Doc. 10550

12 May 2005

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

Recommendation 1675 (2004)

Reply from the Committee of Ministers

adopted at the 925th meeting of the Ministers’ Deputies (3-4 May 2005)

1.       The Committee of Ministers has studied with interest Parliamentary Assembly Recommendation 1675 (2004) on a European strategy for the promotion of sexual and reproductive health and rights, as well as Resolution 1399 (2004) on the same theme, which develops further the Assembly’s recommendations to member states. It has brought them to the attention of the governments of member states.

2.       The Committee of Ministers shares the Parliamentary Assembly’s commitment to furthering access to sexual and reproductive rights, as witnessed by the Assembly's endorsement in 2003 of the Ottawa Statement of Commitment, giving priority to universal access to reproductive health services. The Committee also recalls the Assembly’s Resolution 1394 (2004) on the involvement of men in reproductive health, and welcomes the extensive overview of the current action of the Council of Europe contained in Assembly Resolution 1399 (2004).

3.       The Committee of Ministers recognises the importance to be given to work in the area, which incorporates activities into the framework of broader issues of public health protection. In this context, the Committee recognises the strong link between “sexual and reproductive health and rights” and HIV/AIDS and recalls the commitments made by member states through, inter alia, the United Nations General Assembly (UNGASS) Declaration of Commitment on HIV/AIDS (2001) and the regional conferences on HIV/AIDS in Dublin and Vilnius during 2004. It is hence in the spirit of integrated strategies and multi-pronged approaches that the Council of Europe member states will enhance the protection of “sexual and reproductive health and rights”.

4.       The work of the Steering Committee for equality between Women and Men (CDEG) has addressed issues of reproduction and sexual health as part of the mainstreaming approach to equality between women and men. The European Population Committee (CAHP) has published studies on the sexual and reproductive behaviour (including contraceptive practices and abortion) of adolescents. Its work in 2003 focused on the role of education and information in reproductive health.

5.       The exchange of experiences between member states, as requested by the Assembly, forms part of the regular activities of the European Health Committee (CDSP). The CDSP has expressed its willingness to encourage member states to contribute to these exchanges (see the appended comments) in the area of “sexual and reproductive health and rights”. The Council of Europe’s joint project on “Health Promoting Schools” with the WHO and the European Commission presently provides a means of promoting sex education in Europe. The CDSP considers that many of the recommendations it has already prepared offer guidance for national health strategies, but is ready to consider the inclusion of issues raised by the Assembly in its future recommendations, including those currently under preparation. Furthermore, all the CDSP programmes are based on strategies for incorporating ethical, social and human rights dimensions of health.

6.       With respect to the collection of data and the development of indicators on sexual and reproductive health, the European Population Committee has already taken initiatives in this field. However, the Committee of Ministers considers that other organisations, in particular the WHO, UNAIDS and the OECD, carry out important and useful activities in this field, and the Council of Europe will continue to take advantage of their activities, so as to avoid duplication of work.

7.       As to the Parliamentary Assembly’s call for specific guidelines to assist member states in drafting national sexual and reproductive health strategies, the Committee of Ministers reiterates its opinion that there are many guidelines already developed by international organisations, which could feed into national efforts. The Council of Europe member states would benefit from further exchange of information of such existing tools as well as the guidance by the CDSP in addition to that already provided by the existing Council of Europe instruments in the social and health fields.

Appendix 1 to the reply

Opinion of the European Health Committee (CDSP) on Parliamentary Assembly Recommendation 1675 (2004) and Resolution 1399 (2004) on a European strategy for the promotion of sexual and reproductive health and rights

The European Health Committee (CDSP) examined Assembly Resolution 1399 (2004) and submits the following comments on it:

1.        The CDSP welcomes the Assembly Resolution as a valuable and well documented overview of current issues in the sexual and reproductive health and regards it as a contribution to the Council of Europe’s continuous efforts to assist member states in making their health systems more equitable, efficient and of high quality.

The CDSP has noted with interest the comprehensiveness and the overarching scope of the review of the situation, spanning over almost all fields of activity of the Council of Europe.

2.        It shares the underlying concerns of the Assembly and supports the call to forward the 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. Indeed, the CDSP is of the opinion that in view of the diversity of standpoints in Europe it should be left to domestic legislation to deal with some of the culturally-dependent and politically sensitive issues within the framework set out in the Council of Europe binding instruments.

3.        In reply to the direct requests made to the CDSP, it submits the following comments:

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

–        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;

The CDSP from its very nature is the forum for dialogue and sharing of national experiences, which is an ongoing activity throughout all its meetings. The CDSP is willing to encourage the member states to contribute to the debate. The joint Council of Europe, WHO and European Commission project on “Health Promoting Schools” is already being used as a platform to promote sexual education throughout Europe.

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

The CDSP welcomes the intention behind this proposal but the practicalities of this proposal would require further exploration, and duplication of other activities with similar intentions should be avoided. The CDSP noted that the WHO and OECD are very much involved in updating the country health profiles and creating appropriate databases. CDSP is willing to participate in a joint effort to review the design and content of the country profiles and to propose adequate amendments, when needed.

–        develop guidelines to assist member states in drafting national sexual and reproductive health strategies;

The CDSP noted that the topic is already a priority in activities of many international organisations and NGOs, which have collected a body of evidence and elaborated sound policy guidelines. The CDSP considers that in view of many divergent standpoints, legal and cultural traditions, it would be extremely difficult to reach a consensus needed to draft a Council of Europe recommendation. It is of the opinion that many of the recommendations already developed by the CDSP could offer guidance in developing national sexual and reproductive health strategies. The CDSP draws attention to the fact that for many years its programme has been based on a strategy for incorporating the ethical, social and human rights dimension of health; and its components are perfectly in line with the spirit of the solutions proposed by the Parliamentary Assembly:

-       equity in access to care and health promotion;

-       health care quality standards;

-       the citizen’s role in health: participation and individual responsibility;

-       special protection of the vulnerable populations.

In particular, some of the Recommendations offer an immediate reply to the concerns raised by the Parliamentary Assembly, e.g.

-       Recommendation Rec(2001)12 on the adaptation of health care services to the demand for health care and health care services of people in marginal situations. It calls for developing a coherent and comprehensive policy framework, based on principles of equity, human dignity and participation, avoiding stigmatisation and increasing knowledge base. The definition of the persons living in insecure conditions and in marginal situations might apply to some of the situations described in the Resolution;

-       Recommendation No. R (2000) 5 on the development of structures for citizen and patient participation in the decision-making process affecting health care;

-       Recommendation Rec(2000)18 on criteria for the development of health promotion policies proposed a comprehensive framework for modern strategies in health promotion and disease prevention.

The CDSP is willing to review the content of its draft recommendation on health services in a multicultural society and address some of the relevant issues mentioned in the Parliamentary Assembly Resolution.

In conclusion, the CDSP fully supports the content and rationale of the Parliamentary Assembly Resolution 1399 (2004) on a European strategy for the promotion of sexual and reproductive health and rights and will share its messages among its members.

The CDSP is willing to consider including relevant issues raised by the Resolution in its recommendation, which it is currently drafting.

Appendix 2 to the reply

Comments of the Steering Committee on Equality between Women and Men (CDEG) on Parliamentary Assembly Recommendation 1675 (2004) on a European strategy for the promotion of sexual and reproductive health and rights

The CDEG welcomed Parliamentary Assembly Recommendation 1675 (2004) on a European strategy for the promotion of sexual and reproductive health and rights.

The CDEG took note that the Parliamentary Assembly recommends that the Committee of Ministers design a comprehensive European strategy for the promotion of sexual and reproductive health and rights and instruct the European Health Committee, in cooperation with relevant European partners to develop guidelines to assist member states in drafting national sexual and reproductive health strategies.

The CDEG recalled the reply of the Committee of Ministers on Parliamentary Assembly Recommendation 1515 (2001) on demographic change and sustainable development and the Committee of Ministers’ reply to Parliamentary Assembly Recommendation 1564 (2002) on the state of the world population. In particular the CDEG recalled that the Committee of Ministers considered in its replies that although it was not appropriate to prepare a recommendation based on the concept of right to free choice in matters of sexuality and reproduction, which remains open to discussion in legal terms, it recognised the importance of the underlying concerns and believed that work on the subject should be incorporated, as far as possible, into the CDEG's other activities, and as part of a more intensive use of the mainstreaming approach to equality between women and men involving other Steering Committees concerned with these issues, for example in the area of population and health.

The CDEG recalled that among its activities on this issue, it prepared a background document on “reproductive choice” (doc.EG (99) 4) and a document containing a summary of the answers to a questionnaire sent to member states requesting information on free choice in matters of sexuality and reproduction. Furthermore, the CDEG recalled the proposals and recommendations contained in the proceedings of the Council of Europe International Forum on “Guaranteeing freedom of choice in matters of reproduction, sexuality and lifestyles in Europe: trends and developments” (Tallinn, 27-29 November 1997).

The CDEG stressed the importance of developing joint projects in the field of reproductive health and gender issues and expressed its willingness to work with other Steering Committees dealing with these issues, on specific projects to be defined.