[Documents/Docheader.htm]

European strategy for the promotion of sexual and reproductive health and rights

Doc. 10266
 26 August 2004

Report

Social, Health and Family Affairs Committee
 Rapporteur: Ms Christine McCafferty, United Kingdom, Socialist Group

Summary

According to the definitions adopted at the International Conference on Population and Development (Cairo, 1994), every individual should have a right to sexual and reproductive health, defined as a state of complete physical, mental and social well-being.

There is enormous disparity of standards between member states of the Council of Europe and even within member states. Many countries have issues for concern: rising teenage pregnancies, high rates of sexually transmitted infections (STIs) including HIV/Aids infections, rising infertility rates, poor access, availability, affordability and a lack of use of sexual and reproductive health commodities and services and poor relationship and sex education. Maternal and child morbidity and mortality and reproductive cancers remain serious problems, together with sexual violence and exploitation, including the trafficking of young girls.

The Parliamentary Assembly calls upon member states to adopt comprehensive national strategies for sexual and reproductive health and to provide adequate budgets to achieve these goals and on the Committee of Ministers to instruct the European Health Committee to promote the exchange of best practices and to develop guidelines.

I.           Draft resolution [Link to the adopted text]

1.         The right to protection of health is part of the Council of Europe acquis (Articles 11 and 13 of the revised European Social Charter). Every individual has the right to the enjoyment of the highest attainable standard of health which is defined by the World Health Organisation as a state of complete physical, mental and social well-being.

2.         The right to sexual and reproductive health implies that people are able to enjoy a mutually satisfying and safe relationship, free from coercion or violence and without fear of sexually transmitted infections, including HIV/Aids or unwanted pregnancies. Individuals and couples should be able to regulate their fertility without adverse or dangerous consequences.

3.         The International Conference on Population and Development (ICPD, Cairo, 1994) and the Fourth World Conference on Women (Beijing, 1995) have put sexual and reproductive rights firmly on the human rights agenda. The objectives of the ICPD Programme of Action (PoA) have shifted the focus to the needs and rights of the individual.

4.         A large number of objectives were adopted in Cairo in 1994 as part of the International Conference on Population and Development Plan of Action (ICPD PoA). 179 Countries pledged to reduce maternal mortality and combat HIV/Aids and improve people’s sexual and reproductive health and rights. The ICPD objectives were further reaffirmed in the Millennium Development Goals, which were adopted by the United Nations General Assembly in 2000.

5.         In 2002, parliamentarians from over 70 countries around the world adopted the Ottawa Statement of Commitment, endorsed by this Assembly in September 2003 and pledged to “give high priority to achieving universal access to reproductive health services and commodities in national health and poverty-reduction frameworks, both in terms of budget allocations and in terms of programme activities”.

6.         This year, 2004, marks the 10-year anniversary of the International Conference on Population and Development Plan of Action. To mark this important benchmark, a review has been initiated by the United Nations Population Fund (UNFPA) to assess progress and shortfalls.

7.         Many Council of Europe member states have very high standards of sexual and reproductive health, taking into account indicators such as contraceptive use, HIV/AIDS prevalence, abortion rates, maternal and child morbidity and mortality rates. Their experiences can serve as a useful example to other member states in finding solutions to improve the sexual and reproductive health situation in their own countries.

8.         However, there is enormous disparity of standards between member states and even within member states. In many Council of Europe member states there are issues for concern: rising teenage pregnancies, high rates of sexually transmitted infections (STIs) including HIV/Aids infections, rising infertility rates, poor access, availability, affordability and a lack of use of sexual and reproductive health commodities and services and poor relationship and sex education.

9.         In many Eastern European countries contraceptive use remains low leading to unwanted pregnancies; abortion rates in some areas are among the highest in the world as a result of a lack of appropriate sexual and reproductive health information and services. In some member states women are still forced to resort to illegal, backstreet and therefore unsafe abortions.

10.       Maternal and child morbidity and mortality and reproductive cancers are issues of great concern in many countries, together with sexual violence and exploitation, including the trafficking of young girls.

11.       The Parliamentary Assembly calls upon member states to:

i.                     prepare and adopt comprehensive national strategies for sexual and reproductive health which address the issues of:

a.                  sexual and reproductive health information and education, especially for children and adolescents;

b.                  rising teenage pregnancies;

c.                  rising sexually transmitted infections (STIs) including HIV/Aids;

d.                  infertility;

e.                  high abortion rates, including unsafe abortions in some member states where abortion is illegal;

f.                    lack of affordable, accessible, available sexual and reproductive health commodities and services;

g.                  reproductive cancers;

h.                  sexual violence and exploitation, including the trafficking of young girls;

i.                    maternal and child morbidity and mortality;

ii.                   take all appropriate measures to ensure equality between men and women in all aspects of life, including in relation to universal access to comprehensive sexual and reproductive healthcare services;

iii.                  increase sexually transmitted infections (STI) screening, treatment and voluntary counselling and testing (VCT) for HIV and subsequent treatment for those found to be HIV positive;

iv.                  facilitate access to affordable and wide-ranging contraceptives and services;

v.                    provide age-appropriate, comprehensive sexual and reproductive information and education;

vi.                  respond to the specific needs of young people, with specific reference to confidentiality and youth friendly services;

vii.                 respond to the specific needs of vulnerable population groups, including migrants, minorities and the rural population;

viii.               meet changing sexual and reproductive health needs over the life cycle.

12.       In order to attain the above goals, the Assembly encourages member states to:

i.                     work with and support national and regional non-governmental organisations and the private sector in the formulation and implementation of national strategies for sexual and reproductive health;

ii.                   engage in dialogue with young people and vulnerable population groups in the formulation of appropriate strategies and programmes, which respond to the sexual and reproductive health needs of these groups;

iii.                  encourage the creation in national parliaments of mechanisms and structures which tackle the sexual and reproductive health situation, in the national context, such as all-party parliamentary groups;

iv.                  provide appropriate funding in national health budgets to achieve these objectives.

II.         Draft recommendation [Link to the adopted text]

1.         The Parliamentary Assembly of the Council of Europe refers to its Resolution …. (2004) on European strategy for the promotion of sexual and reproductive health and rights and recommends that the Committee of Ministers :

i.                     forward this Resolution to the governments of member states and request them to take it into account when developing their national strategy for sexual and reproductive health and rights;

ii.                   instruct the appropriate committee, namely the European Health Committee, in co-operation with relevant European partners to:

a.                  promote an exchange of experiences between member states on successful national sexual and reproductive health approaches;

b.                  promote dialogue on sexual and reproductive health rights in public health policy and the advancement of sexual and reproductive health and rights from a European human rights perspective and address the development of new reproductive health technologies;

c.                  support the collection of comparable data and development of indicators regarding sexual and reproductive health;

d.                  to develop guidelines to assist member states in drafting national sexual and reproductive health strategies.

III.        Explanatory Memorandum by the Rapporteur

1.         Basic concepts

1.         Reproductive health, and above all promoting healthy reproductive behaviour, are key priorities for the world community, in line with the Programme of Action of the International Conference on Population and Development (Cairo, 1994).

2.         Definition of reproductive health[1]

            “Reproductive health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.”

3.         Reproductive health service

            The purpose of reproductive health care is to enable enhancement of life and personal relations, besides providing counselling and care related to reproduction and sexually transmitted diseases.

4.         Reproductive rights

            Reproductive rights embrace certain human rights that are already recognized in national laws, and international human rights documents :

            “recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health.“ (Chapter VII, ICPD, 1994)

5.         The Declaration and Platform for action adopted at the World Conference of Women, (1995 Beijing) took the issue further and reads as follows :

            “The human rights of women include the right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences.”[2]

2.         Human Rights relevant to sexual and reproductive health

6.         In order to provide examples of what sexual and reproductive rights encompass, several relevant articles from the European Convention for the Protection of Human Rights and Freedoms (ECHR) and the European Social Charter (ESC) are listed below:

7.         Right to non-discrimination in relation to the Substantive Rights of the Convention (ECHR, article 14)

            “The enjoyment of the rights and freedoms set forth in this Convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.”

8.         Right to Liberty and Security of a Person (ECHR, article 5)

            “Everyone has the right to liberty and security of the person.”

            Government regulation may interfere with the right to liberty and security of the person if it results in compelled sterilization and abortion. The right to liberty of the person may also be violated if the state imposes criminal sanctions to those who provide or seek voluntary sterilization, contraception, abortion and as a result subjects women to compulsory pregnancy.

9.         Right to private life and Family life (ECHR, article 8)

            The right to private life requires states to protect confidentiality in the provision of reproductive and sexual health services.

10.       Right to receive information (ECHR, article 10)

            The right to receive and impart information requires states to ensure that individuals receive information necessary for them to protect and promote their sexual and reproductive health.

11.       Right to protection for mothers and children (ESC, article 8, article 17)

            Women require care and protection during pregnancy, as well as during and after childbirth to ensure maternal health. The two articles regulate conditions of maternity leave for employed women, and call on governments to provide appropriate institutions and services to guarantee the right of mothers and children to social and economic protection.

12.       Right to health (ECS article 3, article 11)

            Without affordable and accessible health services, reproductive health can not be ensured. Reproductive healthcare includes care services to treat existing health problems as well as the provision of preventive measures (counselling and treatment) related to reproduction and sexually transmitted diseases.

13.       Rights of the Family (ESC, article 16)

            Governments have the positive obligation to provide relevant information, education and services to protect family life (legal, economic and social protection). Also, to ensure women’s autonomous and confidential choices in reproductive matters and protection of their private life.

            The promotion of the responsible exercise of these rights for all people should be the fundamental basis for government and community-supported policies.

3.         Challenges

14.       Globally

1.       inadequate levels of knowledge about human sexuality and inappropriate or poor-quality reproductive health information and services

2.       prevalence of high-risk sexual behaviour

3.       discriminatory social practices

4.       negative attitudes towards women and girls and power over their sexual and reproductive lives

5.       adolescents are particularly vulnerable because of their lack of information and access to relevant services in most countries

6.       older women and men have distinct sexual and reproductive health issues which are often poorly addressed

7.       under-funding

8.       opposition from some conservative and religious authorities

15.       Shortcomings in Europe

1.       teenage pregnancies are on the rise ;

2.       HIV/AIDS and sexually transmitted infections are increasing at among the fastest rates in the world ;

3.       contraceptive use remains low in many countries leading to unwanted pregnancies ;

4.       shortages in contraceptive commodity supplies have been declared in numerous member states ;

5.       lack of access to affordable contraceptives even in places where contraceptives are available ;

6.       despite the decrease in abortion rates, in some member states they remain among the highest in the world as a result of a lack of appropriate sexual and reproductive health information and services ;

7.       under-funding ;

8.       opposition from some conservative and religious authorities.

4.         Sexual and reproductive health in Europe

16.       The Rapporteur draws attention to the existing sources of information, namely the work of WHO, UNDP, Unicef, Council of Europe, Eurostat, UNECE, UNFPA and UN Economic and Social Council - Commission on Population and Development reports from 2002 and 2004.

17.       In 2002, in her report on sexual and reproductive health and rights[3], Anne Van Lancker, MEP, has already pointed out to the main issues concerning the current member states of the European Union. She focused on the use and access to modern methods of contraception, abortion policies and special needs of adolescents.

18.       To compensate for the lack of systematic data in countries of Central and Eastern Europe, a number of relevant national NGOs involved in reproductive health issues have contributed to the CRLP research on laws and policies affecting the reproductive lives of women in East and Central Europe, which was published in 2000[4].

19.       More recently, in September 2003, the Council of Europe Directorate General on Social Cohesion (DGIII) published a comprehensive study on reproductive health behaviour of young Europeans[5] which is based on the expert work of European Population Committee (CAHP). The Rapporteur commends the analysis of compiled data and its conclusions.

          Reproductive health services as part of general provision of healthcare?

20.     No national governments in Europe have a clear and separate policy on sexual and reproductive health, but the majority of countries support family planning services, which are, on the whole, widely available through health systems, mostly through general practitioners. Services, including contraceptives, are free of charge in the United Kingdom and Portugal. In other countries clients pay, but in most cases are partially or fully reimbursed. Family planning is not integrated into the health system in Spain and Greece and in Ireland state funding is only available to centres providing "natural methods".

21.     Countries of Central and Eastern Europe shared common heritage prior to 1989, where governments provided universal health care services to all. Not all health care services were necessarily up to WHO standards of care, but over the last decade the budgetary cuts and the regional trend towards privatisation have had detrimental consequences of reducing access to healthcare. CRLP report draws attention to the inadequacy of family planning services. Poland is perhaps the most extreme example in declining to fund family planning as part of its reproductive health commitment. Most countries in the region apply a narrow definition of reproductive health and put resources into maternal and child health programs, neglecting a full range of other services.

          Lack of information and access to contraception

22.     Contraceptive use varies both between and within Member States: services are less available in some countries for young people, for immigrants and for people in rural areas. The average rate of modern methods of contraceptive use in the European Union is around 65 %, Austria and Greece are around 53%, Germany, Finland, the United Kingdom and the Netherlands have the highest rate (around 75%).

23.     The average rate of contraceptive use in the Countries of Central and Eastern Europe is much lower, with an average of around 31 %, with the lowest rates in Romania and Lithuania (around 13,5 %) and the highest rates in the Czech Republic, the Slovak Republic, Hungary and Slovenia (around 47 %). In most countries of the region, modern methods of contraception must be imported and are extremely costly. This is especially the case in Albania, Russia and Romania. As a consequence, statistics show that abortion rates are higher than in most other parts of the world since it has served as the most accessible means of managing unwanted pregnancy.

            Teenage births: an indicator of social exclusion?

24.       Why should teenage birthrates be a matter of such concern? Physiologically, 18 or 19 is a better age to begin childbearing than 35.

25.       Giving birth as a teenager is believed today to put the young mother at a disadvantage, because the statistics suggest that she is more likely to drop out of school, to have no or low qualifications, to be unemployed or low-paid, to live in poor housing conditions, to suffer from depression, and to live on welfare. Similarly the child of a teenage mother is more likely to live in poverty, to grow up without a father, to become a victim of neglect and abuse and to do less well at school.

26.       Rising levels of education, more career choice for women, more effective contraception, and changing preferences, have increased the average age at first birth in all developed countries

27.       In many European countries - with the exception of Ireland, Portugal, Poland, Slovak republic and the United Kingdom - births to teenagers have more than halved in the last 30 years (see figure 8 in appendix 1).

28.       Yet, the relationship between teenage birthrates and overall birthrates varies considerably from country to country, suggesting that national differences in teenage birthrates are caused by factors that affect teenagers in particular.

29.       According the survey of the Innocenti Research Centre (Unicef), the proportion of young women aged 15 to 19 who give birth each year varies from 5.5 per 1000 in Switzerland, to 30.8 per 1000 in the United Kingdom, and above 50 per 1000 in the United States[6]. The teenage birth league (see figure 1 in appendix 1) reveals wide differences between 22 European countries under review.

30.       When measured against five different indicators of disadvantage - including poverty, unemployment and educational underachievement - women who gave birth as teenagers are seen to be markedly worse off in 12 of the 13 EU countries for which data are available, Austria being the exception.

31.       The Innocenti study also shows significant variation between countries in the likelihood of disadvantage associated with teenage pregnancy. In Austria the likelihood of living in poverty in later life is not strongly associated with giving birth as a teenager. But in Belgium, France, Germany and the United Kingdom a teenage mother is seen to be twice as likely to be living in poverty. And in the Netherlands and Denmark the probability is three times as high.

32.       Teenage births are therefore seen today as a matter of public and political concern, demanding government action in countries where teenage pregnancies remain high. They can not be understood outside the context of socio-sexual transformation, nor can they be understood outside the context of economic and social inequality.

            Abortion as means of contraception?

33.       The lowest reported legal abortion rates are in Belgium, Netherlands, Germany (around 7/1000 women), the middle group consists of Finland, France and Italy (around 12/1000 women), the highest abortion rates in the European Union are in Sweden, the United Kingdom and Denmark (around 17/1000 women). The most restrictive policy is in Ireland, where abortion is only allowed to save a woman’s life. In Portugal and Spain legal abortion is only possible in case of foetal impairment or rape, or to protect a women’s physical or mental health. Other countries allow abortion for medical and socio-economic reasons.

34.       In the Central and East European countries, abortion rates are much higher than in the EU. The lowest official abortion rates are in the Czech Republic (17/1000), Lithuania, Slovakia and Slovenia (21/1000 women); the middle group consists of Bulgaria, Latvia, Estonia, Hungary, (around 40/1000 women), the highest abortion rate is in Romania (52/1000 women).[7]

35.       Bulgaria, Romania, Belarus, Russian Federation and Ukraine had more legal abortions than live births according to data for 2000. These rates reflect women's lack of access to modern methods of family planning. Since 1989, little progress has been made towards increasing access to modern contraceptive methods. Most contraceptives are still imported. Many countries in the region also lack the infrastructure to distribute contraceptives effectively, especially in rural areas.

36.       Liberal abortion laws remain in force in Bosnia-Herzegovina, Croatia, Estonia, Latvia, Lithuania, Macedonia, Moldova, the Russian Federation, Slovenia, Ukraine, and the Union of Serbia and Montenegro. The republics of the Caucuses of Armenia, Azerbaijan and Georgia also have liberal abortion laws. Since 1986, Albania, Bulgaria, the Czech and Slovak Republics, Hungary, and Romania have liberalized their abortion laws. The laws recognize a woman's right to an abortion without restriction as to reason up to at least the first 12 weeks of pregnancy. Poland is currently the only country in the region where a woman is denied the right to choose an abortion. The legalisation of abortion in Romania in 1990, and in Albania in 1992, significantly reduced high maternal mortality rates which were due to unsafe illegal abortions.

          HIV and STI sharp increase

37.     In its recent report[8] UNDP warns against the fastest growing rates of HIV/AIDS infection in Eastern Europe and the Commonwealth of Independent States (CIS). Despite a comparatively low prevalence in the region, growth rates in new HIV infections, which are reported over the last several years in Estonia, Russia and Ukraine are among the world's highest. At least one out of every one hundred adults living in these three countries is now estimated to be carrying the virus-a, representing a threshold above which efforts to turn back the epidemic have failed in many other countries. See Table 1 in appendix 1.

5.         Elements for a European Strategy

38.       European strategies must address the mandate of the ICPD PoA and its overall theme, the interrelationships between sexual and reproductive health/populations, sustained economic growth and sustainable development.

39.       All human being are born free and equal in dignity and right. Human beings are at the centre of concern and are entitled to health and productive life in harmony with nature. Gender equality and equity and the empowerment of women, and the elimination of all kinds of violence against women, and ensuring women’s ability to control their own fertility, are cornerstones of sexual and reproductive health and population and development-related programmes.

40.       Everyone must have the right to enjoyment of the highest attainable standard of physical and mental health. States should take appropriate measures to ensure, on a basis of equality of men and women, universal access to health-care services, including related to reproductive health care, which includes family planning and sexual health. Reproductive health-care programmes and clinics must provide the widest range of services without any form of coercion.

41.       The ICPD PoA call on member states to address issues of:

42.       To improve sexual and reproductive health and rights (SRHR) a variety of activities, at different level, and by a multiplicity of actors are required. Personal skills need to be developed, health services need to be reoriented, community action needs strengthening, a supportive environment needs to be created together with in some instances health care reforms, legal reforms, improved access and quality of services, Information, education and communication improved, and capacity training of professionals in both the education and service delivery systems may need to be improved.

43.       Sexual and reproductive health varies enormously in Council of Europe (CoE) member states. Every country will need their own specific needs assessments and strategies, however certain SRHR issues are common and of concern to all CoE members states. CoE members states need to prepare and adopt comprehensive national strategies for SRHR which:

44.       In order to improve SRHR all stakeholders need to be involved. Adolescence is a period of growth, experimentation and identity search, during which youth are particularly vulnerable and many cases ill-informed to make responsible choices that would not compromise their sexual and reproductive health. Engaging young people and vulnerable groups in the formulation of appropriate strategies and programmes are important. Enhancing parenting skills and capacities also has an important part to play.

45.       Providing appropriate funding in national health and education budgets are necessary to implement and monitor national SRHR strategies.

46.       Investing in and improving individuals and couples and populations SRH ensures social progress, economic progress, poverty elimination, environmental protection and sustainable development.

6.         Case studies

            Case study 1 : Ireland : political changes following public opinion

47.       The speed of socio-economic development in Ireland has highlighted divisions on some issues between the traditional influence of Roman Catholic Church and the modernising values of the increasing number of people who believe that the individual must have freedom of choice. Many have therefore welcomed the legalisation of divorce and contraception. Abortion however, remains illegal except in extreme circumstances of a real and substantial risk to life of the mother.

48.       According to the Irish Minister of Health[9], there is a general agreement in society that whatever one’s views on the substantive issue of abortion, the effort must be made to tackle the problem of crisis pregnancy in Ireland, which involves over 6000 women having an abortion in the United Kingdom each year.

49.       In late 2000, the Fifth Progress Report of the All-Party Oireachtas Committee on the Constitution, in dealing with the subject of abortion, concluded that "a major problem facing Ireland is the large number of crisis pregnancies…. There is an urgent need to take measures to reduce the number of crisis pregnancies". The Oireachtas Committee therefore proposed the establishment of an agency which would have responsibility for drawing up a strategy to combat crisis pregnancies, to promote options (other than abortion) and to provide for post crisis pregnancy services. Following All-Party agreement on the issue, the Government announced the establishment of the Crisis Pregnancy Agency in October 2001.  A national strategy to address the issue of crisis pregnancy was adopted in late 2003.

50.       In recent decades, the role of marriage and patterns of family formation have changed significantly in Ireland. Although Ireland's fertility rate remains the highest in Europe[10], contraception is more freely available and 42.9% of sexually active females report that they always use it. Many women are now delaying having children until their thirties. Almost a third of births occur outside marriage, though many are within stable relationships. For example, in 1996, of a sample of 2,000 women attending an antenatal clinic, 35% were unmarried and, of these, over 25% said that they were in a stable relationship. Eleven percent (11%) of the total sample stated they were single.

51.       Irish society is changing rapidly. Factors influencing the cultural dynamic surrounding crisis pregnancy include: changes in patterns of work for parents; an increase in immigration to Ireland; liberalisation of attitudes towards sexuality and contraception; changes in how sexual activity is portrayed in popular culture; increasing acceptance of single parenthood; changes in patterns of sexual activity, with earlier sexual initiation; increases in alcohol consumption and drug use. Taken together, these trends have a significant impact on sexual behaviour which results in unplanned pregnancy.

52.       The national crisis pregnancy Strategy therefore provides for :

53.       The Strategy promotes comprehensive “abstinence plus” sex education, in which young people are encouraged to delay sexual activity but are also prepared for it - a model used in countries with lower teenage pregnancy rates, instead of delivering “abstinence alone” programmes.

54.       Until recently sex education in schools in Ireland, termed Relationships and Sexuality Education (RSE), was an optional stand-alone element of school education. A separate curriculum for RSE was developed for primary, junior and senior cycles in 1996, and was accompanied by specific training for primary and secondary school teachers. Today, Social, Personal and Health Education (SPHE) covers all aspects of health education and skills building, including RSE, and is a mandatory part of the curriculum of the primary and junior cycles. An integrated SPHE programme at senior cycle incorporating RSE is being developed by the National Council for Curriculum and Assessment. Several structures currently support this work. Each Health Board region includes a Schools Support Service in its Health Promotion Department for both primary and secondary schools, guided by the National Health Promotion Strategy.

55.       The Health Promotion Unit of the Department of Health and Children have run, over a number of years, a range of initiatives to promote safer sex. These include:

56.       Services aimed at enabling individuals to avoid crisis pregnancy are underdeveloped in Ireland. For example, contraception services are limited in rural areas. There is also a lack of awareness of the type of service available. Access to emergency contraception ought to play a more important role in preventing crisis pregnancy.  The GP service is well placed to provide a range of contraception service, but they vary between regions and are often poorly understood by young people in particular.

57.       Some of the issues facing women who are experiencing crisis pregnancy in Ireland are : career and job-related concerns; perceived stigma of lone motherhood; consideration of children’s financial and emotional needs; financial considerations; accommodation; education prospects; childcare. Improving other options as alternative to abortion, implies changing policies and practices in the workplace, in the structure of financial supports and in the provision of childcare and accommodation. In some of these areas, such as childcare, change is underway. In other areas, progress will depend on co-operation of statutory partners and their remits, as well as co-operation with the private sector and voluntary organisations.

58.       In the area of post-crisis pregnancy services, the Agency’s goals are to design protocols for medical check-ups and to establish standards of best practice for post-abortion care and counselling.

59.       A range of organisations, both statutory and voluntary, currently provide vital supports and services for women experiencing crisis pregnancy. Many operate under significant financial constraints. The Crisis Pregnancy Agency is committing 1.17 million euro towards the development of the capacity in the areas of: counselling and supports; accommodation for pregnant women and supports for teenage parents.

60.       In conclusion, the prevention of unwanted pregnancy is only one aspect of sexual health. The Crisis Pregnancy Agency recommends the development of a national sexual health strategy for Ireland. In the absence of such national strategy, two health boards (out of 9 regional health boards) are in the process of developing strategies for their own region. In addition, the National AIDS Strategy was adopted in 2000 and the commitment to its full implementation was further reinforced by the National Health Strategy.

            Case study 2 : Poland : poor access to SRH services and education

61.       In February 2004, the Rapporteur visited Poland and met with the Minister of Health, Mr Sikorski, Government Plenipotentiary for Equal Status of Women and Men, Mrs Jaruga-Nowacka, Deputy Minister of Education and Sport, Secretary of State for Justice, Mr Janek head of the Democratic Left Alliance, senators Mrs Sienkiewicz, former Minister of Health and Mrs Kempka, co-founder of women’s parliamentary group and Mr Balicki, MP (Sejm), former Minister of Health. The Rapporteur also met with representatives of the Polish Family Planning Association (FPA), Polish federation for women and family planning and UNDP, and visited clinics in Lublin and Warsaw (see programme in appendix 3).

62.       Sexuality remains a taboo in Polish society where Roman Catholic Church exercises considerable influence in cultural, social and political sphere. As a result of political reluctance and budget deficits in healthcare, Poland today has poor family planning services, poor or virtually no sexual and reproductive health education, restricted access to affordable contraception and prohibited abortion (since 1993). Yet the termination of pregnancy was made legal in Poland already in 1956. In the period between 1956 and early 1990s, sexual and reproductive health services and counselling were widely accessible and received sufficient funding within the state healthcare budget. In 1993 Polish Sejm voted the Family Planning, Protection of Human Fetus and Conditions for Termination of Pregnancy Act. In 1996 there was an attempt to liberalise the Act. However, after the decision of the Constitutional Tribunal in 1997, the Sejm restricted the conditions once again.

63.       According to governmental and non-governmental reports on the effects of the 1993 law, only 2.2% of Poles use oral contraception as means of family planning. Many doctors are reluctant to prescribe contraception for fear of stigma and oral contraceptives became very expensive since most state subsidies were withdrawn in 1998. According to the 1997 report on population behaviour concerning sexually transmitted diseases : 30.1% of respondents admitted not using any method; 9.8% used the calendar cycle; 1.8% used the thermal method; and 15.1% used withdrawal. Only 20.8% used condoms.

64.       Young people are particularly at risk. In 1998, the regulation on the obligatory school programmes “knowledge about the sexual life of human beings” was withdrawn. Education is no longer compulsory and minors can only participate with their parents’ consent. In addition, the focus has shifted on teaching “education for family life” portraying traditional family values and sexual abstinence, with little factual information on how to avoid sexually transmitted diseases and unwanted pregnancy.

65.       There is no HIV preventive screening programme in Poland, and prenatal testing is limited.

66.       The Polish government committed itself to the 1994 International Conference on Population and Development Programme of Action, but has taken no practical action to fulfil this commitment. Family planning is officially included on the list of basic health care services provided by the state, but there are no systematic family planning services offered in its public health care institutions. The United Nations Human Rights Committee has noted the insufficiency of public family planning programs and recommended that Poland introduce policies and programs that would promote full and non-discriminatory access to all methods of family planning and that it reintroduce sex education in public schools.

67.       The Rapporteur believes that “progressive” forces in Poland ought to benefit from support and experience from other member states with more advanced policies for sexual and reproductive health.

            Case study 3 : Slovak Republic : reproductive rights of Romani women

68.       Following the release of the “Body and soul” report on forced sterilization and other assaults on Roma reproductive freedom in Slovakia[11] in January 2003, the Social, Health and Family Affairs Committee has held an exchange of views with the authors of the report, who conducted a human rights fact finding mission in 2002 involving interviews with more than 230 women in almost 40 Romani settlements in Eastern Slovakia. The interviews covered : sterilisation practices, treatment by health-care professionals in maternal wards, and access to reproductive health care information.

69.       The “Body and soul” report concluded with serious questions regarding respect for the bodily integrity of women and their reproductive rights, namely issues of :

70.       In May 2003, the Rapporteur visited several hospitals and Romani settlements in eastern Slovakia and met with the Deputy Prime Minister, head of the EU delegation, members of the Slovak Parliament, the Office of the Attorney General, the Ministry of Interior, the head of the criminal investigation team, health experts, lawyers involved in court cases, Roma NGOs and human rights activists (see programme in appendix 2).

71.       Whilst there was no apparent government policy of the sterilisation of Roma, the Rapporteur identified a number of shortcomings in Slovak legislation and institutional practice towards Roma, particularly lack of access to reproductive information and services. In her statement of 13 May 2003, the Rapporteur suggested several measures that were needed to improve the situation in the future :

- In December 1999, the Slovak Republic ratified the Council of Europe Convention on Human Rights and Biomedicine, which provides a definition of full and informed consent (Chapter 2, Article 5) and ought to serve as guidance for consent procedures in the country;

- development of a code of medical ethics and standardised procedures regarding the treatment of, and information provided to, patients, including access to their medical files, etc;

- training of field nurses who would visit Roma settlements to provide regular ante-natal care, childcare information, as well as information and services on reproductive health;

- amending the 1972 law on healthcare and sterilisation to bring it into line with European standards;

- drafting and adoption of an anti-discrimination law in compliance with European human rights standards;

- developing joint activities with Roma NGOs and dialogue in drafting policies and legislation concerning Roma, in project development at regional levels, and in monitoring;

- avoiding segregation in schools by introducing changes in selection tests to assess IQ and creativity rather than factual knowledge;

- developing training and education for Roma, appropriate for the needs of adults, and if possible in parallel with employment schemes;

- considering the example of a successful UK initiative to “make work pay’ through working families’ tax credits rather than welfare benefits;

- use of success stories to promote a positive image of Roma in the media;

- the adoption by the media of a code of ethics to promote racial harmony (similar, for example, to the BBC code of ethics);

72.     In June 2003, the expert team led by Professor Holoman, chief expert in gynaecology, made several recommendations to the Ministry of Health:

73.       The ten-year strategy for inclusion of Roma, prepared by the Slovak Government, represents an opportunity to address some of these issues. The Rapporteur suggested that the Slovak Government undertake a cost-benefit analysis of the Roma situation; seek an all-party consensus on proposed policies to ensure continuity; reinforce the status of Plenipotentiary with powers to implement policies; and to establish a more open dialogue with Roma NGOs.

74.       The Rapporteur is in full agreement with the findings and recommendations made by Alvaro Gil-Robles, Commissioner for Human Rights, in his Recommendation published in October 2003[12].

            Case study 4 : United Kingdom : implementation of a national strategy

75.       In 2001 the United Kingdom Government published a National Sexual Health and HIV Strategy in response to the country’s declining sexual health.

76.       The Strategy outlines the Government’s sexual health agenda for the next decade. The Government acknowledges the clear relationship between sexual ill health, poverty and social exclusion and is hoping that the strategy will modernise sexual health and HIV services in the country.

77.       United Kingdom sexual health figures show that:

78.       The strategy aims to:

79.       All this adds up to a strategy that proposes:

�         providing clear information so that people can take informed decisions about preventing STIs, including HIV;

80.       The Strategy is ambitious and comprehensive, and requires a ten-year commitment to deliver what it proposes. The UK Government agreed to invest an extra �47.5 million in the first two years to support a range of initiatives set out in the document. If the strategy succeeds it will contribute to reducing health inequalities. It will have set in place modern, efficient and patient-centred services, accompanied by a reduction in the burden of sexual ill health and HIV.

7.         Conclusion : Creating cultural change

81.       Our societies must ensure that every individual is empowered to make safe and responsible choices regarding their sexual and reproductive health. A culture open to the provision of adequate services, which can debate the issues surrounding sexual health openly and maturely, is most likely to contribute to the supportive environment which is vital for encouraging individual responsibility.

Appendix 1

Table 1: HIV/AIDS in Europe and the CIS

Cumulative reported HIV infections per million population

in Eastern European countries

Source: National AIDS Programmes (2002).  HIV/AIDS surveillance in Europe. End-of-year report.  Data compiled by the European Centre for the Epidemiological Monitoring of AIDS.

Figure 8 : Teenage birth rates now and 30 years ago

The pale bars show the number of births to women aged below 20 per 1,000 women ageed 15 to 19 in 1970 (the basis for the ranking). The dark bars show the rates in 1998 (as in Figure 1).

.

The teenage birth league

Figure 1

The table shows the number of births to women aged below 20 per 1.000 women aged 15 to 19. Data are for 1998, the most recent year for which comparable information is available from all countries.

Figure 6 : Low income and age at first birth

The table shows the percentage of mothers in the poorest 20 per cent, by age of mother at first birth. Pale bars indicate mothers who had their first child aged 15 to 19. Dark bars indicate mothers who had their first child aged 20 to 29.

Appendix 2

Council of Europe, Parliamentary Assembly, Social, Health and Family Affairs Committee

Draft Programme for the visit of the Rapporteur to Slovakia - 8-13 May 2003

Rapporteur : Mrs Christine McCAFFERTY (MP, United Kingdom, Soc)

Secretariat : Mrs Dana KARANJAC, Co-Secretary to the Committee

Accompanying person : Mr David TARLO (United Kingdom)

Report on “European strategy for the promotion of sexual and reproductive health”

Thursday 8 May 2003

 

11.00

European Roma Rights Center, Budapest          
Meeting with Mrs Jean Garland and Mr Claude Cahn,

15.00

Departure from Budapest by train
Friday 9 May 2003  

 

Visits to Hospitals in Eastern Slovakia :

10.00

Meeting with the representatives of the Hospital in Spišsk� Nov� Ves (MUDr. Jankech, director of the hospital, MUDr. Štefan Pitko, chief gynaecologist)

12.00

Meeting with the representatives of the Hospital in Prešov (MUDr. Peter Biroš, director of the hospital and also MP for ANO party, eventually MUDr. Sot�k, assistant manager of the hospital, MUDr. Hall�k, MUDr. Mari�n Kysel�)

17.00

Košice : meetings with 
Erika Godleva, Director, Roma Women's Association, Prešov, Slovakia   
NGO Poradna in Slovakia: Barbora Bukovska, Executive Director
Saturday 10 May 2003  

8.00-18.00

Visit to Roma settlements in Eastern Slovakia

18.00

Košice : meetings with 
Eddie Muller, Center for Roma Rights, Košice    
Helena Balogova, NGO Association of Romani Women Lucia in Košice
Sunday 11 May 2003  

8.20

Departure from Košice to Bratislava by train

 

stop over at Sv. Martin : meeting with Mr. Jankech, author of 2 books about treatment of women in maternities :“10 days in white concentration camp” and “They called it medicine”.

16.20

Arrival in Bratislava
Monday 12 May 2003 and Tuesday  13 May 2003  

9.00

Damian Roderic Todd, Ambassador, Embassy of the United Kingdom of Great Britain and Northern Ireland (Pansk� 16, Bratislava)

9.30

Mr van der Linden, Head of EU delegation in the Slovak Republic

11.00

Mr Pal Cs�ky, Vice Prime Minister for European Integration, Human Rights and

12.00

Meeting with members of the Slovak Parliamentary Delegation to the Parliamentary Assembly of the Council of Europe

15.00

Meeting in the Office of the Attorney General of the Slovak Republic(JUDr. Ctibor Košt�l, assistant manager of the Attorney General of the Slovak Republic, JUDr. Ladislav Hanuiker, JUDr. J�lia Džurn�)

16.00

Meeting with Mr F�zik, Director of Roma Parliament NGO and the advisor to the Ministry of Interior on Roma issues

17.00

Mr Hrubala, former lawyer in a court case on the alleged forced sterilization of Roma women
Tuesday 13 May 2003  

9.00

Meeting with MUDr. Michal Kliment a MUDr. Vladim�r Cupan�k, experts on reproductive health (NGO), hospital in Partiz�nska Str., Bratislava.

11. 00

Meeting with representatives of the Ministry of Interior of the Slovak Republic (Mr Col. JUDr. Peter Šimko, Director General of the Section of the Judicial Police of the Ministry of Interior, Mr Col. JUDr. Stanislav Ryban, spokesman of the Ministry of Interior, Mrs LTc. JUDr. Eva Jakubkov�, head of the special investigation team on alleged crimes of forced sterilisation of Roma women)

14.00

Meeting with the Prof. Stencl, rector of the University of Health and president of the Slovak Gynaecological Society and Prof. Holom�n, chief expert of the Ministry of Health of the Slovak Republic for gynaecology

16.00

Press at the CoE Information office, Klariska 5

 

Meeting wit representatives of NGOs : Ladislav Durkovic, NGO People against Racism and Adriana Lamachova, European Roma Rights Center,
Wednesday 14 May 2003  

 

Departure to Budapest by train

Appendix 3

Parliamentary Assembly, Social, Health and Family Affairs Committee

Programme for the visit of the Rapporteur to Poland - 2-4 February 2004

Rapporteur : Mrs Christine McCAFFERTY (MP, United Kingdom, Soc)

Secretariat : Mrs Dana KARANJAC, Co-Secretary to the Committee

Accompanying person : Mr David TARLO (United Kingdom)

Sunday 1 February 2004

 

16.20

Arrival of Mrs McCafferty to Warsaw BA 850

Monday 2 February

 

10.00

Polish Family Planning Association, Mr. Grzegorz Poludniewski, President

11.00

 UNDP office in Warsaw, Mr. Collin Glennie

12.00

Polish Federation for Women and Family Planning, Ms. Wanda Nowicka

13.00

Visit in FPA Clinic in Warsaw

15.00

Ms. Magda Brennek, Task Manager, Delegation of EC (EU health strategy)

Tuesday 3 February

 

09.00

Departure to Lublin

12.30

Visit in TRR clinic and gynecology ward in state hospital in Lublin

15.00

Return to Warsaw

17.00

Mr Janik, head of Democratic Left Alliance

18.00

Mrs Sienkiewicz and Mrs Kempka, Committee on Health and Social Affairs,Senate

Wednesday 4 February

 

9.00

Minister of Health, Mr Leszek Sikorski, Prof. Jakiel, chief gynecologist, Dr Niemec, Mother and Child Institutute in Warshaw, and Dr Wasilewski, sexologist

10.30

Government Plenipotentiary for Equal Status of Women add Men, Mrs Izabela Jaruga-Nowacka

12.00

Ministry of Education and Sport, Mr Izdepski and his team

13.30

Lunch at the Sejm with members of PACE delegation, offered by the head of the delegation Mr Tadeusz Iwinski

15.00

Ministry of Justice, Mr Wotek, Secretary of state and his team

16.30

Mr Balicki, former Minister of Health, Sejm

16.00

Episcopat (cancelled)

Thursday 5 February

 

17.15

Departure of Mrs McCafferty from Warsaw, BA 851 to London Heathrow

Appendix 4

Parliamentary Assembly, Social, Health and Family Affairs Committee

Information on undertakings of Slovakia to improve the situation of sexual and reproductive health following the case of alleged coerced sterilizations of Roma women[13]

1.       Slovakia highly appreciates the involvement of respective bodies of the Council of Europe into the assessment of the case of alleged coerced sterilizations of Roma women in eastern Slovakia. In May 2003 the Rapporteur of the Council of Europe Parliamentary Assembly’s Social, Health and Family Committee Mrs. McCafferty visited Slovakia. The Slovak Government paid a close attention to observations and recommendations of the Rapporteur and continued taking measures aimed at reviewing allegations contained in the NGO�s report Body and Soul – Forced Sterilization and Other Assaults on Roma Reproductive Freedom in Slovakia.

2.         Criminal investigation, which was closed on 24 October 2003, established neither the fact of genocide against Roma population in Slovakia by carrying out coerced sterilizations of Roma women, nor any other criminal offence in connection with mentioned conduct. This decision of the investigator relied, inter alia, on the conclusions from an expert opinion submitted by the most prestigious institute of its kind in the Slovak Republic, the Faculty of Medicine of the Comenius University in Bratislava. Further, in April 2003 an inspection group was set up, on the basis of the authorization of the Minister of Health. It consisted of carefully chosen specialists and experts in the field of gynaecology and obstetrics. The inspection group was tasked to review allegations published in the „Body and Soul“ report, in all medical facilities mentioned in it. The control did not prove the commission of genocide, segregation or discriminatory practices, either. The results of this control were presented to the Committee on Human Rights, Minorities and the Status of Women of the Slovak Parliament at the beginning of June 2003. Through regional and district experts there were further reviewed altogether 67 gynaecology – obstetric departments. The directors of those facilities where administrative shortcomings had been disclosed took corrective measures.

3.         Both, the criminal investigation and the inspection control were carried out professionally and impartially, taking into account sensitivity of the whole issue. Despite some publicized complaints, no intimidation of alleged female victims occurred during the inquiries.

4.         Given the results of the investigation, the Government of the Slovak Republic did not assume political responsibility for alleged coerced sterilizations. Sterilizations of Roma women never represented official governmental policy in Slovakia, nor did the Government officially condone such practice. However, the Office of the Deputy Prime Minister for European Integration, Human Rights and Minorities continued to address submissions on the matter. As a result, the Deputy Prime Minister asked the Prosecutor General to address a December 2003 submission by one of the complainants with regard to the investigation’s conclusions. After a thorough examination of this submission the Prosecutor General informed the Deputy Prime Minister that he found “no substantive or procedural reasons for the revision or annulment of the investigation’s conclusions” as the submission “has no ground in the performed examination of evidence or in the law”.

5.         However, the Government of the Slovak Republic admits that although investigations failed to confirm serious accusations contained in the “Body and Soul” report, certain shortcomings were nevertheless identified in the Slovak healthcare legislation. A misconduct of certain physicians by obtaining informed consent with sterilizations from the patients was also revealed (nevertheless, the obligation to perform sterilization solely on the basis of medical indications was always respected). Being aware of this fact, the Government of the Slovak Republic approved the Report on Developments in Allegations of Forced Sterilizations of Roma Women in the Slovak Republic and the Steps and Measures Adopted on 29 October 2003 an issued a Statement (attachment No.1) on the Report. Furthermore, in a related Resolution 1018 from 29 October 2003 (attachment No.2) the Government tasked respective ministries and other relevant bodies to adopt specific measures.

6.         The tasks concerned involved mainly the amendments to relevant healthcare legislation (comprehensive legal provisions concerning the right to non-discriminatory access to medical care; new legislation on access to medical files; amendment of legal provisions relating to healthcare aimed at defining precise conditions of a voluntary and informed consent). The Minister of Health was tasked with invoking the liability of the physicians and hospitals that violated applicable provisions and with conducting in-depth controls and analyses of all healthcare facilities with a view to verify allegations of coerced sterilizations, to identify discriminatory practices against the Roma, and to examine compliance with the procedures for obtaining voluntary and informed consent of the patients. Other tasks included a review of access of marginalized groups to healthcare, and the strengthening of human rights education of police officers, health care personnel, and public administration staff.

7.         Following the Government’s Resolution 1018/2003 the Ministry of Health of the Slovak Republic worked out a draft law on Health Care and Services Related to the Provision of Health Care (see respective provisions of the bill in attachment No. 3), which is in a compliance with the Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine. The draft law is a part of a complex reform of the health care system proposed by the Minister of Health of the Slovak Republic. It was approved by the Slovak Government on 15 April 2004 and is currently being considered by the Parliament in the first reading. The bill deals extensively with issues of non-discriminatory access to health care services, conditions for obtaining informed consent from patients and carrying out sterilizations, as well as with ensuring adequate access to medical files by patients. It aims to resolve the legal uncertainties pointed to in the course of the investigation of the allegations of coerced sterilizations. The bill abrogates the directives of the Ministry of Health of the Slovak Republic from the year 1972 on providing sterilization and amends the Penal Code supplementing a criminal offence of “illegal sterilization” (considered as a criminal offence against human dignity). The question of separating sterilization from a caesarian section has been resolved by introducing a 30 days period - sterilization cannot be carried out sooner than 30 days after the provision of informed consent.

8.         On 13 May 2004 the Slovak Government adopted the Action Plan on Prevention of all Forms of Discrimination, Racism, Xenophobia, Anti-Semitism and Related intolerance for a Period 2004 – 2005. According to this plan the Ministry of Health will realize, in cooperation with the Slovak Medical University, a project “Systematic education of medical personnel in the field of prevention of all forms of discrimination, racism, xenophobia, anti-Semitism and related intolerance”.

On 20 May 2004, the Slovak Parliament passed the draft law on Equal Treatment in Some Areas, Protection against Discrimination and on Amendment and Supplementation of Certain Laws (Anti-Discrimination Law), proposed by the Slovak Government in February 2004.It regulates conditions of exercising the principle of equal treatment and enacts the means of legal protection in case of its violation, focusing on employment and provision of services including healthcare.  Pending signature by the Slovak President, the law will become effective 1 July 2004.

9.       In April 2003 the Slovak Government adopted, by its Resolution 278, the Basic Theses of the Government of the Slovak Republic Policy Concept for the Integration of Roma Communities. The document, based on temporary countervailing measures, contains long-term (to the year 2010), mid-term (2003-2006) and short-term (2003) aims as well as methods for solving the problems faced by the Roma community in six major areas (human rights; education, employment and social issues, housing; culture and media; health care). Respective bodies of central state administration elaborate concrete steps and measures upon this concept.

10.       In April 2004 the Slovak Government took note of the Evaluation of the Basic Theses of the Government of the Slovak Republic Policy Concept for the Integration of Roma Communities. The document contains the information on implementation of those tasks planned for the year 2003.Taking into account the need to improve the access of Roma to health care and to promote the knowledge of sexual and reproductive health matters within Roma community, the Minister of Health of the Slovak Republic has been tasked with following:

11.     “to ensure provision of information on family planning and sexually transmitted diseases in case of need also in the national minority languages in addition to the official language” (C.23 Gov. Res. 278 from 23 April 2003)

Realisation:

There were financial resources allocated from the state budget for the Ministry of Health of the Slovak Republic for educational projects concerning reproductive health of women. The projects will be realised in three municipalities in central Slovakia during this year. A preparation of activities addressing the issues of reproductive and sexual health of the Roma population has been initiated also in a region of eastern Slovakia where leaflets and other educational materials in Roma language should be distributed and discussions and lectures for Roma women concerning contraception and venereal diseases HIV/AIDS organised through regional branches of the Public Health Office.

12.     “to prepare and submit for the Government’s discussion a National Program of Reproductive Health Protection” (C.22 Gov. Res. 278 from 23 April 2003)

Realisation:

The Ministry of Health of the Slovak Republic is currently preparing a National Program of Sexual and Reproductive Health, which should be submitted to the Government for adoption by the end of 2004.

13.     “to elaborate a Comprehensive Systemic Human Rights Education Programme for health care workers and students of such vocations” (C.21 Gov. Res. 278 from 23 April 2003)

Realisation:

The issue of protection of the rights of Roma and other marginalized groups of population in the health care area is a part of numerous educational trainings organised for medical doctors and dentists and also a part of a supplementary education of medical staff. The code of ethics (code of conduct) of particular categories of medical staff was incorporated into laws regulating performing such professions as medical doctors, pharmacists, nurses and birthing assistants. The laws thus contain an obligation to provide health care regardless of sex, ethnic affiliation, race and religious belief, culture, social status and political opinion.

14.     “to prepare a health care workers intensive training system, in particular for “first contact” health care staff, focusing on cultural differences mainly in regions with higher concentration of Roma communities” (C.20 Gov. Res. 278 from 23 April 2003)

Realisation:

The Faculty of Specialized Medical Studies of the Slovak Medical University shall submit new curricula for medical specialist, which would be in compliance with the Charter of the Union of European Medical Specialists. The curricula in relevant medical branches must also deal with a particular character of Roma communities. Adopting these curricula, the knowledge of a specific approach in health care matters within Roma communities will become compulsory for all medical specialists. The Slovak Medical University should submit a set of new curricula already within the school year 2003/2004.

15.     “to develop a health assistants field work system in Roma settlements” (C.18 Gov. Res. 278 from 23 April 2003)

Realisation:

The Slovak Medical University prepares an educational program for all categories of medical staff aimed at a fieldwork in Roma communities. The medical staff will be assisted by Roma activists and assistants trained for this work by professionally educated lectors. Roma activists and assistants will be selected preferentially out of Roma community members. The lectors will be health care personnel - medical doctors, nurses, birthing assistants, etc. and non-healthcare personnel - teachers, social workers, psychologists and others, trained by the Slovak Medical University. The program of the lectors training will be a part of a separate project. Medical doctors of a “first contact” are educated on the issue of a specific care of the Roma community already within their specialized training. There was the Inter alia the Department of Community Medicine at the Faculty of Public Health prepares academic activities and documents concerning Roma community health care issues. The Faculty of Public Health of the Slovak Medical University has also prepared a program of a health status monitoring in the regions with a high number of Roma communities.

16.     “to develop a health care accessibility system together with financial coverage for marginalized Roma communities” (C.17 Gov. Res. 278 from 23 April 2003)

Realisation:

The Ministry of Health developed and approved a pilot project “Improving the access of Roma to health care” targeting communities living in particularly isolated and marginalized Roma settlements. The project will be financed through EC PHARE fund and co financed from the state budget. The Ministry of Health will chose 10 municipalities with a high percentage of Roma population, where local municipal buildings will be reconstructed into health care centers. Another 10 municipalities (isolated remote settlements lacking basic infrastructure) will be served by mobile ambulances. Within the project 32 healthcare assistants should cooperate with local medical doctors and provide education in health matters for young Roma at schools. The project will last from January 2004 to December 2005 and in case of its successful completion should be expanded on another marginalized localities.

17.       Additional information on 2003 Evaluation of the Basic Theses of the Government of the Slovak Republic Policy Concept for the Integration of Roma Communities

According to the results of the Evaluation of the Basic Theses of the Government of the Slovak Republic Policy Concept for the Integration of Roma Communities, there were following achievements reached in different areas in 2003.

18.       Human rights education

The Ministry of Education of the Slovak Republic allocated about 54 000 euro in 2003 for activities of the Roma education, information, documentation, advisory and consultation center (ROCEPO), which realized several workshops, lectures and trainings for teachers. ROCEPO also published various documents to help teachers to improve the quality of education of Roma pupils. A specialized qualification study project of ROCEPO, the “Teacher’s assistant” in which assistants for work with Roma children are trained, was approved by the Ministry of Education of the Slovak Republic.

The Ministry of Justice of the Slovak Republic has prepared a Plan of systematic education of judges aimed at prevention of all forms of discrimination, racism, xenophobia, anti-Semitism and related intolerance for a 2003–2010 period. Within this plan two international seminars and one workshop were organized in 2003.

In June 2003 the Minister of Interior of the Slovak Republic approved a Plan of systematic education of the members of the Police Corps aimed at prevention of all forms of discrimination, racism, xenophobia, anti-Semitism and related intolerance until the year 2010.

The Ministry of Labour, Social and Family Affaires of the Slovak Republic prepared a plan of systematic education of its employees on prevention of all forms of discrimination, racism, xenophobia anti-Semitism and related intolerance. Within this plan 90 trainers had been schooled, who later organized another educational events.

The Slovak Government approved the information of the Minister for Interior on the results of the analysis of a possible functioning of police specialists working within Roma communities. First specialists could start performing their job by the end of 2007.

19.     Education

In September 2003 the Ministry of Education of the Slovak Republic finalized the Report on a current status of Roma children education and training, which has been used as a basis for a Conception of integrated education of Roma children and youth including high school and university education development prepared also by the Ministry of Education. This conception should be submitted to the Slovak Government for approval in the coming months.

The Office of the Plenipotentiary of the Slovak Government for Roma Communities started to provide financial support for Roma high school and university students in the school year 2003/2004. This support enables talented Roma youth from poor environment to study.

20.     Employment and social issues

The Ministry of Labor, Social and Family Affaires of the Slovak Republic initiated and realized a change of the social benefits system. New and amended laws have made solution of the situation of those in material need more effective, introducing supporting measures, which activate the interest to work. Furthermore, on 26 February 2004 the Slovak Government approved thirteen additional measures to deepen the effects of benefits system change on some groups of the population with a view to accelerate its implementation and to increase the level of information on possibilities people in material need can make use of. The adopted measures are targeted mainly to the problems that emerged in a part of the Roma population.

Financial resources have been allocated within the 2004 state budget for 50 social field workers and for establishing personal hygiene centers and laundries in some municipalities with Roma settlements.

The Ministry of Construction and Regional Development of the Slovak Republic prepared a document Principles of regional policy in accordance with the National Development Plan with respect to marginalized Roma communities. On the basis of these principles a document will be worked out on using EC structural funds for the Roma community benefit.

Within EC funds management, the Ministry of Agriculture of the Slovak Republic incorporated a support for Roma into the Sectoral Operational Program “Agricultural and Rural Development”. It contains provisions according to which those Roma from settlements will automatically be potential recipients of the EC funds aid whose property rights will be settled up and who will become entrepreneurs in agriculture. Also the Sectoral Program Complement includes assessment criteria ensuring that members of Roma community, as applicants for aid from EC structural funds, are preferred within some measures. The assessment criteria also prefer those applicants who realize projects in a municipality with a certain amount of Roma population.

In November 2003 the Slovak Government approved a document prepared by the Ministry of Environment of the Slovak Republic called “The overview of providing a drinking water supply in marginalized Roma settlements with a proposal of affirmative action measures”.

21.       Housing

The representatives of the Ministry of Agriculture, the Slovak Land Fund and of the Office of the Plenipotentiary for Roma communities of the Slovak Government agreed upon a preferential solving of the land ownership legalization in the parts of municipalities with Roma settlements.

In 2001 the Ministry of Construction and Regional Development of the Slovak Republic started a program “The support of building municipal rental flats of a different standard for people in material need and the support of building technical infrastructure in Roma settlements”. There have been 4,5 million euro allocated for the program in 2004.

22.       In 2003 Slovakia joined the World Bank and Open Society Institute initiative Decade of Roma Inclusion 2005 - 2015. At the first meeting of the national working group established in the framework of the Decade three priorities were determined where Slovakia intends to concentrate on achieving tangible results. The Basic Theses of the Government of the Slovak Republic Policy Concept for the Integration of Roma Communities together with proposals by experts – members of the national working group are the starting point. In the 2005 – 2015 period the activities shall focus on these areas: education, housing, employment.

23.       Education

�           to increase the number of pupils from marginalized environment, in particular from Roma settlements who would pass primary, secondary schools and universities of all types

�           to reduce the percentage of Roma children attending special schools and special educational facilities;

�           to use existing re-diagnostic techniques and to implement them in practice as well as to open catching-up classes aiming at the re-integration of pupils from special schools;

�           to increase the number of Roma children attending secondary schools;

�           to increase the number of Roma children attending universities;

�           to support secondary school and university students with scholarships granted from the Roma Educational Fund.

24.       Housing

�           to prepare and implement a long-term housing strategy for marginalized population (under the existing broader rental housing development policy), creating specific rent payment conditions for marginalized groups of population (mainly from Roma settlements), as well as creating a protection system for municipal property - rental flats;

�           to increase the total number of rental flats for marginalized groups of population (mainly from Roma settlements) and to sustain the trend of their housing quality development;

�           to accelerate property settlement of plots in segregated Roma settlements and ghettos in towns;

�           to assist municipalities with drawing funds from structural funds for drafting rental flats development and basic infrastructure designs;

�           to establish a group of external associates at the Office of the Plenipotentiary of the Government of the SR for Roma Communities to ensure technical assistance in elaborating projects applying for funds from European structural funds;

�           to complete the development of the existing housing development infrastructure;

�           to create an existing housing stock maintenance model;

�           to create a long-term training system providing social rental flat living skills for people from less stimulating environment;

�           to create a protection system for municipal property – rental flats;

�           to create specific rent payment conditions for marginalized groups of population aimed at preventing indebtedness and default resulting in the loss of housing with an emphasis on tenant’s obligations and specification of sanctions for failure.

25.       Employment

�           to ensure a long-term growth trend in employability of persons belonging to marginalized groups of population (mainly from Roma settlements) and in their competitiveness in the labour market;

�           to effectively prevent discrimination against marginalized groups of population (mainly the Roma) in the labour market;

�           to actively approach the identification of discrimination against Roma workers in the labour market on the basis of the Labour Code and Employment Services Act through the National Labour Inspectorate and to increase the effectiveness of court proceedings in this matter;

�           to draft and implement a guideline aimed at a targeted preferential treatment of employers who create jobs and employ long-term unemployed from marginalized (Roma) groups of population;

�           to create first contact centres providing counselling and information services, business support programmes and also advising on drawing funds from structural funds with a special focus on the Roma community in regions with the highest unemployment rate;

�           to support the establishment of temporary employment agencies covering the development of self-employment activities, various alternatives and employment forms in a more intense manner.

Attachments:

1.       Statement of the Slovak Government on the Report on Developments in Allegations of Forced Sterilizations of Roma Women in the Slovak Republic and the Steps and Measures Adopted

2.       Resolution of the Slovak Government 1018 on the Report on Developments in Allegations of Forced Sterilizations of Roma Women in the Slovak Republic and the Steps and Measures Adopted

3.       The Draft Law on Health Care and Services Related to the Provision of Health Care (respective provisions)

Bratislava 24 May 2004

Reporting committee : Social, Health and Family Affairs Committee

Reference to committee: Doc. 9512, Ref No. 2757 of  3 September 2002

Draft resolution and draft recommendation adopted on 22 June 2004

Members of the committee: MM. Glesener (Chair), Surj�n (1st Vice-Chair), Mrs McCafferty (2nd Vice-Chair), Mr Mašt�lka (3rd Vice-Chair), Mrs Ahlqvist, Mr Arzilli, Mrs Azevedo, Mrs Bargholtz, Mrs Belohorsk�, MM. Berzinš, Bianco Garcia, Bojovic, Mrs Bolognesi, MM. Braghis, Brunhart, Buzatu, Y�ksel �avusoglu, Chernyshenko, Christodoulides, Mrs Cliveti, MM. Colombier, Cort�s Munoz (Alternate : Mrs Quesada Bravo), MM. Cox, Daban Alsina, Mrs D’Amato, MM. Dees (Alternate: Kox), Donabauer, Dragassakis, Evin, Flynn, Geveaux, Giertych, Glukhovskiy (Alternate : Kolesnikov), Gregory, G�l�i�ek, Irfan G�nd�z, Gusenbauer, Hegyi, (Alternate : Kelemen), Hladiy, H�ie, Mrs Hurskainen, MM. Jacquat, Ja�regui Atondo, Klympush, Baroness Knight of Collingtree (Alternate : Mr Hancock), MM. Kocharyan, Letica, Makhachev (Alternate : Kovalev), Markowski, Mrs Milicevic, MM. Mladenov, Monfils, Mrs Nakashidze, Mrs Oskina, MM. Ouzk�, Padobnik, Popa, Poty, Poulsen, Provera (Alternate : Mrs Paoletti Tangheroni), Pysarenko, Mrs Radulovic-Šcepanovic, MM. Rauber, Riester (Alternate : Haack), Rigoni, Rizzi, Mrs Roseira, Mrs Saks, MM. Schmied (Alternate : Dupraz), Seyidov, Mrs Shakhtakhtinskaya, Mr Skarph�dinsson, Mrs Stantcheva, MM. Stathakis, Stojadinovic, Mrs Streb-Hesse, Mr Sysas, Mrs Topalli, Mrs Vermot-Mangold, (Alternate : Mr Marty), Mrs Wegener, MM. Van Winsen, Zernovski, ZZ…

NB: The names of those members present at the meeting are printed in bold

Secretariat of the Committee: Mr Mezei, Ms Nollinger, Ms Meunier, Ms Karanjac, Mr Chahbazian

[1] ICPD chapter VII - Reproductive rights and reproductive health.

[2] United Nations (UN) Report on the Fourth World Conference on Women, Document A/Conf 117/20, New York, 1995, page 96.

[3] A5-0223/2002, Committee on Women’s Rights and Equal Opportunities, European Parliament, 6 June 2002.

[4] “Women of the World : Laws and policies affecting their reproductive lives : East Central Europe”, edited and published by the Center of Reproductive Law and Policy (CRLP), 2000.

[5] Population studies, No. 42, Council of Europe Publishing, September 2003.

[6] � Teenage births in rich nations �, Innocenti report card N�3, July 2001.

[7] Concise Report on World Population Monitoring 2002, UN Population Division of the Department of Economic and Social Affairs, with input of WHO and UNAIDS.

[8] � Reversing the epidemic : facts and policy option �, United Nations Development Programme, February 2002.

[9] “Irish strategy to address the issue of crisis pregnancy”, Crisis Pregnancy Agency, www.crisispregnancy.ie .

[10] Eurostat, Yearbook 2003.

[11] Center for reproductive rights and Poradna pre obcianske a ludk� pr�va (Centre for Civil and Human Rights of Poradna), 2003, http://www.reproductiverights.org.

[12] CommDH(2003)12 Recommendation of the Commissioner for human rights concerning certain aspects of law and practice relating to sterilization of women in the Slovak Republic, 17 October 2003, http://www.coe.int/T/E/Commissioner_H.R.

[13] Source of information : Ministry of Foreign Affairs of the Slovak Republic.