidents and violence.

435. The Committee recommends that the State party:

(a) Continue taking all appropriate measures to improve the health infrastructure, including through international cooperation, in order to ensure access to basic health care and services adequately stocked with appropriate basic medicines for all children, as well as by paying attention to the mental health of children and young people;

(b) Intensify its efforts to address environmental health concerns, particularly with regard to air pollution and solid waste management, and increase access to safe drinking water and sanitation;

(c) Intensify efforts to improve safety for all children by reducing violence and abuse as well as preventing accidents through, inter alia, life-skills education campaigns and undertaking a review of existing preventive and guidance measures, including counselling, and mental health-care services.

•	Kazakhstan, CRC, CRC/C/132 (2003) 129 at paras. 637, 638, 640 and 641.

637. While welcoming the efforts made in 2002 to increase the accessibility of health services in rural areas, the Committee remains concerned at the reduced quality and accessibility of health-care services, particularly affecting children in rural areas, as noted in the State party's report. The Committee further shares the concerns of CEDAW with respect to access to free medical care for women and the degree of environmental degradation, particularly as it affects access to clean drinking water, which has an extremely negative impact on the whole population and, in particular, women and children.

638. The Committee notes the international cooperation in the sphere of health, the special comprehensive medium-term programme for the protection of mother and child health 2001-2005, and the reduction, in recent years, of the infant mortality rate, the under-5 mortality rate and the maternal mortality rate, but is nevertheless concerned that these remain unacceptably high.

...

640. The Committee expresses its concern at problems of poor access to safe drinking water, lack of food security and serious hazards arising from the Aral Sea disaster, as well as those relating to the Semipalatinsk nuclear testing site (closed in 1989), and notes that insufficient attention has been given to the long-term health and psychosocial consequences of the affected population.

641. The Committee urgently recommends that the State party:

(a) Ensure that all children, especially from the most vulnerable groups and in rural areas, have access to primary health care, and encourages the State party to pursue its efforts in this respect and to implement the recommendations of CEDAW as they relate to children;

(b) Develop a national policy in order to ensure an integrated and multidimensional approach to early childhood development;

(c) Continue and strengthen implementation of the WHO Integrated Management of Childhood Illness programme;

(d) Improve the specialized health care provided to children affected by the Semipalatinsk nuclear testing site, including its psychosocial aspect;

(e) Strengthen its efforts to detect and prevent diseases related to nuclear contamination;

(f) Focus more on a long-term developmental approach to the assistance extended to children through, inter alia, supporting United Nations initiatives in this area;

(g) Take all appropriate measures, including seeking international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution of the environment and food products.

•	San Marino, CRC, CRC/C/133 (2003) 9 at paras. 45 and 46.

45. The Committee is concerned at the very high prevalence of obesity among children in the State party.

46. The Committee recommends that the State party take effective measures to continue and strengthen its special programmes to address the issue of child obesity and promote a healthy lifestyle among children.

•	Canada, CRC, CRC/C/133 (2003) 14 at paras. 84-87.

84. The Committee is encouraged by the commitment of the Government to strengthening health care for Canadians by, inter alia, increasing the budget and focusing on Aboriginal health programmes. However, the Committee is concerned at the fact, acknowledged by the State party, that the relatively high standard of health is not shared equally by all Canadians. It notes that equal provincial and territorial compliance is a matter of concern, in particular as regards universality and accessibility in rural and northern communities and for children in Aboriginal communities. The Committee is particularly concerned at the disproportionately high prevalence of sudden infant death syndrome and foetal alcohol syndrome disorder among Aboriginal children.

85. The Committee recommends that the State party undertake measures to ensure that all children enjoy equally the same quality of health services, with special attention to indigenous children and children in rural and remote areas.

86. The Committee is encouraged by the average decline in infant mortality rates in the State party, but is deeply concerned at the high mortality rate among the Aboriginal population and the high rate of suicide and substance abuse among youth belonging to this group.

87. The Committee suggests that the State party continue to give priority to studying possible causes of youth suicide and the characteristics of those who appear to be most at risk, and take steps as soon as practicable to put in place additional support, prevention and intervention programmes, e.g. in the fields of mental health, education and employment, that could reduce the occurrence of this tragic phenomenon.

•	New Zealand, CRC, CRC/C/133 (2003) 27 at paras. 147 and 148.

147. The Committee welcomes the adoption of the Child Health Strategy in 1998. However, the Committee is concerned that immunization coverage is not universal and at the relatively high rates of infant mortality and injuries among children. The Committee also notes with concern that child health indicators are generally lower among the Maori population.

148. The Committee recommends that the State party:

(a) Allocate sufficient human and financial resources to implement the Child Health Strategy;

(b) Take all necessary measures to ensure universal immunization coverage and develop preventive health care and guidance for parents and families that effectively address the relatively high rates of infant mortality and injuries;

(c) Take all necessary measures to address disparities in health indicators between ethnic communities, in particular the Maori population.

•	Pakistan, CRC, CRC/C/133 (2003) 37 at paras. 224, 225, 238 and 239.

224. The Committee is very concerned at the high number of children living in poverty, the shortage of adequate housing, clean water, adequate sanitation and sewage and the problem of air pollution, all of which have a serious negative impact on the living conditions of children in the State party, causing injuries, sickness and death.

225. In accordance with article 27 of the Convention, the Committee recommends that the State party:

(a) Reinforce its efforts to provide support and material assistance to economically disadvantaged families and to guarantee the right of children to an adequate standard of living;

(b) Pay particular attention to the rights and needs of children in its poverty reduction strategy paper and in all programmes intended to improve the standard of living in the country, including access to clean water and unpolluted air;

(c) Strengthen the social security system to broaden its coverage so as to include non-working parents.

...

238. The Committee is concerned at the high rate of drug abuse among children.

239. The Committee recommends that the State party:

(a) Develop a national drug control plan, or master plan, with the guidance of the United Nations Drug Control Programme;

(b) Provide children with accurate and objective information about substance use, including hard drugs and tobacco, and protect children from harmful misinformation;

(c) Cooperate in this regard with UNICEF and WHO;

(d) Develop rehabilitation services for children who are victims of substance abuse.

•	Georgia, CRC, CRC/C/133 (2003) 111 at paras. 527, 528, 562 and 563.

527. The Committee is deeply concerned at the very low budget allocation for the implementation of the Convention, noting particularly the constant decrease in public expenditure on health and education which is now at a very low level despite the reasonably high level of economic growth (5.2 per cent in 2002). The Committee reiterates in this regard its concern at the very poor system of tax collection and, although acknowledging the efforts of the State party to address corruption, at the still widespread corruption.

528. The Committee reiterates its previous recommendation to the State party to significantly improve the effectiveness of its tax collection system and urges the State party to substantially increase the budget allocation and ensure transparency of the use of funds for the implementation of the Convention, in particular in the areas of health and education, and strengthen its efforts to eliminate corruption.

...

562. The Committee welcomes the information contained in the State party's report (para. 181) on the national health-care policy and on the strategic plan to develop health care in Georgia over the period 2000-2009. The Committee is aware of efforts to reduce infant mortality, but remains deeply concerned at the high rate of infant mortality during the reporting period (68/1,000 for 1998 and 51/1,000 for 1999). It is equally concerned that the supply of safe and good-quality drinking water is inadequate.

563. The Committee reiterates its previous recommendation regarding the allocation of human and financial resources for the implementation of the National Health Policy. In particular, the Committee recommends that the State party:

(a) Strengthen its efforts to implement the National Health Policy through adequate and sustainable allocation of resources (both human and financial), including the training of sufficient numbers of health-care professionals, the provision of adequate salaries for health-care workers, and investments in health-care infrastructure, especially in the most disadvantaged areas;

(b) Improve the effectiveness of antenatal care and maternal health education with a view to reducing the high incidence of infant mortality;

(c) Address the situation regarding the supply of safe drinking water by, inter alia, seeking further support from the World Bank for the Municipal Development Fund of Georgia for the rehabilitation of the network of water supply and sewerage systems;

(d) Seek technical assistance from, inter alia, UNICEF.

•	Indonesia, CRC, CRC/C/137 (2004) 8 at paras. 76, 77, 93 and 94.

76. The Committee is...concerned that the fragmentation of policies on health issues and care impedes the coordination and implementation of comprehensive approaches to child and adolescent health.

77. The Committee recommends that the State party:

...

(d) Ensure that a life-course approach is taken with respect to child and adolescent health and development through the development of holistic and comprehensive health policies for children and adolescents;

...

93. The Committee is concerned at the large number of children who use drugs or narcotics and that those children are treated as criminals rather than victims.

94. The Committee recommends that the State party:

(a) Provide children with accurate and objective information about the harmful consequences of substance abuse;

(b) Ensure that children using drugs and narcotics are treated as victims and not as criminals;

(c) Develop recovery and reintegration services for child victims of substance abuse;

(d) Seek cooperation with and assistance from WHO and UNICEF.

•	Guyana, CRC, CRC/C/137 (2004) 26 at paras. 160 and 161.

160. The Committee welcomes the National Strategic Plan HIV/AIDS 2002-2006 and the manufacturing of anti-retroviral drugs in the State party and supplying them free of charge to adults. However, the Committee is concerned about the rapid spread of HIV/AIDS within the State party causing a large number of children to be infected or affected by HIV/AIDS.

161. The Committee recommends that the State party integrate respect for the rights of the child into the development and implementation of its HIV/AIDS policies and strategies on behalf of children infected with and affected by HIV/AIDS, as well as their families, in accordance with the Committee's general comment No. 3 (2003) on HIV/AIDS and the rights of the child (CRC/GC/2003/3).

•	Armenia, CRC, CRC/C/137 (2004) 36 at paras. 226, 227, 239 and 240.

226. The Committee reiterates its concern at the high incidence of environmental threats. In particular, the Committee notes with concern that old water pipes and failures in the water supply system have led to contamination of drinking water and serious outbreaks of infectious diseases.

227. In the light of article 24 (c) of the Convention, the Committee reiterates its recommendation that the State party take all appropriate measures, including international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution and contamination of water supplies. The Committee encourages the State party to collect data on access to clean water and sanitation.

...

239. The Committee reiterates its concern about the increasing use of and traffic in illicit drugs among persons under 18 years. The Committee also notes with concern that child drug abusers are considered as criminals under article 231 of the Criminal Code and not as children in need of care and protection.

240. The Committee recommends that the State party develop a national drug control plan, or a Master Plan, with the guidance of the United Nations Drug Control Programme. The Committee encourages the State party to continue its efforts to provide children with accurate and objective information about substance abuse. The Committee urges the State party to ensure that child drug abusers are not criminalized, but treated as victims in need of assistance towards recovery and reintegration, and that the State party develop preventive and reintegration programmes for children who are victims of substance abuse. The Committee recommends cooperation with and assistance from WHO and UNICEF.

•	Germany, CRC, CRC/C/137 (2004) 51 at paras. 293 and 294.

293. The Committee expresses its concerns at the widespread abuse of drugs, alcohol and tobacco among children; at the high incidence of infants born with the foetal alcohol syndrome; and that the number of children either of whose parents is a drug addict is estimated at 3 million.

294. The Committee recommends that the State party take all necessary measures to combat the abuse of drugs and alcohol among children and parents by, inter alia, undertaking intensive education campaigns and setting up adequate rehabilitation services.

•	Slovenia, CRC, CRC/C/137 (2004) 104 at paras. 575 and 576.

575. While acknowledging the measures taken by the State party to ensure that basic health care is provided for the most vulnerable groups in society and the overall good health indicators in Slovenia, the Committee is concerned at the relatively poor health situation of some children, particularly those belonging to the Roma community, and the relatively high maternal mortality rate. Furthermore, the Committee is concerned about the increasing incidence of alcohol abuse and tobacco smoking among adolescents.

576. The Committee recommends that the State party give priority attention to identifying and addressing the causes of the poor health situation of some children, particularly Roma children, and the high maternal mortality rate. It also recommends that the State party take further preventive measures and treat adolescents who abuse tobacco and/or alcohol.

•	Japan, CRC, CRC/C/137 (2004) 116 at paras. 649 and 650.

649. The Committee is highly concerned about:

(a) The increasingly high rate of youth suicide;

(b) The lack of qualitative and quantitative data on suicide and attempted suicide and its causes;

(c) The fact that the police have been designated as one of the primary organizations to deal with the issue of youth suicide.

650. The Committee recommends that the State party undertake an in-depth study of youth suicide and its causes and use this information to develop and implement a national plan of action on youth suicide, in cooperation with Child Guidance Centres, social workers, teachers, health workers and other relevant professionals.

•	Liberia, CRC, CRC/C/140 (2004) 67 at paras. 356 and 357.

356. While noting the various efforts being made to address the spread of HIV/AIDS, the Committee remains deeply concerned at the recent increase in the prevalence of HIV/AIDS and the number of children affected by it.

357. The Committee recommends that the State party, taking into account General Comment No. 3 of the Committee on HIV/AIDS and the Rights of the Children, continue to strengthen its efforts in preventing and treating the effects of HIV/AIDS. It also recommends the State party to pay particular attention to children infected themselves or who have become orphans due to the death of HIV/AIDS parents, through providing adequate psychological and material support and by involving the community.

•	Democratic People's Republic of Korea, CRC, CRC/C/140 (2004) 111 at paras. 561 and 562.

561. While noting that health services are free and cover all areas of the country, the Committee is concerned about increasing infant and child mortality rates, high rates of malnutrition and stunting in children, alarming increases in maternal mortality rates and due to the high rate of voluntary termination of pregnancy. It is also very concerned that, despite the competence of doctors and other medical or paramedical staff, hospitals and clinics acutely suffer from shortages of basic medicine and medical instruments. The Committee is also seriously concerned that access to clean drinking water is rare in the country, sanitation conditions are poor, and that human excrements are sometimes used as fertilizers.

562. The Committee recommends that the State party:

(a) Take all necessary measures to improve the quality of its health system and its health expenditures, reducing infant, child and maternal mortality rates, preventing communicable diseases by stepping up immunization programmes, preventing and treating diarrhoeal diseases and acute respiratory tract infections and malaria, among others;

(b) Improve accessibility to information on family planning and availability of contraceptives;

(c) Effectively address the serious issue of malnutrition by providing adequate nutritional food and supplements, as well as education on healthy early habits; and

(d) Seek, where necessary, international cooperation.

•	France, CRC, CRC/C/140 (2004) 124 at paras. 621 and 622.

621. The Committee welcomes the information contained in the State party's report related to the protection of mothers, infants and school-age children. However, the Committee notes that this aspect of health care and services is the responsibility of departments, and, in this respect, is concerned at possible inequalities among the various regions. The Committee is concerned, in particular, at the:

(a) Lack of psychiatric services;

(b) "Conditioned" access to health care by undocumented migrants;

(c) Lack of a national body to promote and encourage exclusive breastfeeding.

622. The Committee recommends that the State party:

(a) Strengthen its efforts to ensure the provision of adequate and sustainable allocation of resources (human and financial), including for training of sufficient numbers of health-care professionals, provision of adequate salaries for health-care workers, and investments in health-care infrastructure, especially in the most disadvantaged areas;

(b) Establish a national mechanism for the promotion of breastfeeding, including evaluation and coordination.

•	Angola, CRC, CRC/C/143 (2004) 78 at paras. 439 and 440.

439. The Committee notes with deep concern the large number of landmines which remain spread out across the country, causing many deaths and injuries every year and posing a threat to the life, survival and development of children in the State party.

440. The Committee recommends that the State party take all necessary measures to protect children against landmines, including by continuing and strengthening its mine clearance programmes and programmes for mine awareness and physical rehabilitation of child victims.

•	Albania, CRC, CRC/C/146 (2005) 19 at paras. 149 and 150.

149. The Committee is concerned at the increase in drug abuse, in particular among young children, including through the free distribution of drugs by drug dealers with the aim of luring children into drug use, which may occur also in school environments.

150. The Committee encourages the State party to continue and expand its activities in the area of prevention of substance abuse and use of children in the trafficking of such substances, and to support recovery programmes dealing with child victims of drug abuse. The Committee recommends that the State party consider seeking technical assistance from UNICEF and OHCHR.

•	Luxembourg, CRC, CRC/C/146 (2005) 36 at paras. 211 and 212.

211. The Committee is concerned at the high level of use of illicit drugs and substances among adolescents and notes the difficulties confronted by the State party in dealing with this phenomenon.

212. The Committee recommends that the State party undertake a study to carefully analyse the causes and consequences of this phenomenon as well as its possible links with violent behaviour and the high suicide rate among adolescents in the State party. It further recommends that the State party use the outcome of this study to increase its efforts to prevent the use of illicit drugs and substances.

•	Austria, CRC, CRC/C/146 (2005) 47 at paras. 263 and 264.

263. While noting the efforts made by the State party, the Committee remains concerned about the health problems faced by adolescents, in particular about drug and tobacco use and alcohol abuse and that the regulation of their consumption by children and adolescents falls within the competence of the Länder. Furthermore, the Committee is concerned at the suicide forums accessible on the Internet where young people can exchange experiences and suicidal thoughts.

264. The Committee recommends that the State party strengthen its efforts to prevent drug and tobacco use and alcohol abuse and to harmonize the different regulations in the various Länder on this matter. The Committee recommends that the State party undertake practical measures to prevent access to information through the Internet inciting suicide.

•	Islamic Republic of Iran, CRC, CRC/C/146 (2005) 88 at paras. 490 and 491.

490. While welcoming the establishment and success of the primary health-care system, the Committee is concerned that despite a specific programme designed to address the problem of nutrition the percentage of moderately and severely underweight, stunted and wasted children remains static.

491. The Committee recommends that the State party make concerted efforts to combat malnutrition, inter alia, by completing and implementing the national Nutritional Strategy for Children.

•	Togo, CRC, CRC/C/146 (2005) 104 at paras. 579 and 580.

579. The Committee welcomes the adoption on 18 March 1998 of Act No. 98/008 on drugs control and the setting up in 1996 of the National Anti-Drug Committee (CNAD) and in 2000 of the National Anti-Drugs Plan. However, the Committee remains concerned about the large number of children, in particular street children, using and selling drugs.

580. The Committee recommends that the State party:

(a) Provide children with accurate and objective information about substance use, including tobacco use, and protect them from harmful misinformation through comprehensive restrictions on tobacco advertising;

(b) Develop recovery services for children who are victims of substance abuse;

(c) Seek cooperation with and assistance from, among others, WHO and UNICEF.

•	Bolivia, CRC, CRC/C/146 (2005) 121 at paras. 654 and 655.

654. The Committee notes with concern the increasing number of children who use drugs and harmful substances in the State party.

655. The Committee recommends that the State party:

(a) Formulate a rights-based plan of action for the protection of children and adolescents from the dangers of drugs and harmful substances, and involve children in its formulation and implementation;

(b) Provide children with accurate and objective information about the harmful consequences of substance abuse;

(c) Ensure that children using drugs and harmful substances are treated as victims and not as criminals;

(d) Develop recovery and reintegration services for child victims of substance abuse;

(e) Seek cooperation with and assistance from WHO and UNICEF.

•	Nigeria, CRC, CRC/C/146 (2005) 135 at paras. 712, 713, 718 and 719.

712. The Committee takes note of efforts made by the State party to improve its health system, including the Baby Friendly Hospital Initiative and the Integrated Management for Childhood Illness, as well as the establishment of the National Programme on Immunization Agency. Nevertheless, the Committee remains gravely concerned at the alarmingly high rate of infant, child and maternal mortality, and the high incidence of major illnesses affecting children, including polio, malaria and diarrhoea as well as the low rate of immunization coverage in the country, particularly in the northern regions, and of malnutrition and the low rates of exclusive breastfeeding. The Committee is also concerned at the very low level of knowledge among mothers on basic health issues, such as about the use of oral rehydration solutions (ORS) for diarrhoea. The Committee, while acknowledging the adoption of the new National Water Supply and Sanitation Policy, also remains concerned at the access to safe drinking water and sanitation, particularly in rural areas.

713. The Committee recommends that the State party:

(a) Address, as a matter of urgency, the very high mortality rates among infants, children and mothers, by, inter alia, stepping up the immunization programmes and improving antenatal and post-natal care;

(b) Continue taking all appropriate measures to improve the health infrastructure, particularly in rural areas, including through international cooperation, in order to ensure access to basic health-care services which are adequately staffed and stocked with appropriate resources, including basic medicines for all children;

(c) Take measures to introduce awareness-raising programmes for women, on the importance of, inter alia, prenatal and post-natal health care, preventive measures and treatment for common illnesses; immunization and balanced diet for the healthy development of children;

(d) Strengthen their data collection system, inter alia, with regard to important health indicators, ensuring timeliness and reliability of both quantitative and qualitative data and using it for the formulation of coordinated policies and programmes for the effective implementation of the Convention;

(e) Ensure universal access to drinking water and sanitation services.

...

718. While acknowledging that the minimum age of marriage is set federally at 18 years, the Committee notes with concern that the legislation of most states and the customary law allows for early marriages, and girls can be forced into marriage as soon as they reach puberty. The Committee is particularly concerned at the reports of a large number of young women suffering cases of vesico-vaginal fistula, a condition caused by giving birth when the cervix is not well developed...

719. The Committee recommends that the State party amend existing legislation to prevent early marriages... The Committee also recommends that the State party develop sensitization programmes, involving community and religious leaders and society at large, including children themselves, to curb the practice of early marriages.

•	Philippines, CRC, CRC/C/150 (2005) 24 at paras. 163, 164, 186 and 187.

163. The Committee is concerned, despite the legislative and other measures taken by the State party, about environmental problems, such as air and water pollution and environmental degradation which have serious consequences for children's health and development. As regards access to safe drinking water and sanitation, the Committee is concerned about the regional disparities. Furthermore, poor knowledge of hygienic practices both among children and their parents give cause for concern.

164. The Committee recommends that the State party:

(a) Continue to strengthen its efforts to reduce pollution and environmental degradation by strengthening the implementation of domestic environmental laws, including Ecological Solid Waste Management Act (Republic Act No. 9003) and the Clean Air Act (Republic Act No. 8749);

(b) Increase children's knowledge of environmental health issues by introducing environmental health education programmes in schools;

(c) Take effective measures to improve access to safe drinking water and sanitation facilities, particularly in the remote areas of the country, as well as raise awareness on hygiene among children and their parents.

...

186. The Committee reiterates its grave concern at the high number of children living in the streets and their special vulnerability to various forms of violence and abuse, including sexual abuse and exploitation, economic exploitation and substance abuse... Notwithstanding the efforts taken by the State party and, in particular, many non-governmental organizations working with and for street children, for example ChildHope Asia Philippines, the Committee is concerned about street children's limited access to adequate nutrition, clothing, housing, social and health services and education. Furthermore, the Committee is concerned about health risks faced by street children, including environmental health risks, such as toxic and hazardous wastes and air pollution.

187. The Committee recommends that the State party:

...

(c) Ensure that street children are reached through trained street educators and counsellors and provided with adequate nutrition, clothing and shelter as well as with social and health services and educational opportunities, including vocational and life skills training, in order to support their full development and provide them with adequate protection and assistance;

(d) Provide street children with adequate recovery and social reintegration services for physical, sexual and substance abuse and promote reunification with their families, when feasible;

(e) Reduce and prevent the environmental health risks faced by children living in the streets, inter alia, through raising awareness about environmental health risks among these children and instructing appropriate behaviours which protect them from these risks;

...

(g) Collaborate with and support non-governmental organizations working with and for street children.

•	Nepal, CRC, CRC/C/150 (2005) 66 at paras. 348, 349, 364 and 365.

348. The Committee notes with concern that certain harmful traditional practices continue to prevail in the State party, most notably the caste system and traditions such as the Deuki, Kumari, Jhuma, Badi, Kamlari and Chaupadi, causing extreme insecurity, health hazards and cruelty to girl children. The Committee regrets the absence of legal prohibition and sufficient interventions on the part of the State party to address the harmful effects of these traditional practices on the enjoyment of rights by children who are affected by these practices.

349. The Committee recommends that the State party, as a matter of urgency, take all necessary measures to eradicate all traditional practices harmful to the physical and psychological well-being of children, by strengthening awareness-raising programmes. The Committee further recommends the State party to adopt legislation prohibiting such practices.

...

364. The Committee expresses concern at the widespread prevalence of alcohol consumption by children, as well as the growing incidence of substance abuse by children, including the use of cannabis, heroin, opiates and intravenous drug use. The Committee is also concerned about the harmful effects of alcohol and substance consumption by parents on the physical, emotional and psychological development and well-being of children in the State party. While noting that the Alcohol Act prohibits the selling of alcohol to children aged 16 years or below, the Committee expresses concern that the Act carries no penalty in case of violation, and that legislation prohibiting the use of alcohol by minors is generally ineffectively implemented. It is also concerned at the absence of specific legislation prohibiting sale, use and trafficking of controlled substances by children, and also of treatment programmes in this regard.

365. The Committee recommends that the State party take initiatives to combat drug and alcohol abuse by children, including through public education awareness campaigns and ensure that children who abuse alcohol and/or use drugs and other harmful substances have access to effective structures and procedures for treatment, counselling, recovery and reintegration. The Committee further recommends that parents are educated, through, inter alia, awareness-raising campaigns, on the harmful effects of parents' use of alcohol and controlled substances on the development and well-being of children. The Committee urges the State party to adopt the necessary legislation to prohibit sale, use and trafficking of controlled substances by children, and to ensure effective implementation of all legislation prohibiting alcohol and substance use by children.

•	Ecuador, CRC, CRC/C/150 (2005) 91 at paras. 437-440.

437. Despite the considerable efforts made by the State party in the area of health, in particular the reduction in infant mortality over the last 10 years, the Committee remains concerned at the increasing adolescent mortality rates as stated in the State party report ([CRC/C/65/Add. 28,] para. 143). The Committee is also concerned at the high levels of malnutrition, in particular in rural areas.

438. The Committee recommends that the State party strengthen its efforts to improve the health situation of children in the State party and improve access to quality health services and address the issue of malnutrition, particularly in rural and remote areas. The Committee also recommends that the State party strengthen the "Mother-and-child friendly hospitals" Initiative and update training manuals for health professionals on the promotion and protection of breastfeeding.

439. The Committee reiterates the concern raised in its previous concluding observations (CRC/C/15/Add.93) with regard to the damaging effect of oil extraction and the spraying of illegal crops under Plan Colombia on the environment and on the health of children.

440. The Committee recommends that the State party effectively address the problem of pollution and environmental degradation, including by seeking bilateral agreements and international cooperation. It also recommends that the State party strengthen its environmental health education programme.

•	Norway, CRC, CRC/C/150 (2005) 105 at paras. 495 and 496.

495. The Committee remains concerned about the high incidence of eating disorders (bulimia and anorexia nervosa). Furthermore, the Committee is concerned about the growing problems of overweight among children that results from low physical activity combined with poor diet.

496. The Committee recommends that the State party pay close attention to child and adolescent health, taking into account the Committee's general comment No. 4 (2003) on adolescent health and development in the context of the Convention on the Rights of the Child. In particular, the Committee recommends that the State party strengthen measures to address the occurrence of eating disorders and promote a healthy lifestyle among adolescents.

•	Nicaragua, CRC, CRC/C/150 (2005) 132 at paras. 637-639.

637. The Committee is extremely concerned about the persistence of a high degree of poverty in the State party, especially in the Caribbean/Atlantic region and in rural areas, which create grievous gaps in access to health and health services between rural and urban zones and the Caribbean/Atlantic region. Serious concern is expressed at the State party's information that about 2.38 million people (out of a total of about 5.37 million) are in a condition of poverty, while 15.1 per cent of the population is in a situation of extreme poverty.

638. Furthermore, the Committee is concerned that:

(a) Only about two thirds of the population have access to clean drinking water and that there is a huge discrepancy between the rates of urban and rural population having access to clean drinking water;

(b) One out of every three children suffers some degree of chronic malnutrition and that about 10 per cent of them are said to suffer from severe malnutrition;

(c) While the Committee notes the progress made in the reduction of infant and child mortality, including the National Plan for the Reduction of Maternal, Perinatal and Infant Mortality of March 2000, it continues to be concerned at the level of infant and child mortality as well as at the high rate of maternal mortality.

639. The Committee recommends that the State party:

(a) Take all possible actions to reduce poverty and equalize living conditions throughout the country, and ensure access to basic goods and services, such as clean drinking water, especially in remote and rural areas;

(b) Ensure basic health care and services to all children throughout the country and urgently address the problem of malnutrition, with special emphasis on rural and remote areas;

(c) Strengthen its efforts to urgently tackle the grievous issue of infant, child and maternal mortality throughout the country.

•	Yemen, CRC, CRC/C/150 (2005) 161 at paras. 799 and 800.

799. The Committee is concerned at the high number of people chewing quat among whom are a significant number of children.

800. The Committee recommends that the State party consider quat as a dangerous substance and take all necessary measures to raise awareness on the risks of its consumption and to prohibit access to it by children.