III. CONCLUDING OBSERVATIONS

CERD

•	Guatemala, CERD, A/50/18 (1995) 58 at para. 310.

Concern is expressed that conditions of extreme poverty and social exclusion are endured, particularly by the indigenous Maya Quiche population. Such conditions adversely affect the enjoyment of the rights guaranteed under article 5 of the Convention such as the right to own property, the right to work, the right to form and join trade unions, and the right to housing, public health and education.

•	Norway, CERD, A/52/18 (1997) 77 at para. 609.

Concern is expressed about allegations that immigrants of African descent disproportionately test positive for HIV and that Africans have been obliged to undergo tests for HIV simply because they are Africans.

•	Peru, CERD, A/54/18 (1999) 21 at para. 155.

Major shortcomings in the health services provided for the rural population in the Andes and in Amazonia are noted, as are allegations of forced sterilization of women belonging to indigenous communities.

ICESCR

•	Mali, ICESCR, E/1995/22 (1994) 64 at para. 350.

It is of concern that child, infant and maternal mortality rates in Mali are still among the highest in the world. Thus, almost one in five children under the age of five dies each year. Approximately 1,000 deliveries per 100,000 births result in the death of the mother. Diarrhoea, malaria and acute respiratory infections, aggravated by malnutrition, alone account for more than 40 per cent of deaths. Acquired immune deficiency syndrome (AIDS) is spreading rapidly. With regard to water and sanitation, the average rate of access to water country-wide is about 50 per cent, but as low as 4 per cent in the difficult terrain of the north of the country. The overall rate of access to sanitation facilities is estimated at approximately 15 per cent. The geographical distribution of health services and personnel continues to show a heavy urban bias.

•	Philippines, ICESCR, E/1996/22 (1995) 30 at para. 122.

It is noted with concern that in the face of a rapidly growing population infected by HIV and AIDS, only several hundred of an affected population estimated to be in excess of 30,000 have been registered under the Government's programme. This would seem to indicate that the programme is either punitive of those who register or is not adequately publicized and made available to victims of the virus.

•	Ukraine, ICESCR, E/1996/22 (1995) 50 at para. 275.

The Government should continue to make full use of international assistance in the collection and analysis of data in general, including data regarding the most vulnerable groups of persons, and in addressing their needs. Such categories of persons include pensioners, the unemployed, children with disabilities and children assigned to homes or institutions, members of repatriated minority groups and victims of the Chernobyl accident. With regard to the latter group, it is urged that special assistance and medical care be further granted to the persons concerned and that special measures continue to be taken to clean the environment and to dispose of contaminated objects and consumable items with which people may come into contact.

•	Guatemala, ICESCR, E/1997/22 (1996) 29 at para. 134.

Concern is expressed at the issue of low access to safe water for the rural population, the higher incidence of infant mortality within certain socio-economic groups, the situation of persons with disabilities, the prevalence of endemic diseases, the problem of the inadequacy of social welfare and security, the persisting housing shortage and the inadequacy of access to health care. This general situation affecting the most vulnerable in Guatemalan society deprives them of their full enjoyment of the economic, social and cultural rights provided for in the Covenant.

See also:

•	Dominican Republic, ICESCR, E/1997/22 (1996) 44 at para. 255.

•	Belarus, ICESCR, E/1997/22 (1996) 51 at paras. 286 and 291.

Paragraph 286

Although it is noted that the Government's assurance that sufficient detoxification and rehabilitation centres for drug and alcohol addicts have been created, concern remains that what is being done in this area does not appear to be sufficient to meet the needs that exist.

Paragraph 291

The need for the State party to respond to the challenge of HIV/AIDS with adequate new legislative and social measures is noted. In this connection, it would be appropriate if the Government coordinated with the relevant departments of the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

•	Russian Federation, ICESCR, E/1998/22 (1997) 27 at paras. 110-113, 124-126 and 128.

Paragraph 110

The level of contamination of both domestically produced and imported foodstuffs is high by international standards, and appears to be caused - for domestic production - by the improper use of pesticides and environmental pollution, such as through the improper disposal of heavy metals and oil spills, and - for imported food- by the illegal practices of some food importers. It is the responsibility of the Government to ensure that such food does not reach the market.

Paragraph 111

Alarm is expressed at the extent of the environmental problems in the State party. The industrial leakage of harmful waste products is such a severe problem in some regions that they could be correctly declared environmental disaster areas. Concern is expressed that there has been a curtailment of funds to modernize an out-of-date water-delivery system, which adversely affects the population's access to clean water.

Paragraph 112

Concern is expressed over the re-emergence of tuberculosis in the State party, particularly in prisons, where the health and social conditions of detention are unacceptable.

Paragraph 113

Serious concern is expressed that in 1996 there was an eightfold increase in the rate of HIV-
infection, which was largely due to increased drug use. It is also a source of concern that drug addiction is a major and growing problem among the young.

Paragraph 124

The question of an acceptable and adequate food supply is also linked to questions relating to a seriously polluted environment and the lack of investment in infrastructure for the maintenance and improvement of the water supply. The State party should examine these linkages and take appropriate action to clean up the environment and prevent enterprises from engaging in further pollution, especially that which contaminates the food chain. The maintenance and improvement of the water-supply system should be undertaken as a matter of priority. It is recommended that vigorous action be taken against enterprises which have been found to have imported contaminated food.

Paragraph 125

It is strongly recommended that the State party take immediate action to improve the health conditions in prisons, especially with regard to the rise in the rate of tuberculosis among prisoners and detainees.

Paragraph 126

The State party is urged to address the eightfold increase in HIV-infection in 1996 as a health question of the utmost importance. An information campaign which explains the nature of the disease, the modes of transmission, including sexual modes of transmission, and prevention techniques should be undertaken in the mass media. It is recommended that the State party adopt laws and take all necessary measures to prevent discrimination against persons who are HIV-
positive, so that they may live normal lives.

Paragraph 128

Efforts to treat drug addiction and to apprehend and punish drug dealers should be continued and intensified.

•	Dominican Republic, ICESCR, E/1998/22 (1997) 43 at paras. 226 and 243.

Paragraph 226

Prevention campaigns carried out in the State party are insufficient in addressing the appropriate ways and means available to combat the transmission of HIV. The persistence of sex tourism in resort areas, sometimes involving minors, which is one of the causes of the spread of AIDS, is noted.

Paragraph 243

With regard to AIDS, the need for the State party to adopt adequate new legislative and social measures is stressed. In particular, the launching of a specific and explicit information campaign on HIV/AIDS, its causes and prevention measures is recommended.

•	Iraq, ICESCR, E/1998/22 (1997) 50 at para. 266.

With respect to article 12 of the Covenant, it is noted with concern that, with the destruction of parts of the infrastructure in the State party, the non-availability of safe drinking water has led to widespread contaminated water and related health problems, such as waternborne and diarrhoeal diseases and cholera. Due to food shortages and the resulting restrictions on its distribution, and to the non-availability of certain medicines, medical equipment and other articles of personal hygiene, the standard of physical health of the population is declining at a rapid pace. In particular, certain diseases previously eradicated from the State party have reappeared, such as typhoid, infantile paralysis, tetanus, viral hepatitis, Giardia, German measles, kala-azar, undulant fever, haemorrhagic fever, croup, whooping cough, rickets, scabies, hydrocysts and rabies.

•	Uruguay, ICESCR, E/1998/22 (1997) 67 at para. 368.

The resources devoted to public health and education are considered inadequate. Alarm is expressed at the fact that the very low wages paid to nurses has led to a low ratio of nurses to doctors (lower than 1:5), which tends to diminish the quality and accessibility of medical care available to the community.

•	Luxembourg, ICESCR, E/1998/22 (1997) 69 at paras. 396 and 405.

Paragraph 396

The occurrence in the State party of adolescent health problems, due particularly to drug abuse, is of concern. Alarm is expressed about the high incidence of suicide among young people.

Paragraph 405

The State party should continue its efforts to prevent and combat drug abuse and suicide among the youth and, where necessary, reinforce existing measures.

•	Poland, ICESCR, E/1999/22 (1998) 32 at paras. 155 and 164.

Paragraph 155

The deteriorating health indicators that have been recorded during the last five years are of concern. Attention is also drawn to several areas of particular concern identified during the dialogue, namely, declining levels of nutrition, rising alcoholism, and increasing cardiovascular disease and cancers.

Paragraph 164

The State party should engage in a large-scale public information campaign to promote healthy lifestyles among the Polish people in order to improve the quality of their nutrition, combat alcoholism and smoking, and reduce the risks of cardiovascular diseases and cancers. The campaign should extend to schools, where such information should be incorporated into the regular curricula.

•	Germany, ICESCR, E/1999/22 (1998) 54 at paras. 322 and 334.

Paragraph 322

The alarming number of persons affected by HIV/AIDS in the territory of the State party is a cause for concern.

Paragraph 334

More adequate assistance should be provided to persons with HIV/AIDS, without any discrimination on the basis of race, origin, nationality or gender.

•	Iceland, ICESCR, E/2000/22 (1999) 26 at para. 86.

The State party should increase its social welfare expenditures so as to strengthen its health and social welfare centres around the country. The development of a social indicator model of drug and alcohol abuse and its treatment is recommended. In addition, there should be an elaboration of educational and social programmes to deal with problems of the victims of alcohol and drug abuse on a long-term basis.

•	Denmark, ICESCR, E/2000/22 (1999) 29 at para. 117.

The Government should continue its efforts to combat the problem of youth suicide and it is recommended that statistical data be collected and that thorough and targeted studies be conducted on the extent, the causes and the consequences of this problem. Attention is drawn to the importance of detection measures and preventive policies, and the authorities are encouraged to continue with their campaigns for the prevention of this phenomenon.

•	Ireland, ICESCR, E/2000/22 (1999) 33 at para. 139.

The increase in tobacco use is the single most important contributing factor to the disease burden facing Ireland and the State party's responses have been inadequate to deal with this problem. The alcohol-related problems in the State party which have not yet been addressed are also of concern.

•	Solomon Islands, ICESCR, E/2000/22 (1999) 40 at para. 205.

Infant mortality remains a major cause of concern, in spite of the commendable health policies of the Government, which have drastically decreased the mortality rate of children under the age of 5. According to WHO, in 1996, the infant mortality rate was estimated at 26.8 deaths per 1,000 live births, while, according to the first country cooperation framework for the Solomon Islands (1997-
2001), the maternal mortality rate is as high as 550 deaths per 100,000 live births. The low percentage of the population with access to adequate sanitation (only 9 per cent of the rural population) and to safe drinking water available in the home or within reasonable access (63 per cent of the entire population), is of concern. The lack of adequate sanitation facilities directly adds to the severe malaria problem affecting more than one third of the population.

•	Argentina, ICESCR, E/2000/22 (1999) 49 at para. 286.

The State party is urged to review its policies on health, and in particular, to pay attention to the issues of mental health, maternal mortality, adolescent pregnancies and HIV/AIDS.

•	Cameroon, ICESCR, E/2000/22 (1999) 56 at para. 359.

The State party is urged to review its policies on health in order to address, in particular, maternal mortality, adolescent pregnancies and the HIV/AIDS epidemic. In this respect, the Government is urged to review its family planning policies with a view to increasing access to information concerning contraceptives through educational programmes.

•	Egypt, ICESCR, E/2001/22 (2000) 38 at para. 180.

The State party is urged to ensure that its laws, policies and practices in relation to HIV/AIDS are non-discriminatory and in full conformity with the International Guidelines adopted at the Second International Consultation on HIV/AIDS and Human Rights in 1996.

•	Congo, ICESCR, E/2001/22 (2000) 43 at paras. 206, 207 and 213.

Paragraph 206

Grave concern is expressed regarding the decline of the standard of health in the Congo. The AIDS epidemic is taking a heavy toll on the country, while the ongoing financial crisis has resulted in a serious shortage of funds for public health services, and for improving the water and sanitation infrastructure in urban areas. The war has caused serious damage to health facilities in Brazzaville. According to a joint study by WHO and UNAIDS, some 100,000 Congolese, including over 5,000 children, were affected by HIV at the beginning of 1997. More than 80,000 people are thought to have died from AIDS, with 11,000 deaths reported in 1997 alone. Some 45,000 children are said to have lost either their mother or both parents as a result of the epidemic.

Paragraph 207

In addition, the Committee is concerned that as a result of the violence and the ensuing massive displacements, epidemics of diseases such as cholera and diarrhoea have occurred. Furthermore, owing to the disruption to the infrastructure of the country, including transportation and communications, humanitarian aid organizations have limited access to displaced groups outside Brazzaville.

Paragraph 213

The State party is strongly urged to pay immediate attention to and take action with respect to the grave health situation in its territory, with a view to restoring the basic health services, in both urban and rural areas, and to preventing and combating HIV/AIDS and other communicable diseases such as cholera and diarrhoea. The Government is encouraged to work closely with WHO and UNAIDS in its efforts to cope with these problems.

•	Mongolia, ICESCR, E/2001/22 (2000) 53 at para. 273.

The Committee is disturbed to learn about the deteriorating health situation for Mongolians since 1990 and regrets that government expenditure on health has decreased in recent years (according to the government submission, public expenditure on health fell from 5.8 per cent of GDP in 1991 to 3.6 per cent in 1998). The challenges faced by the State party include improving access to health-care services in rural areas and for the poor, the relatively low life expectancy, the increase in non-communicable and degenerative diseases, as well as sexually transmitted diseases, substance abuse, child suicide, high maternal mortality, especially in rural areas, and limited access to contraceptives.

•	Sudan, ICESCR, E/2001/22 (2000) 57 at para. 314.

The persisting problem of malaria, often a cause of death in the State party, as well as the increasing incidence of HIV/AIDS is of concern. A lack of medicines at affordable prices compounds these difficulties.

•	Kyrgyzstan, ICESCR, E/2001/22 (2000) 62 at para. 350.

Although the general state of health of the population is satisfactory, new health threats such as increasing alcoholism and drug abuse, the growing incidence of sexually transmitted diseases and the re-emergence of communicable and vaccine-preventable diseases such as tuberculosis, and above all the decreasing resources allocated to the health sector demand the State party's urgent response.

•	Portugal, ICESCR, E/2001/22 (2000) 70 at para. 424.

The State party should intensify its efforts to prevent drug addiction among young people and impose appropriate penalties on persons who commit offences relating to paedophilia, child pornography and trafficking in women.

•	Morocco, ICESCR, E/2001/22 (2000) 82 at paras. 541 and 565.

Paragraph 541

Concern is expressed that the State party does not exercise sufficient control, by means of legislative and administrative measures, over factories manufacturing foodstuffs which do not conform to international standards and cause death or constitute a health hazard to the population.

Paragraph 565

The State party is urged to take the appropriate legislative and administrative measures to ensure that sufficient control is exercised on factories manufacturing foodstuffs so that the products manufactured conform to international standards and do not constitute any health hazard.

•	Honduras, ICESCR, E/2002/22 (2001) 33 at paras. 133 and 154.

Paragraph 133

The insufficiency of medical services, especially in rural areas, and the difficulties experienced by people in gaining access to health care institutions are of concern. Of deep concern is the high incidence of HIV/AIDS in the State party, which is among the highest in the region, and the inadequate information provided by the State party on the measures it has taken with regard to the provision of essential drugs.

Paragraph 154

The State party is urged to undertake effective measures to address the high rate of persons living with HIV/AIDS, and in particular to facilitate access to essential drugs, and to seek international cooperation to this effect.

•	Togo, ICESCR, E/2002/22 (2001) 57 at paras. 319 and 324.

Paragraph 319

Concern is expressed about the extremely low quality of health services and the significant lack of qualified personnel in the public sector, and in particular, about the alarming rate of HIV/AIDS cases, which is three times as high as the average for countries with a low human development index (185.2 cases per 100,000 people, as opposed to the average of 67.5), and amounting to 8.52% of the adult population living with HIV/AIDS.

Paragraph 324

The State party is urged to take action with respect to the current health situation in the country, which still remains inadequate to address the basic health needs of the population, such as the improvement of basic health services and providing the necessary preventive and remedial steps in combating the HIV/AIDS pandemic and other communicable diseases. It is recommended that the State party take into account the General Comment No. 14 on the right to an adequate standard of health.

•	Senegal, ICESCR, E/2002/22 (2001) 61 at para. 331.

The efforts undertaken with regard to the prevention of the spread of HIV/AIDS in the State party are noted with satisfaction. Owing to the national campaigns undertaken to rally and involve all sectors of society, including religious authorities, the State party has one of the lowest rates of infection in sub-Saharan Africa.

•	Panama, ICESCR, E/2002/22 (2001) 73 at para. 459.

The growing number of HIV/AIDS cases registered during the last decade is considered to be a serious health problem.

•	Ukraine, ICESCR, E/2002/22 (2001) 78 at paras. 499 and 512.

Paragraph 499

The deterioration in the health of the most vulnerable groups, especially women and children, and in the quality of health services is of concern. The rise in the incidence of sexually transmitted diseases (STD) and the spread of HIV/AIDS is noted with concern. There is also concern about the high incidence of alcohol abuse and tobacco use, especially among persons under 18 years.

Paragraph 512

The State party should ensure that its commitment to primary health care is met by adequate allocation of resources and that all persons, especially from the most vulnerable groups, have access to health care. It is suggested that the State party establish comprehensive reproductive health programmes, as well as measures to ensure that abortion is not perceived as a method of contraception. It is further recommended that adolescents have access to and are provided with reproductive health education, as well as with STD and HIV/AIDS prevention programmes. Children should be provided with accurate and objective information about alcohol and tobacco use, and activities by the public mass media promoting their consumption should be discouraged.

•	Nepal, ICESCR, E/2002/22 (2001) 83 at para. 551.

There is deep concern that the HIV/AIDS epidemic in the State party is spreading at an alarming rate due to commercial sex and trafficking of women and children, and sex tourism.

•	Japan, ICESCR, E/2002/22 (2001) 90 at paras. 601 and 628.

Paragraph 601

The Committee is concerned about reported incidents in nuclear power stations and the lack of transparency and disclosure of necessary information regarding the safety of such installations, and also the lack of advance nationwide and community preparation for the prevention and handling of nuclear accidents.

Paragraph 628

Increased transparency and disclosure to the population concerned of all necessary information on issues relating to the safety of nuclear power installations is recommended and the State party is further urged to step up its preparation of plans for the prevention of, and early reaction to, nuclear accidents.

CEDAW

•	Senegal, CEDAW, A/49/38 (1994) 120 at para. 725.

The State party should step up its public information campaigns on behalf of women and expand its programmes to combat traditional practices which affect women's health and advancement in order to eliminate persistent forms of discrimination against women.

•	Uganda, CEDAW, A/50/38 (1995) 61 at paras. 331 and 338.

Paragraph 331

The alarming death rates among women as a result of the AIDS crisis, particularly among women of child-bearing age, and its association with high fertility rate is of serious concern.

Paragraph 338

Existing measures should be reassessed to combat AIDS. Foremost of these should be the intensification of preventive measures, such as public education in sexual and reproductive health, as well as more effective health delivery systems in these areas.

•	Ethiopia, CEDAW, A/51/38 (1996) 19 at paras. 149 and 161.

Paragraph 149

The prevalence of prostitution and male promiscuity, which increased the spread of AIDS, is of concern.

Paragraph 161

There must be an intensive programme to combat the spread of HIV/AIDS. Infected women and men must be guaranteed equal enjoyment of their human rights.

•	Cuba, CEDAW, A/51/38 (1996) 26 at para. 224.

The Government should do everything possible to meet the demand for contraceptives. Special information programmes relating to sexually transmitted diseases, especially HIV/AIDS, should be strengthened for young girls, particularly those engaged in prostitution, in keeping with general recommendation 15.

•	Ukraine, CEDAW, A/51/38 (1996) 32 at paras. 286 and 292.

Paragraph 286

Concern is expressed over sexual stereotyping and overprotective labour legislation. Protective labour laws had the sole effect of restricting women's economic opportunities, and were neither legitimate nor effective as a measure for promoting women's reproductive health. Women should have a right to free choice as to their employment, and the high rates of infant mortality and fetal abnormality resulting from the ecological disaster should be addressed as a matter of public health.

Paragraph 292

The growing rate of suicide and deaths related to alcohol poisoning are of concern.

•	Rwanda, CEDAW, A/51/38 (1996) 36 at para. 321.

Dismay is expressed at the deep psychological trauma, the unwanted pregnancies and the massive rape of women and girls during the genocide, which resulted in widespread HIV/AIDS and other sexually transmitted diseases. This can eventually lead to further illness and death for thousands of women and girls.

•	Slovenia, CEDAW, A/52/38/Rev.1 part I (1997) 15 at para. 121.

Measures for the early detection and the preventive treatment of breast cancer should be increased.

•	Israel, CEDAW, A/52/38/Rev.1 part I (1997) 87 at para. 181.

Public health services should supply free and accessible contraceptives.

•	Luxembourg, CEDAW, A/52/38/Rev.1 part II (1997) 92 at para. 222.

An analysis of women's health needs should be undertaken and awareness-raising campaigns on mammography should continue so as to ensure that more women make use of that service.

•	Zimbabwe, CEDAW, A/53/38/Rev.1 part I (1998) 13 at paras. 147 and 160.

Paragraph 147

The effect of the HIV/AIDS pandemic and the very high rate of infection among young women, who comprise 84 per cent of those infected in the 15 to 19 year age group and 55 per cent of the 20 to 29 year age group, is of deep concern. This is of particular concern, given the risks of transmission to infants through childbirth and breastfeeding.

Paragraph 160

The Government should increase its efforts to combat the HIV/AIDS pandemic and to ensure that appropriate sexual and reproductive health information, education and services are provided to all women and, in particular, to adolescents.

•	Indonesia, CEDAW, A/53/38/Rev.1 part I (1998) 24 at para. 298.

The limited information provided on the problem of HIV/AIDS is of concern. There is no data on the extent of the problem, rates of increase or any sex-disaggregated data. Concern is particulary expressed over the problem of HIV/AIDS being attributed to women in prostitution. Concern is also expressed about programmes designed to "clean the city streets" of prostitutes whenever there is a major international event in Jakarta. Information provided by other sources suggests that women taken off the streets have been subjected to forced vaginal examinations.

•	Nigeria, CEDAW, A/53/38/Rev.1 part II (1998) 61 at para.168.

Concern is expressed over the fact there are no statistics and information on AIDS and sexually transmitted diseases. Note is also taken of the fact that polygamy and prostitution were also serious risk factors in the spread of sexually transmitted diseases.

•	Kyrgyzstan, CEDAW, A/54/38/Rev.1 part I (1999) 15 at paras. 125 and 126.

Paragraph 125

The increase in alcoholism and drug addiction, to the extent that these are causes of health problems, as well as violence against women everywhere, is of concern.

Paragraph 126

Programmes should be put in place to create awareness about the negative impact of alcoholism and drug addiction on individuals and on society in general. It is also recommended that rehabilitation programmes be introduced for victims of such addictions.

•	China, CEDAW, A/54/38/Rev.1 part I (1999) 26 at para. 289.

The decriminalization of prostitution is recommended. Given the HIV/AIDS pandemic, due attention should be paid to health services for women in prostitution. The Government is also urged to take measures for the rehabilitation and reintegration of prostitutes into society.

•	Belize, CEDAW, A/54/38/Rev.1 part II (1999) 49 at para. 59

The Government should implement awareness-raising programmes and policies about the prevention of HIV/AIDS and encourage the use of condoms.

•	Ireland, CEDAW, A/54/38/Rev.1 part II (1999) 60 at para. 186.

The Government is urged to facilitate a national dialogue on women's reproductive rights, including on the restrictive abortion laws. It is also urged to further improve family planning services and the availability of contraception, including for teenagers and young adults and to promote the use of condoms to prevent the spread of HIV/AIDS.

•	Spain, CEDAW, A/54/38/Rev.1 part II (1999) 67 at para. 268.

Awareness-raising campaigns should be undertaken concerning the preventable health hazards stemming from tobacco consumption, and the need for additional regulatory and education measures to prevent and reduce smoking by women, especially among adolescents and young women, should be assessed.

•	United Kingdom of Great Britain and Northern Ireland, CEDAW, A/54/38/Rev.1 part II (1999) 71 at para. 310.

Teenage conception and pregnancy should be addressed by a multiplicity of measures, including a greater focus on male responsibility and a review of the primary school curriculum with a view to introducing age-appropriate sex education. Resources should be allocated for prevention and treatment programmes for sexually transmitted diseases directed at adolescents within a holistic approach to sexual and reproductive health, including sexual violence.

•	India, CEDAW, A/55/38 part I (2000) 7 at para. 76.

The fact that women and girls are exploited in prostitution and inter-state and cross-border trafficking is of concern. Also of concern is that those women are exposed to HIV/AIDS and health risks and that existing legislation encourages mandatory testing and isolation.

•	Belarus, CEDAW, A/55/38 part I (2000) 34 at para. 374.

The collection of data on illnesses affecting women more than men and the monitoring of HIV/AIDS prevalence among women is recommended. Further efforts should be made by the Government to address the effects on women and children of the Chernobyl disaster, availing itself of international humanitarian assistance.

•	Cameroon, CEDAW, A/55/38 part II (2000) 53 at paras. 52, 59 and 60.

Paragraph 52

In the light of the HIV/AIDS pandemic in the State party, full attention must be paid to the health services available to prostitutes.

Paragraph 59

The high rate of fertility and repeated pregnancy, the high mortality rate among mothers and children, and the HIV/AIDS pandemic in Cameroon, are noted with concern.

Paragraph 60

The Government should strengthen its awareness campaigns to make women aware of the risks and effects of sexually transmitted diseases, including HIV/AIDS.

See also:

•	Burkina Faso, CEDAW, A/55/38 part I (2000) 25 at para. 276.

•	Guyana, CEDAW, A/56/38 part II (2001) 60 at para. 181.

•	Republic of Moldova, CEDAW, A/55/38 part II (2000) 56 at para. 110.

The Government is urged to maintain free access to basic health care, to include a life-cycle approach to women's health in its health policy, and to improve its family planning and reproductive health policy, including availability and accessibility of modern contraceptive means. The Government is encouraged to include sex education systematically in schools, including vocational training schools, to continue its cooperation with international organizations to improve the general health situation of women and girls in the State party, and to take measures aimed at reducing occupational health risks to women workers.

•	Iraq, CEDAW, A/55/38 part II (2000) 66 at paras. 203 and 204.

Paragraph 203

The overall health situation of women is of concern. The high incidence of maternal mortality and the lack of basic health services, medicines and reproductive health services, including qualified birth attendants, are noted. It is of particular concern that, given the socio-economic difficulties, no measures have been put in place to address the mental and psychological health of women. That no steps have been taken to determine the prevalence of HIV/AIDS in the country, and that no relevant preventive education and information campaigns aimed at women exist, are also matters of concern.

Paragraph 204

The Government is urged to put in place mechanisms to provide the greatest possible protection of women's health rights. Women and children should be targeted effectively so that they benefit from available resources and such resources should not be diverted to other purposes. The Government should take a holistic view of women's health, in line with general recommendation 24 relating to article 12 of the Convention, and should put in place measures to ensure women's mental and psychological well-being.

•	Cuba, CEDAW, A/55/38 part II (2000) 73 at para. 271.

While recognizing the Government's sustained efforts to ensure women's right to health, the necessity of continued efforts to address HIV/AIDS, and in particular its potential impact on high-
risk groups, such as prostitutes and young adults, is emphasized. The occurrence of suicide among older women is of concern. The Government should study the cause of women's suicide with a view to adopting preventive measures.

•	Romania, CEDAW, A/55/38 part II (2000) 77 at paras. 314 and 315.

Paragraph 314

Concern is expressed over the health situation of women, especially women's reproductive health. While appreciating recent declines in maternal and child mortality rates, these indicators are still high compared to other countries in the region. The abortion rates and the use of abortion as a means of fertility control, are of particular concern. The increase in HIV/AIDS infection rates and in sexually transmitted diseases, are also matters of concern. Concern is further expressed over the situation of the environment, including industrial accidents and their impact on women's health.

Paragraph 315

While commending the State party for maintaining a system of universal free health care, it is recommended that increased efforts be placed on improving women's reproductive health. In particular, the availability, acceptability and use of modern means of birth control to avoid the use of abortion as a method of family planning should be improved. The Government is further encouraged to include sex education systematically in schools, including vocational training schools. High risk groups should be targeted for HIV/AIDS prevention strategies and strategies to prevent the spread of other sexually transmitted diseases.

•	Burundi, CEDAW, A/56/38 part I (2001) 7 at paras. 59 and 60.

Paragraph 59

The increasing rate of HIV/AIDS, which has eroded earlier gains in the country, is alarming. The absence of facilities for the care of those infected and affected is of concern.

Paragraph 60

The Government is urged to take a multifaceted and holistic approach to combating the HIV/AIDS pandemic, one which not only incorporates broad-based educational strategies but also includes practical prevention efforts, such as increased access to both male and female condoms. International assistance should be considered for this purpose. The fact that the collection of reliable data on the incidence of HIV/AIDS is critical to gaining an understanding of the pandemic and to informing policies and programmes is emphasized.

•	Kazakhstan, CEDAW, A/56/38 part I (2001) 10 at paras. 105 and 106.

Paragraph 105

The large number of women suffering from anaemia and the incidence of infectious diseases is alarming. Concern is also expressed over the degree of environmental degradation in the country and its extremely negative impact on the health of the whole population, in particular on women and children.

Paragraph 106

The State party is urged to maintain free access to adequate health care. The Government is encouraged to promote sex education for both girls and boys, as well as educational programmes to combat alcohol and drug abuse among women. The Government should design and implement a sound environmental policy aimed at protecting the health of women and children.

See also:

•	Uzbekistan, CEDAW, A/56/38 part I (2001) 18 at paras. 185 and 186.

•	Finland, CEDAW, A/56/38 part I (2001) 29 at para. 309.

Concern is expressed about the increase in smoking and in the use of drugs among young people, particularly girls. Efforts aimed at combatting the use and supply of drugs and smoking should be intensified.

•	Guinea, CEDAW, A/56/38 part II (2001) 55 at paras. 130, 131, 136 and 137.

Paragraph 130

Alarm is expressed at the increasing rate of HIV/AIDS and the absence of measures for the care of women and girls infected and affected by HIV/AIDS.

Paragraph 131

Holistic measures should be taken to combat the HIV/AIDS pandemic and further practical preventive measures should be taken by providing access to condoms for women and men. The Government is also urged to ensure that women and girls infected by HIV/AIDS are not discriminated against and are given appropriate assistance. It is emphasized that the collection of reliable data on HIV/AIDS is critical to gaining an understanding of the pandemic.

Paragraph 136

It is noted with concern that despite legislative prohibition, prostitution is growing at an alarming rate and that the prevalence of HIV and other sexually transmitted diseases among prostitutes is increasing.

Paragraph 137

Laws that prohibit the exploitation of prostitution should be strictly enforced without penalizing women who provide sexual services and full attention should be paid to the provision of health services for prostitutes so as to curb the rise in the number of HIV/AIDS cases.

•	Guyana, CEDAW, A/56/38 part II (2001) 60 at paras. 178 and 179.

Paragraph 178

The increasing number of HIV/AIDS cases in Guyana, especially among young people, is noted with concern.

Paragraph 179

A multifaceted and holistic approach to combating HIV/AIDS should be taken, including broad-
based educational strategies and practical prevention efforts, targeted at women and adolescents.

•	Viet Nam, CEDAW, A/56/38 part II (2001) 68 at paras. 266 and 267.

Paragraph 266

The persistence of stereotypical attitudes with respect to women's health concerns is of concern, especially contraception which appears to be regarded as the sole responsibility of women, as well as the increased incidence of HIV/AIDS, malaria and tuberculosis among women.

Paragraph 267

The Government is urged to maintain free access to basic health care. Also, sex education for both boys and girls should be promoted, paying special attention to HIV/AIDS prevention.

•	Nicaragua, CEDAW, A/56/38 part II (2001) 72 at paras. 300 and 301.

Paragraph 300

It is of concern that the leading causes of mortality among women are cervical and breast cancer, and pregnancy-related problems, including post-partum haemorrhage and toxaemia.

Paragraph 301

Every effort should be made to increase access to health-care facilities and medical assistance by trained personnel in all areas, including rural areas. The implementation of programmes to prevent cervical and breast cancer, and to ensure the availability of pregnancy-related medical care are also recommended.

CRC

•	Russian Federation, CRC, CRC/C/16 (1993) 21 at para. 88.

The primary health care system should be improved regarding the effectiveness of, inter alia, antenatal care, health education, including sex education, family planning and immunization programmes. As regards to the problems relating specifically to the immunization programme, the Government should look to international cooperation for support in the procurement and manufacturing of vaccines.

•	Burkina Faso, CRC, CRC/C/29 (1994) 15 at para. 70.

Vaccination programmes are not adequate, both in terms of the range of vaccines offered and the groups covered, and they do not correspond to the real needs, especially in rural areas.

•	Jamaica, CRC, CRC/C/38 (1995) 25 at para. 165.

Health education should be developed so as to ensure a better understanding by the population of the benefits of preventive health care and the detrimental effects on children of the persistence of traditional practices prejudicial to their health.

•	Sri Lanka, CRC, CRC/C/43 (1995) 26 at para. 176.

The development of sexual exploitation of children, especially of boys, through sex tourism is of deep concern. The authorities should engage in a prevention campaign on the HIV virus and strengthen its procedures to supervise tourist areas where the problem prevails.

•	Ukraine, CRC, CRC/C/46 (1995) 11 at para. 58.

The health status of children, particularly in the aftermath of the Chernobyl nuclear disaster, the increasing child mortality rate, the apparent priority given to curative rather than preventive health care, the low prevalence of breast-feeding, the high number of abortions and insufficient health, education and services on family planning, and the discrepancy between the urban and rural health systems are of concern.

•	Holy See, CRC, CRC/C/46 (1995) 27 at para. 180.

The insufficient attention paid to the promotion of education of children on health matters, the development of preventive health care, guidance for parents and family planning education and services is of concern.

•	Yugoslavia (Serbia and Montenegro), CRC, CRC/C/50 (1996) 17 at paras. 115 and 118.

Paragraph 115

The State party should accord greater attention and consideration to the development of a strong primary health-care system. Such a system would have the benefits of according due attention to developing a culture of nutrition, hygiene and sanitation education, transmitting health skills to parents, and enhancing participatory approaches to the distribution and use of resources throughout the health-care system.

Paragraph 118

Serious consideration should be given to the possibility of allocating further resources for programmes for the prevention of sexual abuse and exploitation and the rehabilitation of victims, including training of and support to the professionals dealing with these issues and the development of an integrated and coordinated approach to assist both the victims and the perpetrators of such abuse. In this connection, the State party should consider greater use of the media in relation to awareness-raising and education on the dangers of sexual exploitation and abuse and the issues of HIV/AIDS and other sexually transmitted diseases.

•	Finland, CRC, CRC/C/50 (1996) 35 at paras. 225 and 236.

Paragraph 225

The State party's current shortage of facilities for the psychiatric treatment of children is a concern. This shortage may result in the non-separation of children from adults in psychiatric establishments. The high rates of suicide and the increasing rates of drug abuse among youth are also of concern.

Paragraph 236

The State party should take all appropriate measures to prevent mentally-ill children being institutionalized in the same facilities as adults. Additional research should also be undertaken in the areas of suicide and drug abuse to improve the understanding of those phenomena and generate appropriate measures to deal efficiently with them.

•	Nepal, CRC, CRC/C/54 (1996) 25 at para. 172.

The increasing phenomenon of child prostitution that affects in particular children belonging to the lower castes is a concern. The absence of measures to combat this phenomenon and the lack of rehabilitation measures is also a worry. The inadequate measures taken to address the situation of children addicted to drugs are also a concern.

•	Guatemala, CRC, CRC/C/54 (1996) 31 at para. 225.

The State party is encouraged to strengthen its support to families in carrying out their child-rearing responsibilities, such as by providing nutritious food and conducting vaccination programmes. As a means of addressing the problems of maternal death and poor antenatal care and delivery services, the State party should consider introducing a more effective system training medical personnel and birth attendants. The State party should also consider requesting international cooperation from relevant international organizations to address issues relating to the reproductive health of women.

•	Ghana, CRC, CRC/C/66 (1997) 15 at paras. 94, 99 and 120.

Paragraph 94

The persistence of malnutrition and the apparent difficulty in reversing this negative trend is of concern. The rapid spread of HIV/AIDS throughout the country and its devastating impact on children is also of concern.

Paragraph 99

The recent emergence of substance abuse among children and the limited prevention and rehabilitation measures and facilities to combat this phenomenon are of concern.

Paragraph 120

All appropriate measures should be taken to prevent and combat drug and substance abuse among children, such as public information campaigns, including in schools. In this regard, technical assistance should be considered from competent international organizations, such as the World Health Organization (WHO).

See also:

•	Togo, CRC, CRC/C/69 (1997) 39 at para. 267.

•	Lao People's Democratic Republic, CRC, CRC/C/69 (1997) 8 at paras. 55 and 79.

•	Fiji, CRC, CRC/C/79 (1998) 18 at para. 123.

•	Paraguay, CRC, CRC/C/66 (1997) 29 at para. 194.

The absence of large-scale public campaigns for the prevention of unwanted pregnancies, sexually transmitted diseases and HIV/AIDS, especially for children and adolescents, is of concern. The lack of sufficient reproductive health information and services for adolescents is also of concern.

•	Lao People's Democratic Republic, CRC, CRC/C/69 (1997) 8 at paras. 50 and 74.

Paragraph 50

Concern is expressed over the high maternal mortality rate, the high mortality and morbidity rates among children, the lack of access to prenatal and maternity care, the generally limited access to public health care and to medicines, particularly in rural areas, and the very high level of malnutrition. The high incidence of traffic accidents involving children and the inadequacy of the efforts to raise awareness about HIV/AIDS in the communities and at school, particularly in the rural areas, are also of concern.

Paragraph 74

Adolescent health should be promoted by strengthening reproductive health education and services to prevent and combat HIV/AIDS. All appropriate measures should be taken to prevent traffic accidents, such as teaching traffic rules at school.

See also:

•	Trinidad and Tobago, CRC, CRC/C/69 (1997) 33 at para. 234.

•	Uganda, CRC, CRC/C/69 (1997) 21 at para. 149.

Information and prevention programmes should be strengthened to combat HIV/AIDS, particularly to prevent the transmission to children of HIV/AIDS and other sexually transmitted diseases (STDs), and to eliminate discriminatory attitudes towards children affected by or infected with HIV/AIDS. Family planning and reproductive health educational programmes, including for adolescents, should be pursued and strengthened.

See also:

•	Ghana, CRC, CRC/C/66 (1997) 15 at para. 115.

•	Togo, CRC, CRC/C/69 (1997) 39 at para. 286.

•	Czech Republic, CRC, CRC/C/69 (1997) 28 at paras. 181 and 191.

Paragraph 181

The rising incidence of gambling addiction, alcohol consumption and drug abuse among children and the insufficient preventive measures taken are of concern.

Paragraph 191

Reproductive health measures designed to reduce the incidence of pregnancies among teenage girls should be adopted and information and prevention programmes to combat HIV/AIDS and other sexually transmitted diseases (STDs) should be strengthened.

•	Togo, CRC, CRC/C/69 (1997) 39 at paras. 262 and 291.

Paragraph 262

The difficult health situation faced by a majority of children, inter alia, high under-five child mortality rate, weak nutritional status, high incidence of malaria and iodine deficiency, and limited access to clean water and safe sanitation, are matters of concern. The spread of HIV/AIDS throughout the population of the country, which bears a direct impact on the lives of children, is worrisome.

Paragraph 291

All appropriate measures should be taken to prevent and combat drug and substance abuse among children, such as public information campaigns, including in schools and in other institutions. All rehabilitation programmes dealing with children victims of drug and substance abuse should be supported. In this regard, technical assistance from relevant international organizations, such as the World Health Organization (WHO) should be considered.

•	Micronesia, CRC, CRC/C/73 (1998) 20 at paras. 122 and 137.

Paragraph 122

The prevalence of malnutrition and vitamin A deficiency in the State party, as well as the limited access to safe water and adequate sanitation, are matters of concern. The problems of adolescent health, particularly the high and increasing rate of early pregnancies, the lack of access by teenagers to reproductive health education and services, the insufficient preventive measures on HIV/AIDS, as well as the insufficient sexual education at school, are also of concern. The high rate of suicide among teenagers and the insufficiency of financial and human resources for its prevention are matters of concern. The insufficient legal framework, as well as the insufficient social and medical programmes or services to tackle those issues, are also of concern.

Paragraph 137

Taking into account the changes occurring in the institution of the "extended family", which provided children with an environment in which to discuss their problems, it is suggested that complementary initiatives be encouraged, such as youth peer counselling groups in schools, community-awareness programmes on youth problems such as alcohol and suicide, and parental education programmes.

•	Hungary, CRC, CRC/C/79 (1998) 7 at paras. 46 and 61.

Paragraph 46

The high rate of youth suicide, the insufficient measures taken to address adolescent health issues such as reproductive health and the incidence of early pregnancies, and the increase in drug abuse and alcohol consumption among children, are matters of concern.

Paragraph 61

In order to reduce the number of teenage pregnancies, reproductive health education programmes should be strengthened and information campaigns should be launched concerning family planning and prevention of HIV/AIDS. Efforts in undertaking comprehensive studies on suicide among youth to enable authorities to improve their understanding of this phenomenon should be continued and the appropriate measures should be taken to reduce the suicide rate. Further preventive and curative measures, including rehabilitation and reintegration programmes, should be taken to address the issue of drug abuse and alcohol consumption among adolescents.

•	Fiji, CRC, CRC/C/79 (1998) 18 at paras. 119, 136 and 142.

Paragraph 119

The high and increasing rate of early pregnancies, the incidence of sexually transmitted diseases among the youth, the occurrence of teenage suicide, the insufficient access by teenagers to reproductive health education and counselling services, including outside schools, and the insufficient preventive measures on HIV/AIDS are of concern.

Paragraph 136

All appropriate measures, including revision of legislation, should be taken to prevent and combat ill-treatment within the family, including domestic violence and sexual abuse of children. Authorities should set up social programmes to prevent all types of child abuse as well as to rehabilitate the child victims. Law enforcement should be strengthened with respect to such crimes; adequate procedures and mechanisms to deal with complaints of child abuse should be developed, such as special rules of evidence and special investigators or community focal points.

Paragraph 142

Efforts should be strengthened to prevent and combat drug and substance abuse among children, and all appropriate measures should be taken, including public information campaigns in and outside the schools. Rehabilitation programmes for child victims of drug and substance abuse should be supported. In this regard, technical assistance should be considered from, inter alia, UNICEF and WHO.

See also:

•	Japan, CRC, CRC/C/79 (1998) 25 at para. 192.

•	Maldives, CRC, CRC/C/79 (1998) 31 at para. 239.

•	Japan, CRC, CRC/C/79 (1998) 25 at paras. 167 and 188.

Paragraph 167

The high number of suicides among children and the insufficient measures to prevent this phenomenon, the insufficient access by teenagers to reproductive health education and counselling services, including outside schools, and the incidence of HIV/AIDS among adolescents are of concern.

Paragraph 188

All necessary measures should be taken to prevent suicides and incidents of HIV/AIDS among adolescents, including the collection and analysis of information, the launching of awareness-raising campaigns, reproductive health education and establishing counselling services.

•	Maldives, CRC, CRC/C/79 (1998) 31 at para. 234.

Adolescent health policies and programmes should be promoted by strengthening reproductive-
health education and counselling services as well as improving preventive measures to combat HIV/AIDS. Further efforts, both financial and human, such as the development of counselling services for both young people and their families, should be undertaken for the prevention and care of adolescents' health problems and for the rehabilitation of victims.

•	Luxembourg, CRC, CRC/C/79 (1998) 38 at para. 278.

Studies on the causes of suicide and other mental health problems among young people should be undertaken and measures to combat this phenomenon should be adopted. "Youth-friendly" preventive, curative and rehabilitative measures should be undertaken to address the increasing problem of drug and substance abuse among young adolescents.

•	Bolivia, CRC, CRC/C/80 (1998) 22 at para. 113.

The situation of children living in the Chapare region, who are constantly exposed to the side effects of anti-narcotics interventions and live in a violent environment, which has a negative impact on their development, is of concern. All appropriate measures should be taken to ensure the protection of children living in the Chapare region.

•	Thailand, CRC, CRC/C/80 (1998) 35 at para. 175.

The persistence of poor breastfeeding practices and the high rate of malnutrition are of concern. Comprehensive policies and programmes should be developed to promote and improve breastfeeding practices and to prevent and combat malnutrition, especially among vulnerable and disadvantaged groups of children. The State party should consider seeking technical assistance for the integrated management of childhood illnesses and other measures for child health improvement from, inter alia, UNICEF and WHO.

•	Belize, CRC, CRC/C/84 (1999) 12 at paras. 84 and 88.

Paragraph 84

The limited availability of programmes and services and the lack of adequate data in the area of adolescent health, including accidents, suicide, violence and abortion is of concern. The high and increasing incidence of teenage pregnancy, HIV/AIDS and sexually transmitted diseases (STDs) is also of concern. Further measures, including the allocation of adequate human and financial resources, should be undertaken to develop youth-friendly care and rehabilitation facilities for adolescents.

Paragraph 88

The high and increasing incidence of drug and substance abuse among youth; the lack of legal provisions in relation to narcotic drugs and psychotropic substances; and the limited social and medical programmes and services available in this regard are of concern. All appropriate measures, including legislative, administrative, social and educational measures, should be taken to protect children from the illicit use of narcotic drugs and psychotropic substances and to prevent the use of children in the illicit production and trafficking of such substances. Rehabilitation programmes dealing with child victims of drug and substance abuse should be supported. In this regard, technical assistance should be considered from, inter alia, UNICEF, WHO and the United Nations International Narcotics Control Board.

See also:

•	Guinea, CRC, CRC/C/84 (1999) 21 at para. 123.

•	Saint Kitts and Nevis, CRC, CRC/C/87 (1999) 17 at para. 91.

•	Grenada, CRC, CRC/C/94 (2000) 72 at para. 410.

•	Georgia, CRC, CRC/C/97 (2000) 18 at paras. 140 and 141.

•	Suriname, CRC, CRC/C/97 (2000) 84 at paras. 503 and 504.

•	Guinea, CRC, CRC/C/84 (1999) 21 at para. 115.

The spread of the HIV/AIDS epidemic and its direct and indirect effects on children are of deep concern. The programmes relating to the incidence and treatment of children infected with or affected by HIV/AIDS should be reinforced, and international cooperation from UNICEF, WHO and UNAIDS is encouraged.

•	Sweden, CRC, CRC/C/84 (1999) 29 at para. 148.

The rising incidence of substance abuse among adolescents is of concern. Systematic efforts should be undertaken to collect data on and monitor substance abuse, particularly on its impact among the more vulnerable groups.

•	Yemen, CRC, CRC/C/84 (1999) 33 at para. 175.

The high and increasing rate of teenage pregnancies and the insufficient access to reproductive health education and counselling services for teenagers, including outside schools, are of concern. The lack of preventive measures, including information campaigns, regarding STDs and HIV/AIDS are also of concern. Adolescent health policies should be promoted and reproductive health education and counselling services should be strengthened. Awareness-raising campaigns should be undertaken to prevent and combat the spread of STDs and HIV/AIDS and to establish health facilities and programmes for the care of children infected or affected by HIV/AIDS.

•	Barbados, CRC, CRC/C/87 (1999) 9 at para. 55.

The high levels of adolescent pregnancy and abortion, the rising incidence of HIV and AIDS and the effect this has on children infected or affected (in particular those orphaned) by the epidemic are of concern. Careful attention should be given to the recommendations formulated by the Committee during its day of general discussion on "The rights of children living in a world with HIV/AIDS." Efforts to provide appropriate adolescent health services should be increased, the possibility of actively involving adolescents in the formulation of policies and treatment programmes in accordance with their evolving capacity should be considered and it should be made possible for adolescents to have access to medical advice and treatment without parental consent in accordance with their age and maturity.

•	Saint Kitts and Nevis, CRC, CRC/C/87 (1999) 17 at para. 87.

Efforts should be increased in promoting adolescent health policies and counselling services as well as strengthening reproductive health education, including the promotion of male acceptance of the use of contraceptives. A comprehensive and multidisciplinary study should be undertaken to understand the scope of adolescent health problems, including the special situation of children infected with, affected by or vulnerable to HIV/AIDS and STDs. Additionally, further measures should be undertaken, including the allocation of adequate human and financial resources, to develop youth-friendly care, counselling, and rehabilitation facilities for adolescents.

•	Honduras, CRC, CRC/C/87 (1999) 26 at para. 122.

The high and increasing rate of teenage pregnancy and the insufficient access to reproductive health education and counselling services, including outside schools, and the increasing rate of substance abuse among adolescents are of concern. Further efforts should be undertaken for the development of child-friendly counselling services, as well as care and rehabilitation facilities for adolescents. Measures to prevent and combat substance abuse among adolescents should be strengthened.

•	Benin, CRC, CRC/C/87 (1999) 35 at paras. 156 and 162.

Paragraph 156

The limited availability of programmes and services and the lack of adequate data in the area of adolescent health, including accidents, suicide, violence and abortion, are of concern. Also of concern is the high and increasing incidence of teenage pregnancy, HIV/AIDS and sexually transmitted diseases (STDs). The 1920 law which continues to prohibit the use of contraceptives, including for health purposes, and impedes the full implementation of family planning programmes, including the safe motherhood initiative, is of concern. A comprehensive and multi-disciplinary study should be undertaken to understand the scope of adolescent health problems, including the negative impact of early pregnancy, as well as the special situation of children infected with, affected by or vulnerable to HIV/AIDS and STDs. Further measures should be undertaken, including the allocation of adequate human and financial resources, to develop youth-friendly counselling, care and rehabilitation facilities for adolescents that would be assessable, without parental consent, where in the best interests of the child. The 1920 law concerning family planning and the use of contraceptives should be repealed.

Paragraph 162

The high and increasing incidence of drug and substance abuse among youth; the lack of legal provisions in relation to narcotic drugs and psychotropic substances; and the limited psycho-social and medical programmes and services available are of concern. All appropriate measures, including legislative, administrative, psycho-social and educational measures, should be taken to protect children from the illicit use of narcotic drugs and psychotropic substances and to prevent the use of children in the illicit production and trafficking of such substances. Furthermore, programmes should be introduced within the school environment to educate children about the harmful effects of narcotic drugs and psychotropic substances. Technical assistance should be sought from, inter alia, UNICEF, WHO and the United Nations International Narcotics Control Board.

•	Chad, CRC, CRC/C/87 (1999) 45 at para. 193.

The spread of the HIV/AIDS epidemic and its direct and indirect effects on children is of deep concern. In this regard, international cooperation should be sought from UNICEF, WHO and UNAIDS to set up programmes relating to the incidence and treatment of children infected with or affected by HIV/AIDS.

•	Nicaragua, CRC, CRC/C/87 (1999) 54 at para. 239.

The high and increasing rate of teenage pregnancy, the high maternal mortality rate related to abortion and the insufficient access by teenagers to reproductive health education and counselling services, including outside the school system, remain issues of concern. Also of concern is the increasing rate of children infected by HIV/AIDS. Measures for the prevention of HIV/AIDS should continue to be taken and consideration should be given to the Committee's recommendations adopted on its day of general discussion on "Children living in a world with HIV/AIDS." A comprehensive and multidisciplinary study should be undertaken to understand the scope of adolescent health problems as a basis for promoting adolescent health policies and strengthening reproductive health education. Further efforts should be undertaken for the development of child-friendly counselling services as well as care and rehabilitation facilities for adolescents. International technical assistance should be sought from, inter alia, UNICEF and UNAIDS.

See also:

•	Venezuela, CRC, CRC/C/90 (1999) 10 at para. 54.

•	Dominican Republic, CRC, CRC/C/103 (2001) 91 at paras. 518 and 519.

•	Russian Federation, CRC, CRC/C/90 (1999) 18 at paras. 107, 108, 110, 123 and 124.

Paragraph 107

The persistently high infant mortality rate, the deteriorating health infrastructure and services, the increase in parasitic, infectious and respiratory illnesses (tuberculosis in particular), and the increase in malnutrition and the small percentage of children who are breastfed, are issues of great concern.

Paragraph 108

Technical assistance should be considered in order to continue efforts to reverse the deterioration in primary health care. Efforts should continue to be taken to cure and prevent the spread of tuberculosis and other diseases; to continually reduce the use of abortion as a means of contraception; and to promote breastfeeding.

Paragraph 110

The effectiveness of measures taken should be guaranteed to ensure access for adolescents to sex education, including information about contraception and STDs, to promote adolescent health by strengthening reproductive health and family planning services, as well as counselling services, and to prevent and combat HIV/AIDS, STDs and teenage pregnancy and abortions.

Paragraph 123

The growing problem of alcohol, drug and other substance abuse among children and their families is of concern.

Paragraph 124

Additional efforts should be taken to prevent the abuse of alcohol by children and to prevent their involvement in the distribution and consumption of drugs. Further measures should also be taken to provide adequate treatment, rehabilitation and support services to children and their families involved in alcohol, drug and substance abuse.

•	Vanuatu, CRC, CRC/C/90 (1999) 29 at para. 155.

The limited availability of programmes and services and the lack of adequate data in the area of adolescent health, including accidents, suicide, violence and abortions, are of concern. The high and increasing incidence of teenage pregnancy and sexually transmitted diseases (STDs) as well as the prevalence of the use of alcohol and tobacco among youth are of particular concern. Efforts should be increased to promote adolescent health policies, particularly with respect to accidents, suicide, violence, alcohol consumption and tobacco use. Furthermore, a comprehensive and multidisciplinary study should be undertaken on adolescent health problems, including the negative impact of early pregnancy and STDs. Measures should be undertaken, including the allocation of adequate human and financial resources, to develop youth-friendly counselling, care and rehabilitation facilities that would be accessible, without parental consent, in the best interests of the child. Reproductive health education programmes for adolescents should be strengthened and the inclusion of men in all training programmes on reproductive health should be ensured.

•	Mexico, CRC, CRC/C/90 (1999) 34 at para. 186.

The high teenage maternal mortality rate and the high number of teenage pregnancies remain of concern. Efforts to prevent the spread of HIV/AIDS should be taken and child-friendly counselling services and care and rehabilitation facilities for adolescents should be developed.

•	Mali, CRC, CRC/C/90 (1999) 43 at paras. 220 and 227.

Paragraph 220

Efforts should be increased to promote adolescent health policies, particularly with respect to accidents, suicide and violence, and efforts should be made to strengthen reproductive health education and counselling services. Further measures should be undertaken, including the allocation of adequate human and financial resources, to develop youth-friendly counselling, care and rehabilitation facilities for adolescents that would be accessible without parental consent, where this is in the best interests of the child.

Paragraph 227

The high and increasing incidence of drug and substance abuse among youth and the limited psycho-
social and medical programmes and services available in this regard are of concern. All appropriate measures, including educational measures, should be taken to protect children from the illicit use of narcotic drugs and psychotropic substances and to prevent the use of children in the illicit production and trafficking of such substances. Technical assistance from, inter alia, UNICEF and WHO is encouraged.

•	The Netherlands, CRC, CRC/C/90 (1999) 53 at para. 251.

Breastfeeding promotion campaigns should be undertaken to stress its advantages and the negative impact of substitutes, while providing counselling to HIV/AIDS-infected mothers about the risk of transmission of HIV/AIDS through breastfeeding.

•	India, CRC, CRC/C/94 (2000) 10 at paras. 82 and 83.

Paragraph 82

Adolescent suicides, especially among girls, and HIV/AIDS affected children are matters of serious concern.

Paragraph 83

The State party should combat discrimination against HIV/AIDS affected persons by strengthening awareness-raising and sensitization programmes for the public, and particularly health professionals.

•	Sierra Leone, CRC, CRC/C/94 (2000) 24 at paras. 175, 198 and 199.

Paragraph 175

It is recommended that the State party urgently develop mechanisms to effectively monitor the incidence and spread of HIV/AIDS. The State party should rapidly develop and implement a strategy for prevention, including through the use of information campaigns, and for care of people who are victims of HIV/AIDS, including for alternative care of their children. The State party is urged to seek assistance from the World Health Organization.

Paragraph 198

The recent and rapid increase in the abuse of drugs by children, particularly among former child combatants is a concern.

Paragraph 199

Recognizing the State party's efforts in Freetown to combat drug use, the State party is urged to establish similar activities in other towns and in internally displaced persons camps. The State party should seek international cooperation in this domain, including for the provision of psycho-social assistance for addicts.

•	Costa Rica, CRC, CRC/C/94 (2000) 37 at paras. 231 and 232.

Paragraph 231

With regard to adolescent health issues, concern remains about the high and increasing rate of teenage pregnancies; at the insufficient access by teenagers to reproductive health education and counselling services; and at the increasing rate of substance abuse among adolescents. The State party should undertake effective measures to develop adolescent-friendly health policies and strengthen reproductive health education and counselling services in order, inter alia, to prevent and reduce teenage pregnancies. Measures to prevent and combat substance abuse among adolescents should be strengthened.

Paragraph 232

The State party should develop early identification programmes to prevent disabilities, implement alternative measures to the institutionalization of children with disabilities, envisage awareness-
raising campaigns to reduce discrimination against them, establish special education programmes and centres as needed and encourage their inclusion in the educational system and in society, and establish adequate monitoring of private institutions for children with disabilities.

See also:

•	Suriname, CRC, CRC/C/97 (2000) 84 at para. 496.

•	United Kingdom of Great Britain and Northern Ireland (Isle of Man), CRC, CRC/C/100 (2000) 31 at para. 195.

•	The Former Yugoslav Republic of Macedonia, CRC, CRC/C/94 (2000) 45 at paras. 276, 277, 290 and 291.

Paragraph 276

Recognizing the State party's significant efforts to address health concerns related to HIV/AIDS, the Committee is concerned that such efforts be maintained in the interests of preventing the spread of HIV/AIDS.

Paragraph 277

It is recommended that the State party continue with its current efforts to address HIV/AIDS concerns, including through the continuous use of effective monitoring and prevention mechanisms.

Paragraph 290

The Committee acknowledges the State party's recognition of, and expresses its own concern at, recent increases in drug abuse among children.

Paragraph 291

The State party should continue to monitor the incidence of drug abuse among children, proceed with preventive measures and make appropriate rehabilitative and other assistance available to children who are already addicted to drugs.

•	Armenia, CRC, CRC/C/94 (2000) 53 at paras. 346 and 347.

Paragraph 346

The increasing use and traffic in illicit drugs, and the alarming rates of tobacco use among persons under 18 years is a concern.

Paragraph 347

The State party should develop a national drug control plan, or a Master Plan, with the guidance of United Nations Drug Control Programme (UNDCP). The State party is encouraged to continue its efforts to provide children with accurate and objective information about substance use, including tobacco use; and to protect children from harmful misinformation through comprehensive restrictions on tobacco advertising. Rehabilitation services should be developed for children who are victims of substance abuse.

See also:

•	India, CRC, CRC/C/94 (2000) 10 at paras. 104 and 105.

•	Kyrgyzstan, CRC, CRC/C/97 (2000) 51 at paras. 324 and 325.

•	Peru, CRC, CRC/C/94 (2000) 64 at para. 377.

The increasing rates of substance abuse and of HIV/AIDS among children and adolescents and the constant discrimination they are exposed to are matters of concern.

•	Grenada, CRC, CRC/C/94 (2000) 72 at paras. 387 and 406.

Paragraph 387

The efforts of the State party in the area of primary health-care services are noted. In particular, the high immunization and low malnutrition rates are noted. The enactment of the School Children Immunization Act is welcomed, as this facilitates the immunization of all children at the pre-school and primary school levels.

Paragraph 406

The State party should develop early identification programmes to prevent disabilities, increase efforts to implement alternatives to the institutionalization of children with disabilities, establish special education programmes for children with disabilities and further encourage their inclusion in society. The State party should take all appropriate measures to ensure that adequate resources are allocated for the effective implementation of the Early Intervention Programme for Children with Disabilities.

•	South Africa, CRC, CRC/C/94 (2000) 81 at paras. 444 and 451.

Paragraph 444

Concern is expressed regarding the limited availability of programmes and services and the lack of adequate data in the area of adolescent health, including teenage pregnancies; abortions; drugs and substance abuse, including alcohol and tobacco use; accidents; violence; and suicide. While the State party has taken a tough anti-smoking stance with the introduction of strong legislation, many under-age smokers are still able to buy tobacco products. The high and increasing incidence of HIV/AIDS and STDs remains a concern. It is recommended that the State party take effective measures to ensure that legislation is fully implemented and enforced, particularly as regards the use of tobacco products. The State party should reinforce adolescent health policies, particularly with respect to accidents, suicide, violence and substance abuse. It is also recommended that the State party undertake a study to assess the situation of children with mental health concerns and introduce programmes to guarantee adequate care and protection for them. Additionally, it is recommended that the State party undertake further measures, including the allocation of adequate human and financial resources, to develop youth-friendly counselling, care and rehabilitation facilities for adolescents that would be accessible, without parental consent where this is in the best interests of the child. Training programmes are recommended for youth on the topics of reproductive health, HIV/AIDS and STDs . These programmes should be based not only on gaining knowledge, but also on the acquisition of competencies and life skills that are essential to the development of youth. The full participation of youth in the development of strategies to respond to HIV/AIDS at the national, regional and local levels is recommended. Particular emphasis should be placed on changing public attitudes toward HIV/AIDS and identifying strategies to address the continued discrimination experienced by children and adolescents infected with HIV.

Paragraph 451

The high and increasing incidence of drug and substance abuse among youth and the limited psycho-
social and medical programmes and services available in this regard are a concern. In light of article 33 of the Convention, it is recommended that the State party take all appropriate measures, including educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances and to prevent the use of children in the illicit production and trafficking of such substances. In this context, it is further recommended that programmes be reinforced within the school environment to educate children about the harmful effects of narcotic drugs and psychotropic substances.

See also:

•	United Kingdom of Great Britain and Northern Ireland (Isle of Man), CRC, CRC/C/100 (2000) 31 at paras. 202 and 203.

•	Colombia, CRC, CRC/C/100 (2000) 64 at paras. 387 and 388.

•	Marshall Islands, CRC, CRC/C/100 (2000) 89 at paras. 533 and 534.

•	Lithuania, CRC, CRC/C/103 (2001) 47 at paras. 290 and 291.

•	Georgia, CRC, CRC/C/97 (2000) 18 at paras. 120 and 121.

Paragraph 120

Concern is expressed about the health situation of children which continues to be affected by the poor economic situation within the State party. In particular, note is taken of the limited access to and quality of health services, particularly among children living in conflict zones as well as in the mountainous regions; the increasing cost of basic health care of which the State party covers only 15-20 per cent; the inadequate allocation of funding for health; the high maternal, child and infant mortality rates; the increasing malnutrition rate; and the deteriorating situation of sanitation and safe drinking water. While it is noted that the State party is receiving technical assistance for the immunization campaign, vaccines continue to be unavailable. Negative social attitudes towards vaccinations have resulted in a resurgence of preventable diseases such as diphtheria.

Paragraph 121

Appropriate resources should be allocated for the implementation of the National Health Policy and, where appropriate, additional policies and programmes should be developed to improve the health situation of children, especially those living in mountainous regions and conflict zones; facilitate greater access to and quality of primary health services; ensure the availability of vaccines; reduce the incidence of maternal, child and infant mortality; prevent and combat malnutrition, especially in vulnerable and disadvantaged groups of children; and increase access to safe drinking water and sanitation. The State party is encouraged to continue its cooperation with respect to the Integrated Management of Childhood Illnesses initiative.

•	Jordan, CRC, CRC/C/97 (2000) 31 at paras. 183 and 184.

Paragraph 183

Concern is expressed about the high incidence of traffic accidents which claim the lives of children.

Paragraph 184

The State party should strengthen and continue efforts to raise awareness about and should undertake public information campaigns in relation to accident prevention.

•	Norway, CRC, CRC/C/97 (2000) 43 at para. 246.

Note is taken of the efforts made by the State party to reduce the level of alcohol consumption among adolescents. The State party should continue to promote a healthy lifestyle among adolescents. Further, recognizing that it can be difficult to identify all cases of suicide by children and in accordance with its previous recommendations, research into the incidence and causes of child suicide, including by children under the age of 10, should be continued, and the results of this research should be used to inform and further develop the State party's 1994 suicide prevention programme.

•	Kyrgyzstan, CRC, CRC/C/97 (2000) 51 at paras. 310, 311, 314 and 315.

Paragraph 310

The deterioration in the health of the most vulnerable groups, especially women and children, is a concern. In particular, note is taken of the increase in the incidence of communicable diseases, including vaccine-preventable diseases, and in childhood malnutrition. Moreover, concern is expressed that because of distant facilities and insufficient numbers of personnel and medication, children in rural regions suffer most.

Paragraph 311

It should be ensured that the commitment to primary health care, including implementation of the Integrated Management of Childhood Illnesses strategy, is met by adequate allocation of resources, both human and financial, and that all children, especially from the most vulnerable groups, have access to health care. The State party should undertake awareness-raising campaigns to ensure that families, especially refugee families, are adequately informed of the need to be registered in polyclinics. Comprehensive family planning programmes, as well as measures to ensure that abortion is not perceived as a method of contraception should be established. The State party is encouraged to continue cooperation with and seek assistance from, among others, UNICEF and WHO.

Paragraph 314

In light of article 24 of the Convention, concern is expressed at problems involving the recycling, collection and disposal of waste in urban areas and poor access to safe water and adequate sanitation in rural areas, which negatively impact upon the health of children. Concern is also expressed about the inadequate measures taken to protect the health of children from the negative impact of dangerous environmental hazards resulting from inappropriate storage of, inter alia, radioactive and toxic wastes.

Paragraph 315

In light of article 24 (c) of the Convention, all appropriate measures should be taken, including through international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution and contamination of water supplies.

See also:

•	Tajikistan, CRC, CRC/C/100 (2000) 53 at paras. 305 and 306.

•	Cambodia, CRC, CRC/C/97 (2000) 64 at paras. 374-377.

Paragraph 374

The international cooperation initiative "Strengthening Health Systems" between the Ministry of Health and several United Nations agencies (WHO, UNICEF, UNDP and UNFPA) is welcomed. This initiative aims at rebuilding the Government's capacity in the development of a national programme for immunization, in particular against polio. Nevertheless, concern is expressed that the State party's infant mortality and under-five mortality rates remain among the highest in the region.

Paragraph 375

The issue of childhood morbidity and mortality should be addressed by taking a multisectoral approach recognizing the critical role of illiteracy, lack of clean water supplies and food insecurity in the current pattern of childhood illnesses. Priority areas must be identified on the basis of baseline data collected by careful and comprehensive research. Such a strategy must take into account that most health care takes place outside health facilities and outside State control. It must also recognize the needs of particularly isolated communities. In addition, it is recommended that measures be put in place for establishing an efficient primary health care sector, including strategies to encourage care-seeking for childhood illnesses. The State party is encouraged to continue working in cooperation with international agencies.

Paragraph 376

The measures taken for the prevention of HIV/AIDS and the care of infected persons are noted. Deep concern is expressed about the fact that the State party has the fastest growing rate of HIV/AIDS infection in the region and that children are among the most affected groups, in particular due to mother-to-child transmission.

Paragraph 377

The State party should continue to take effective measures for the prevention of HIV/AIDS, including awareness-raising and educational campaigns. The State party should take into consideration the Committee's recommendations adopted on its day of general discussion on children living in a world with HIV/AIDS (CRC/C/80). International technical assistance from UNICEF, WHO and UNAIDS, among others, should continue to be requested in this regard.

See also:

•	Comoros, CRC, CRC/C/100 (2000) 110 at para. 632.

•	Suriname, CRC, CRC/C/97 (2000) 84 at para. 492.

The Government should allocate appropriate resources and develop comprehensive policies and programmes to improve the health situation of children, especially those living in the interior; facilitate greater access to primary health services; increase the number of trained medical and other health personnel; take steps to reduce the incidence of maternal, child and infant mortality; promote healthier breastfeeding and weaning practices; prevent and combat malnutrition, especially among vulnerable and disadvantaged groups of children; increase access to safe drinking water and sanitation and reduce the incidence of malaria. It is recommended that the State party undertake a study on suicides and accidents involving children with the view to understanding their nature and scope and implementing appropriate preventative policies and measures.

•	Djibouti, CRC, CRC/C/97 (2000) 96 at paras. 550, 551, 564 and 565.

Paragraph 550

The poor health status of children in Djibouti is of concern. In particular, concern is expressed the high rates of infant and under-five mortality, maternal mortality, child malnutrition and smoking. While welcoming the adoption of baby-friendly hospital initiatives, the Committee is also concerned about the risk of mother-to-child transmission of HIV, given the high rates of HIV infection. The decline in spending on the health sector and the reduction in vaccination coverage is regretted.

Paragraph 551

The State party is encouraged to increase its efforts in the health sector, including through the strengthening of data collection and disease surveillance mechanisms, the allocation of adequate resources and the reinforcement of training and support for health sector staff. The State party should ensure equitable access to existing health-care services, make every effort to increase vaccination coverage, including by ensuring the maintenance of a cold chain, and undertake effective collection and recording of data in this respect. Effective measures should be taken to provide information and support to HIV-infected mothers to prevent HIV transmission, in particular by providing safe alternatives to breastfeeding. It is recommended that the State party address the social factors preventing vulnerable groups (including women and children) from seeking health care, and that particular efforts be made to reach refugee and displaced children and those living on the streets. The State party is urged to develop effective partnerships with NGOs and civil society groups, and to seek the technical assistance of United Nations agencies such as WHO and UNICEF in this respect.

Paragraph 564

Concern is expressed about the high and increasing involvement of children in the production, trafficking and consumption of psychotropic drugs (and especially of khat), and about the impact on children of widespread khat consumption in the State party which affects families and the entire society.

Paragraph 565

In view of articles 33 and 39 of the Convention, the State party is urged to take all appropriate measures to prevent the involvement of children in the production, trafficking and consumption of khat and other psychotropic drugs as well as to provide care and rehabilitation, and to pay particular attention in this regard to vulnerable groups, including children who drop out of school, live on the streets, or work in the port area. The State party is encouraged to seek technical assistance from UNICEF and WHO, among others, and to involve children in the design, implementation and evaluation of relevant strategies, and to continue its cooperation with the United Nations Drug Control Programme in this regard.

•	Burundi, CRC, CRC/C/100 (2000) 17 at paras. 139, 140, 145 and 146.

Paragraph 139

The low immunization rate, the high levels of malnutrition and micro-nutrition deficiencies and the extremely poor health conditions among children in general, and particularly in camps, are matters of deep concern. Further, the Committee is concerned at high mortality rates among children, high maternal mortality rates, at low investment in health care, the limited number of hospitals and health centres that are operational, the limited drug supply and relatively high cost of medicines, including generic drugs, and the concentration of medical professionals in Bujumbura city.

Paragraph 140

The State party is urged to make significant increases in the health budget, to make every effort to improve public health, including primary health care, and to ensure adequate access for all children to health services, with particular regard to those living in rural communities and in camps. It is recommended that the State party implement integrated policies and programmes for the management of childhood illnesses and measures to improve child and maternal health. The State party should seek the assistance of UNICEF and WHO in this regard.

Paragraph 145

Deep concern is expressed about the high incidence of HIV/AIDS in the State party and its impact, either direct or indirect, on children and adolescents.

Paragraph 146

Noting the efforts made in this regard, including the national programme to combat HIV/AIDS, the State party should pursue and increase its current efforts to promote awareness and prevention of HIV/AIDS, in the light of the recommendations adopted at the Committee's day of general discussion on children living in a world with HIV/AIDS (see CRC/C/80, chap. III.C).

•	United Kingdom of Great Britain and Northern Ireland (Isle of Man), CRC, CRC/C/100 (2000) 31 at paras. 192 and 193.

Paragraph 192

That cigarette smoking is still prevalent among school-age children, especially girls is of concern. While the enactment of the Mental Health Act is noted, additional efforts are needed to strengthen child mental health services. Additional efforts are also needed better to address adolescent reproductive health concerns, particularly as regards teenage pregnancy and sexually transmitted diseases (STDs).

Paragraph 193

Efforts made to address drug and alcohol abuse and cigarette smoking among adolescents, especially among schoolgirls should be reinforced. All appropriate measures should be taken to strengthen reproductive health education, including the promotion of male acceptance of the use of contraceptives. A comprehensive and multidisciplinary study should be undertaken to understand the scope of adolescent reproductive health concerns, including the incidence of STDs. Additionally, the Isle of Man should undertake further measures, including the allocation of adequate human and financial resources to ensure the provision of youth-friendly care, counselling and rehabilitation services for adolescents, and to strengthen child mental health services.

•	Tajikistan, CRC, CRC/C/100 (2000) 53 at paras. 304 and 308.

Paragraph 304

The State party should provide early childhood care and special education for children with disabilities; develop early identification programmes to prevent disabilities; and provide services for children with learning disabilities and behavioural disorders. Awareness campaigns which focus on prevention, inclusive education, family care and the promotion of the rights of children with disabilities need to be undertaken. Adequate support, supervision and training should be given to persons working with these children.

Paragraph 308

It is recommended that the State party undertake a comprehensive study in order to understand the nature and extent of adolescent health problems, and with the full participation of adolescents, use this as a basis to formulate adolescent health policies and programmes. In the light of article 24, adolescents should have access to and be provided with reproductive health education, child-friendly counselling and rehabilitation services. STD and HIV/AIDS prevention programmes should be undertaken. The State party should establish comprehensive family planning programmes, as well as measures to ensure that abortion is not perceived as a method of contraception.

See also:

•	Jordan, CRC, CRC/C/97 (2000) 31 at para. 194.

•	Central African Republic, CRC, CRC/C/100 (2000) 77 at paras. 453, 454, 477 and 478.

Paragraph 453

Deep concern is expressed about the high level of HIV/AIDS infection among children or their parents or other persons, such as teachers, with a particular responsibility towards children.

Paragraph 454

The State party is urged to strengthen its efforts to combat HIV/AIDS infection, including through efforts to combat tuberculosis. The State party is also urged to consider ways of minimizing the impact upon children of HIV/AIDS-related deaths of parents, teachers and others, in terms of children's reduced access to a family life, to emotional care and education.

Paragraph 477

The incidence of drug abuse by children, including the sniffing of petrol and glue, is of concern.

Paragraph 478

Measures should be implemented to prevent and eliminate the abuse of drugs by children, including the sniffing of petrol and glue, inter alia through sensitization of children and adults about the harm caused by such abuse and through the implementation of measures providing for the care, rehabilitation and social reintegration of child drug abusers.

•	Slovakia, CRC, CRC/C/100 (2000) 100 at paras. 582-585.

Paragraph 582

The high levels of pollution in industrialized areas are of concern, particularly air pollution and water and food contamination caused by nitrates, pesticides and heavy metals.

Paragraph 583

In light of article 24(c) of the Convention, all appropriate measures should be taken to prevent and combat the dangers and risks to the health of children posed by environmental pollution.

Paragraph 584

Rising rates of tobacco and alcohol use among adolescents are of concern.

Paragraph 585

The State party is encouraged to provide children with accurate and objective information about substance use, including tobacco use, and to protect them from harmful misinformation through comprehensive restrictions on tobacco advertising. Rehabilitation services should be developed for children who are victims of substance abuse.

•	Comoros, CRC, CRC/C/100 (2000) 110 at paras. 630 and 631.

Paragraph 630

The high infant and maternal mortality rates, the large number of births taking place outside the hospital system and the high rate of malnutrition among children are matters of concern. Children's limited access to the health services are of concern, especially with regard to the shortage of medication and technical equipment, and of medical and public health personnel. The spread of the HIV/AIDS epidemic and its direct and indirect effects on children, as well as the general lack of attention to the health problems of adolescents, are also matters of concern.

Paragraph 631

Efforts should be increased in the health sector, including through the strengthening of data collection and disease surveillance mechanisms, the allocation of adequate resources and the reinforcement of training and support for health sector staff. The State party should ensure equitable access to existing health-care services and make every effort to increase vaccination coverage. The State party is urged to adopt, in cooperation with international agencies, effective plans to combat childhood and maternal mortality, such as the WHO/UNICEF Integrated Management of Childhood Illness scheme.

•	Latvia, CRC, CRC/C/103 (2001) 9 at paras. 62 and 63.

Paragraph 62

While noting that the State party started a process focusing on preventive health care, the situation of maternal, child and reproductive health is poor. In particular, it is noted with concern that infant mortality rates are high. Child morbidity, in particular the high incidence of tick-induced encephalitis and diphtheria is a concern. It is noted that the immunization programme has been delayed because sufficient funds were not available and that it is no longer available in schools.

Paragraph 63

Appropriate resources should be allocated and comprehensive policies and programmes developed to improve the health situation of all children, without discrimination. With reference to the immunization programme, the State party should look to international cooperation for support in the manufacture and procurement of vaccines.

•	Liechtenstein, CRC, CRC/C/103 (2001) 19 at paras. 108 and 109.

Paragraph 108

The comprehensive approach to implementing primary prevention of drug abuse among adolescents is noted with interest. However, concerns remain about the health problems faced by adolescents within the State party.

Paragraph 109

The State party should continue with and expand to other areas, the comprehensive approach of primary prevention, in particular concerning alcohol abuse and also with regard to the possibility of adolescents making independent decisions in health matters that directly affect them. Furthermore, the State party should continue and strengthen its activities to prevent HIV/AIDS and STDs and teenage pregnancies and to pay special and increased attention to adolescent victims of

road accidents.

•	Ethiopia, CRC, CRC/C/103 (2001) 24 at paras. 168, 169, 174 and 175.

Paragraph 168

Deep concern is expressed at the extremely high infant mortality rates and low life expectancy in the State party. In particular, concern is expressed at the high incidence of malaria and tuberculosis and their effects upon children, at the fragile health infrastructure, limited health awareness among the public and the limited implementation of the 1993 Health Policy and the 1994 Social Policy. The implementation of health policies has been slow and only limited progress has been achieved in this area.

Paragraph 169

The State party is urged to ensure that access to primary health care services is increased, that the national health infrastructure is strengthened and that public health education programmes are used to lower infant mortality rates and raise life expectancy in the State party. Assistance should be sought from the World Health Organization, UNICEF and the United Nations Development Programme in this regard.

Paragraph 174

Concern is expressed at the large number of children with HIV/AIDS or who are affected by the HIV/AIDS-related illness or death of their parents and other family members, and at the need for concerted action by the State party.

Paragraph 175

The State party is urged to make efforts to remain informed of the scale of the HIV/AIDS problem in the country, to reduce the spread of HIV/AIDS and to provide assistance to children with HIV/AIDS and to children whose parents and other family members have HIV/AIDS. The State party should give particular attention to HIV/AIDS orphans and to ensuring that children with HIV/AIDS are not discriminated against. It is recommended that the State party make use of educational measures.

•	Lithuania, CRC, CRC/C/103 (2001) 47 at paras. 300 and 301.

Paragraph 300

The reported increasing use of drugs, including psychotropic substances, among children and adolescents in the State party, in particular those living in the street is of concern. The present welfare service system is unable to deal with the growing need for services.

Paragraph 301

The State party should undertake studies on the abuse of drugs among children and adolescents, in particular those living in the street, with a view to understanding the extent, scope and nature of these practices, adopting adequate measures and policies and changing attitudes. Further, awareness raising and preventive measures should be pursued, including drug education in schools. More resources should be allocated for treatment and rehabilitation services specifically tailored for children and adolescents.

See also:

•	Finland, CRC, CRC/C/100 (2000) 8 at paras. 79 and 80.

•	Lesotho, CRC, CRC/C/103 (2001) 57 at paras. 353-356.

Paragraph 353

The poor health situation of children in the State party is noted with concern, particularly the limited access to basic health care for children (especially in rural and mountainous areas), high maternal, child and infant mortality rates, low and decreasing immunization levels, high rates of malnutrition, poor sanitation and limited access to safe drinking water, especially in rural communities. The health risk linked to male circumcision is also a matter of concern. Concern is also expressed about the low and decreasing number of trained health personnel, including mental health and social welfare professionals, which is contributing to the insufficient provision of essential services.

Paragraph 354

It is noted that the State party is currently reviewing its Social Welfare Policy. The State party is urged to pursue its efforts to ensure that the new policy covers all groups of vulnerable children. The State party should ensure that the policy provides an effective basis for addressing the challenges of poverty and HIV/AIDS. Appropriate resources should be allocated and comprehensive policies and programmes should be developed to improve health infrastructure, to increase the number of trained health and welfare, including mental health, professionals, to improve the health situation of children, to facilitate greater access to primary health services, to reduce the incidence of maternal, child and infant mortality, to prevent and combat malnutrition, especially in vulnerable and disadvantaged groups of children, and to improve access to safe drinking water and sanitation. Health risks associated with male circumcision should also be addressed.

Paragraph 355

Extreme concerns exist about the alarmingly high incidence and increasing prevalence of HIV/AIDS amongst adults and children, in particular amongst teenage girls, and the high incidence of teenage pregnancy and sexually transmitted diseases (STDs). Furthermore, concern is expressed about the insufficient availability of adolescent health programmes and services and about the incidence of suicide, violence, sexual exploitation and abortion, alcohol consumption and tobacco and dagger smoking.

Paragraph 356

The State party is strongly urged to fully implement the National AIDS Strategic Plan 2000/2001-
2003/2004 and the Policy Framework on HIV/AIDS Prevention, Control and Management as soon as possible and to devote to them ample resources to ensure their success. A comprehensive and multi-disciplinary study should be undertaken to understand the scope of adolescent health problems, including the negative impact of early pregnancy, as well as the special situation of children infected with, affected by or vulnerable to HIV/AIDS and STDs. Particular attention should be given to the secondary consequences of HIV/AIDS, such as an increase in child-headed households following the death of adult family members. Additionally, further measures should be undertaken, including the allocation of adequate human and financial resources, to develop youth-friendly counselling, care and rehabilitation facilities for adolescents, especially girls, which would be accessible by them without parental consent. The State party should increase its efforts to promote adolescent health policies, including mental health, particularly with respect to suicide prevention. Reproductive health education and counselling services should also be strengthened. All training programmes on reproductive health should address boys as well as girls. Furthermore, the State party should implement measures to discourage the abuse of alcohol and the smoking of tobacco and dagger by adolescents.

•	Palau, CRC, CRC/C/103 (2001) 79 at paras. 466 and 467.

Paragraph 466

Concern is expressed about the limited availability of programmes and services and the lack of adequate data in the area of adolescent health, including suicides; mental health, particularly with respect to boys; teenage pregnancy; STDs; and the use and abuse of tobacco, betelnut, alcohol and illicit drugs.

Paragraph 467

The State party should increase its efforts to promote adolescent health policies and services and to further strengthen reproductive health education, including the promotion of male acceptance of the use of contraceptives. A comprehensive and multidisciplinary study should be undertaken to understand the scope of adolescent mental health concerns. Additionally, further measures, including the allocation of adequate human and financial resources should be undertaken, to increase the number of social workers and psychologists, and to develop accessible youth-friendly care, counselling, and rehabilitation facilities for adolescents.

•	Turkey, CRC, CRC/C/108 (2001) 18 at paras. 131-134.

Paragraph 131

It is noted that infant, child and maternal mortality rates and malnutrition rates are particularly high in rural areas on the south eastern region and in poor urban areas. It is also noted that the immunization programme does not cover all children in the State party and that immunization rates are particularly low in the eastern region.

Paragraph 132

To prevent child mortality and morbidity, adequate antenatal and post-natal health care services should be provided and campaigns developed to provide parents with basic knowledge of child health and nutrition, the advantages of breast-feeding, hygiene and environmental sanitation, and the prevention of accidents. The State party is encouraged to look to international cooperation for the full and efficient implementation of the immunization programme.

Paragraph 133

Concern is expressed regarding the high rates of early pregnancy, the rise in the number of children and young people using tobacco and drugs, the increase in cases of sexually transmitted diseases (STDS), in particular syphilis, and the growing number of case of HIV/AIDS among young people. Furthermore, the limited availability of programmes and services in the area of adolescent health, including mental health, in particular treatment and rehabilitation programmes for drug addiction, is noted. The lack of sufficient prevention and information programmes, especially on reproductive health, in schools is also noted.

Paragraph 134

Efforts should be increased to promote adolescent health, including mental health, policies particularly with respect to reproductive health and substance abuse and the programme for health education in schools should be strengthened. It is suggested that a comprehensive and multidisciplinary study be undertaken to understand the scope of adolescent health problems, including the negative impact of STDs and HIV/AIDS, in order to be able to develop adequate policies and programmes. It is also recommended that the State party undertake further measures, including the allocation of adequate human and financial resources, to evaluate the effectiveness of training programmes in health education, in particular as regards reproductive health, and to develop youth-sensitive counselling, care and rehabilitation facilities that are accessible without parental consent, when this is in the best interests of the child.

See also:

•	Guatemala, CRC, CRC/C/108 (2001) 47 at paras. 268, 271 and 272.

•	Mauritania, CRC, CRC/C/111 (2001) 8 at paras. 64, 65, 68 and 69.

•	Paraguay, CRC, CRC/C/111 (2001) 103 at paras. 506 and 507.

•	Democratic Republic of the Congo, CRC, CRC/C/108 (2001) 31 at paras. 197, 198, 201, 202, 221 and 222.

Paragraph 197

Particular concern is expressed at the weaknesses in the health infrastructure, including a lack of appropriate equipment within many health centres, the limited quality of service and low immunization rates.

Paragraph 198

It is recommended that the State party improve the access of children and mothers to health care, including primary and mental health care, continue and strengthen its vaccination campaign, and develop and implement a clear health policy with regard to children including the promotion of breastfeeding, the implementation of adequate family planning programmes and action to reduce and prevent malnutrition. It is further recommended that assistance be sought from UNICEF and WHO in this regard.

Paragraph 201

Deep concern is expressed at the very high number of children affected by HIV/AIDS through direct infection, including mother-to child transmission, or following the illness or death of a parent. There is also concern about provisions in the Criminal Code banning contraception given the growing need to prevent transmission of HIV/AIDS.

Paragraph 202

Every effort should be made to reduce the incidence of HIV/AIDS by preventing its transmission among the population through the procurement of suitable medication, a review of legislation, and suitable prevention campaigns. It is further recommended that assistance be provided to children and their families affected by HIV/AIDS. Assistance should be sought from UNICEF and WHO in this regard.

Paragraph 221

The number of children abusing substances, such as by inhaling solvents and using cannabis, is of concern.

Paragraph 222

Measures should be implemented to prevent substance abuse by children, including through preventing the sale of such substances to children and addressing factors leading to vulnerability. The State party should pursue its efforts to use information campaigns to alert children and adults to the risks of substance abuse and child victims of substance abuse should be provided with appropriate care, rehabilitation and assistance towards their social reintegration.

•	Côte d'Ivoire, CRC, CRC/C/108 (2001) 59 at paras. 325, 326, 329 and 330.

Paragraph 325

The survival and development of children within the State party continues to be threatened by early childhood diseases such as acute respiratory infections and diarrhoea. Concern is also raised by the poor situation of sanitation and the insufficient access to safe drinking water, especially in rural communities.

Paragraph 326

The State party should facilitate greater access to primary health services; reduce the incidence of maternal, child and infant mortality; prevent and combat malnutrition, especially in vulnerable and disadvantaged groups of children; promote proper breastfeeding practices; and increase access to safe drinking water and sanitation. Additionally, the State party is encouraged to pursue additional avenues of cooperation and assistance for child health improvement with, among others, WHO and UNICEF.

Paragraph 329

While noting the existence of the National Programme for the Control of AIDS, Sexually Transmitted Infections and Tuberculosis, the establishment of a special Ministry on HIV/AIDS, and the setting up of a committee on HIV/AIDS orphans, extremely concern remains at the alarmingly high incidence and increasing prevalence of HIV/AIDS amongst adults and children and the resulting large number of children orphaned by HIV/AIDS. The lack of alternative care for these children is also of concern. The large number of teachers dying of HIV/AIDS in the State party is of deep concern.

Paragraph 330

The State party should increase its efforts to prevent HIV/AIDS. The State party is also urged to consider ways of minimizing the impact upon children of the HIV/AIDS-related deaths of parents, teachers and others, in terms of children's reduced access to a family life, to adoption, to emotional care and to education. Technical assistance should be sought from, among others, UNAIDS.

See also:

•	Kenya, CRC, CRC/C/111 (2001) 21 at paras. 124 and 125.

•	Monaco, CRC, CRC/C/108 (2001) 97 at paras. 527 and 528.

Paragraph 527

Drug abuse among children is a matter of concern.

Paragraph 528

The State party should implement measures to prevent and end drug abuse among children and to provide rehabilitative assistance, where needed, to children who have abused drugs.