For debate in the Standing Committee — see Rule 15 of the Rules of Procedure

Doc. 9566

24 September 2002

Maternity in Europe: improving social and health conditions

Report

Social, Health and Family Affairs Committee

Rapporteur: Mrs Irena Belohorská, Slovakia, European Democratic Group

Summary

Under the European Social Charter (Article 8), employed women have the right to maternity protection. They are entitled to leave before and after childbirth, may not be dismissed, are entitled to time off for nursing, and may not perform dangerous, unhealthy or arduous work. Similarly, the ILO Maternity Protection Conventions and Recommendations invite states to adopt progressive measures in this area. However, thousands of women in Europe do not yet enjoy this basic protection as the legislation of several countries offers only partial and limited guarantees. Not all the Council of Europe member states by any means have accepted the provisions of Article 8 of the European Social Charter, while only 14 Council of Europe member states have ratified the ILO Convention adopted in 1919, and only 3 the latest Convention adopted in 2000. The report recommends that all the member states should ratify these instruments in order to improve the standards of maternity protection in Europe.

In terms of health care, the situation of pregnant women and young mothers varies widely in Europe. There has been an overall improvement in the rates of infant and maternal mortality in Europe, but they are subject to wide variation and steps should be taken to reduce them further. The report recommends that member states follow the guidelines on safe motherhood and pregnancy advocated by the World Health Organisation.

I.       Draft resolution

1.       Under the European Social Charter, employed women have the right to maternity protection. They are entitled to leave before and after childbirth, may not be dismissed, are entitled to time off for nursing, and may not perform dangerous, unhealthy or arduous work.

2.       Similarly, the International Labour Organisation (ILO) Maternity Protection Conventions adopted in 1919 (No. 3), 1952 (No. 103, now closed to ratification) and 2000 (No. 183), as well as ILO Maternity Protection Recommendations Nos. 95 (1952) and 191 (2000), invite states to adopt progressive measures in this area.

3.       However, thousands of women in Europe do not yet enjoy this basic protection as the legislation of several countries offers only partial and limited guarantees. The 1919, 1952 and 2000 ILO Conventions have been ratified by only 14, 17 and 3 Council of Europe member states, respectively.

4.       Much remains to be done to further the rights of working mothers, particularly as regards maternity leave, continued payment of salaries, protection from dismissal, authorised absences for medical follow-up or for nursing purposes, and adjustment of working hours. In the working environment, pregnant women and young mothers may come up against many obstacles and may sometimes be faced with psychological pressure exerted by their employers, giving them a feeling of exclusion.

5.       In terms of health care, the situation of pregnant women and young mothers varies widely in Europe. There has been an overall improvement in the rates of infant and maternal mortality in Europe, but they are still too high in several member states and are subject to wide variation.

6.       According to the Council of Europe’s demographic statistics, the infant mortality rate in member states ranged in 2000 from 35.3 ‰ in Turkey to 3 ‰ in Iceland, with the Central and Eastern European countries varying between 18.6 ‰ in Romania and 4.1 ‰ in the Czech Republic. It is in Eastern Europe that rates are generally above the European average of 9 ‰.

7.       The Assembly is concerned to ensure that health and nutrition conditions for expectant and young mothers and their babies should be improved, including vaccination coverage. Preventive policies should also be stepped up to combat alcoholism and drug abuse.

8.       From a social and legal point of view, some significant developments with regard to the conditions of maternity in Europe warrant particular attention and call for legislative changes, including an increase in the number of children born out of wedlock all over Europe, and an increase in the number of very young mothers.

9.       Maternity raises the issue of family policy and the reconciliation of family and working life. Consideration needs to be given to ways of establishing a balance in the roles of the two parents, particularly in order to enhance the father's parental role. The European Social Charter provides for a right of workers with family responsibilities to equality of opportunity and treatment, but further efforts are required to promote its practical application.

10.       Therefore, the Parliamentary Assembly calls on the member states of the Council of Europe:

i.       to continue to build family policies upon the social traditions of Europe with a view to raising the standards of maternity and parental leave to the highest possible extent and ensuring that the level of benefits and parental-leave schemes such as flexible and reduced-hour employment do not result in poverty;

ii.       to fund maternity benefits through state social-insurance funds, as these mechanisms minimise the risk that employers will discriminate against potential leave takers who might otherwise be seen as unusually expensive employees;

iii.       to improve, where necessary, access to affordable, high quality substitute child care such as childcare centres and kindergartens with pre-primary programmes within the educational system;

iv.       to resolve the tension between work and family by promoting gender equality, address the issue of fathers as care-givers and introduce incentives that encourage men to assume a larger share of care-giving work in the home;

v.       to defend family values against the corrosive effects of self-interest;

vi.       to aim for a kinder and wiser form of economic development by supporting the social fabric in which individual families exist, seeking to resolve the conflict between the "invisible hand" of the market place characterised by competition and individual achievement, and the "invisible heart" which emphasises obligation, reciprocity, and caring for others;

vii.       to step up their efforts to combat poverty, social exclusion and unemployment, which often lead to a worsening of relationships in families as characterised by the rise in divorce, violent behaviour, irritation, aggression, egoism, alcoholism, consumption of drugs and lack of tolerance;

viii.       to ratify, if they have not yet done so, ILO Maternity Protection Convention No. 183 (2000) and Recommendation No. 191 (2000);

ix.       to ratify, if they have not yet done so, the European Social Charter and Revised Charter and the European Code of Social Security, its Protocol and the Revised Code, in particular in respect of maternity rights and benefits;

x.       to implement World Health Organisation’s guidelines on safe motherhood and pregnancy, including those on “Advancing safe motherhood through the application of human rights” and on the “Promotion of effective perinatal care”;

xi.       to step up their support for the work of the United Nations Population Fund (UNFPA) and of such organisations as the International Planned Parenthood Federation (IPPF) in promoting sexual and reproductive health, following the regrettable decision of the United States Administration to cut funding to the UNFPA.

II.       Explanatory memorandum by Mrs Belohorská

1.       State of motherhood in society

1. No doubt one of the most important indicators of the quality of society is family policy, including the level of care for mothers during pregnancy and for parents performing their parental role. The overall protection of the rights of family members, especially women and children, is an issue of great importance. The UN Convention on the Elimination of All Forms of Discrimination against Women, the UN Convention on the Rights of the Child, the ILO Maternity Protection Conventions, the European Social Charter and many other international documents clearly illustrate the concern attached to the position of women, mothers, children and families in Europe and the rest of the world.

2. A majority of the 60 million people living in poverty in the European Union are women. Women all across Europe bear more than their share of poverty, job market discrimination, worsening social security benefits, and poor access to training and health. However the worst-off are the mothers living in poverty with consequences for their physical and emotional health. The material, social and health conditions of poor mothers, whether in western or eastern Europe, are indecent, and thus they form an especially vulnerable social group. Current social security benefits often provide an inadequate income for mothers and babies. Most women on benefits cannot pay for a healthy diet. Managing materially, physically and emotionally is very hard, as one mother demonstrated in saying "I had to total up my shopping at the supermarket before I reached the check-outs. Even knowing that I only needed a basket and never a trolley made me feel miserable". In the eastern European countries the vast majority of mothers experience similar hardship.

3. Maternal poverty now extends to the middle classes, some of whom have been precipitated out of a comfortable lifestyle by unemployment and the cost of home ownership. But, most importantly, two incomes are needed these days to provide for children where one would have done some years ago.

4. Mothers bring up their children in a society that obliges them to struggle against tremendous odds in carrying out what is universally recognised - at least on the surface - to be a vital social task. But one of the main challenges to motherhood is precisely this contrast between rhetoric and practice. Mothers and children are prized on the level of cultural values, but the actual social arrangements made for their welfare convey a different message. As a society, we should not tend to support only some mothers. Young mothers, single mothers, and all those unable to manage financially on their own fall into a different category from those who are married, have their children at a respectable age and do not ask for any help from the state. Even the emphasis we give to desirable maternal behaviour such as breast-feeding, known to be linked to better health not only in infancy but also in adulthood, is not adequately reflected in practice in the workplace.

5. Motherhood often brings demotion in the world of work; half the loss of earnings women incurs through motherhood is due to having to take lower-status, lower-paid work and often part-time work after having children. Income inequality in European countries is higher now, as underlined by the growing proportion of the population dependent on state benefits. The poor are getting poorer and the rich are getting richer. One result is that in many areas of Europe the living standards and life opportunities of the poorest are simply unacceptably low. Having children may profoundly disadvantage women in social terms - and it ought not to, given the right social and economic structures and policies.

6.       Motherhood is a vexing and difficult subject, both wonderful and troubling. There are many factors which affect how motherhood and women are defined. These include: beliefs about the proper behaviour of men and women, attitudes to abortion, medical science and the health-care system, the role of the state in maternal and child welfare, globalisation and the family, value-orientation and atmosphere in the family, economic problems in the family, the role of women in society, and feminism. To find out how women experience motherhood in various country-specific contexts in Europe, we should really listen to them, let women's voices be heard and take account of their voices in national laws and regulations and at European level by dealing with issues such as poor medical care, inadequate nutrition, poverty, social exclusion, discrimination and violence. Motherhood seems a high price to pay for doing the right thing.

2.       Feminisation of poverty

7.       Over the last decades the European countries have faced a developing trend: social exclusion and poverty. Income inequalities play a significant role in this area. Moreover, income inequality is often associated with more health inequality. But exclusion and poverty go beyond income inequalities. It is the accumulation and the combination of several types of deprivation: lack of education, deteriorating health conditions, homelessness, loss of family support, non-participation in the regular life of society, and lack of job opportunities. Each type of deprivation increases the other types. The result is a vicious circle, leading from long-unemployment to the breaking of family ties, and eventually to marginality and delinquency. States, and to a great degree their markets, prove inefficient in stopping increasing family instability, rising structural unemployment and inequality in wages and income, or in keeping even the standard family out of poverty. Unfortunately, mothers (and with them their children) are often the ones to experience poverty, hardship, discrimination in the labour market and inefficient services while taking care of their children.

8.       I will illustrate the feminisation of poverty with the example of my own country – the Slovak Republic. Even though the system of maternity care in Slovakia meets international standards (see below, 4.2), mothers taking care of their babies who live on parental benefit, which is 3, 790 SK a month for a child up to 3 years of age, this sum falls below the minimal wage income set by national law from October 2002 at 5,570 SK a month for an employed person, the minimal wage income guaranteed by the State. The poverty line (or the living minimum) is 3,930 SK for an adult.

9.       In this way, the mothers in Slovakia who make the choice to stay at home with their child put themselves in a quite disadvantageous position, as the parental benefit (3,790 SK) during the parental leave is paradoxically below the poverty line - living minimum (3,930). Although current legislation admits options such as participation of fathers in parental or maternity leave such practice is not common in Slovakia. As for part-time work or flexible hours for mothers, they have to decide either to start working after the end of maternity leave or to stay at home with the child with very little money at their disposal from the State. This is a very sad situation when we consider that a child is supposed to be the fruit of love. Why do mothers who undertake the vital social task of raising children - our future generation - receive no financial recognition for their work? Is it because they are in love with the State and they therefore ask nothing in return?

10.       To demonstrate the socio-economic disadvantage of women even in the wealthy countries of Western Europe, let me present you now with some interesting findings from the EUROSTAT report about the social situation in the European Union in the year 2000. I have specifically focused on the issues concerning women and their social standing.

2.1.       Long-term unemployment

11.       EU-wide, long-term unemployment is slightly more prevalent among unemployed females (49%) than males (46%). Unemployed women in Denmark, Greece, Spain and Austria, however, are much more likely than men to find themselves out of work for more than twelve months. In contrast, in Ireland, Finland and the United Kingdom, a larger proportion of men than women are unemployed for a lengthy period.

2.2.       Low income households

12.       Around 18% of EU citizens had an equalised income that was less than 60% of the median for their country (the poverty line) in 1994. At EU level, three types of household stand out with higher than average levels of “poverty”: single-parents with dependent children (36%), couples with three or more dependent children (27%) and people living alone (23%), particularly women (26%). More than 50% of single-parents in Ireland and the United Kingdom can be classified as having a "low income". At national level, other household types seem particularly at risk: in Greece and Portugal, more than 40% of elderly couples have an income that is less than 60% of the median.

13.       Throughout the Union, "poverty" is slightly more prevalent among women than among men (EU average of 19% versus 17%). The gender gap is even larger among persons living alone, particularly among the elderly. The proportion of children (under the age of 16) living in a household with low income (21%) is higher than for the population as a whole (18%). Children in Ireland (28% versus 21%) and the United Kingdom (28% versus 20%) seem to be particularly worse off. However, children in Denmark (6% versus 11%) and Greece (16% versus 21%) are considerably less likely to live in "poor" households.

14.       Social transfers other than pensions reduce the percentage of “poor” people in all the Member States, but to very differing degrees. The reduction is smallest in Greece, Italy and Portugal: between 7% and 15%. In no other Member State is it less than 25%, and in Denmark and the Netherlands, it is around 60% - these two countries have the lowest “poverty rate” after payment of benefits. Ireland and the United Kingdom have a high proportion of people on low equalised incomes both before and after payment of benefits. However, after payment of benefits, the share of those still in poverty is highest in Portugal. It is because Italy has the lowest poverty rate before benefits that the percentage of “poor” people in this country is close to the EU mean, despite the low impact of transfers.

2.3.       Female employment

15.       Despite progress in recent years, women still have particular problems in gaining access to the employment market, in career advancement, in earnings and in reconciling professional and family life. Although the net additional jobs created over the past decade or so have virtually all gone to women, this job growth has failed to keep pace with the increasing number of women who want to work. As a result, unemployment among women is much higher than for men. Despite the fact that women form around 43% of the EU labour force, they account for slightly over half of the unemployed. Employment rates for women remain systematically lower than for men. Moreover, many women work part-time.

16.       The combination of increasing education and changing attitudes means that employment rates of women are converging on those men – in the decade following 1988, they rose from 45% of the working-age population to 51%, whereas those for men declined from 74% to 71%. Although the difference is diminishing, it remains large in the vast majority of countries. In Finland and Sweden, the employment rate for women is still around 90% that of men although there has been a relative decline in women in work in these countries over the last few years. In virtually all Member States, the employment rates for young females are closer to those of young men than their elders. EU-wide, women are concentrated in the growing service sector (80% of all employed women against 55% of all employed males) and are therefore less at risk of losing their job than men, who are employed disproportionately in agriculture and industry where restructuring has been taking place. Occupational segregation may limit the choice of women entering or wishing to enter the labour market. Women are still under-represented in the "top" jobs with only 6% in managerial posts (of the total in employment) compared with 10% of men. Overall, mothers aged 25-49 with at least one young child (aged 0-5) are less likely (53%) to be employed than childless women of the same age (67%). The gap between these two groups of women is particularly large in Germany and the United Kingdom. In contrast, in Belgium and Portugal the two rates are almost identical. Differences between countries reflect the varying levels of discrimination, the extent of child-care provision, the availability of part-time work, taxation, welfare support, attitudes towards women, etc.

17.       In the Union as a whole, 33% of women in employment are working part-time against only 6% of males. Female part-time work is particularly prevalent in the Netherlands (68%), the United Kingdom (45%) and Sweden (39%). Among full-time employees, women work fewer hours than men in all Member States although in the Netherlands, Austria and Sweden the difference is less than one hour. In contrast, the gender gap is 5 hours in the United Kingdom.

18.       The unemployment rate in 1998 was higher for women than men in most parts of the Union, averaging 11,7% as against 8,6%. In Belgium, Denmark, Spain, Italy, the Netherlands and Portugal, the female rate is between 55% and 92% higher than that of men. Active women in Luxembourg and Greece are more than twice as likely as men to be unemployed. The situation is more favourable for women only in Ireland, Sweden and, most notably, the United Kingdom where the rate for women is 20% less that of men.

2.4.       Earnings of men and women

19.       In 1995, the average gross monthly wage of women working on a full-time basis was 74% of the earnings of a man. In Belgium, Denmark, Luxembourg and Sweden, the average wages of women are equivalent to 84% of men’s. In Ireland and the United Kingdom, on the other hand, women’s wages represent only 70% of men’s. These discrepancies should primarily be interpreted as the result of comparing averages for two populations of employees with very different characteristics. Firstly, women and men do not have the same jobs. In the population under review, 38% of women working full-time are office clerks against only 12 % of men, while 48% of men are manual workers or plant operators compared with only 19% of women. On average, manual workers are better paid than office clerks. Secondly, working women tend to be younger: 36% are less than 30 years old compared with 24% of men. As a result, women on average have less seniority and less of an opportunity to be in management positions. This clearly has an impact on their average salary level. Thirdly, the attainment levels of women are in general lower than men which, in turn, means that they are more likely to earn less. Furthermore, women are less likely than men to have technical education for which the average salary is higher than for a more general secondary education.

20.       Differences in pay levels are smallest in traditional “female” occupations (such as office clerks, service workers, shop and market sales workers) where women often outnumber men. In occupations where a technical background is required (such as craft and related trades workers), the difference in earnings is larger than the average.

21.       Comparing the inequality structure of earnings by age shows that pay differences between men and women increase rapidly with age. This is mainly due to the occupational structure of older women which is more concentrated in lower-paid clerical positions than the average. However, this may also be explained by the fact that some older women have quite long career breaks which means that pay differences increase. The age gap is most pronounced in Greece and the United Kingdom.

22.       Overall, pay differences between men and women appear to increase with the level of education although the picture is far from homogenous between Member States. In Belgium, Denmark, Spain, France, Italy, and the Netherlands, the highest qualified women are the most unequally paid compared to their male colleagues. The opposite is true in Greece and Ireland. In the other Member States, the level of education appears to have minimal influence on wage differences.

3.       Teenage and lone mothers

23.       The teenage birth rate has fallen in many continental Western European countries but remained stable in English-speaking countries (UNICEF 2001):

- in the continental West - European countries: between 6 and 14 per thousand;

- in the UK and some other English-speaking countries: between 18 and 31 per thousand;

- in the United States: as high as 52 per thousand.

24.       Teenage motherhood has been of concern to governments for two distinct reasons - medical and socio-economic. Teenage mothers and their babies show higher than average risks of unsatisfactory progress during pregnancy, difficulties at the birth, and poor health in subsequent years. Teenage mothers and their families have also been shown to experience social disadvantage on such measures as education, housing, employment and family income.

25.       The UNICEF Innocenti Research Centre conducted a systematic comparison between countries in the European Union, which confirm that teenage mothers and their families are often at a disadvantage compared with those whose children are born in their twenties or thirties. Teenage mothers are socio-economically disadvantaged in all countries, but the severity of their position varies substantially between countries.

26.       Teenage mothers had relatively poor educational qualification; they were less likely to be married than other mothers; they (and their partners) were less likely to have jobs; and they (and their families) were more likely to live in poverty.

27.       There is a chain of causes between teenage motherhood at the beginning and poverty at the end. The direct consequence of having a baby as a teenager might be that the young woman had to leave school; she was unlikely to be married when she got pregnant and that increased the chances of her remaining single both immediately after the birth and in subsequent years. The low level of education then influences her chances of getting a job, and the lack of a partner reduces the likelihood of receiving financial support within the family. The absence of earnings then increases the risk of poverty.

28.       Moreover, the lone mother's paid employment becomes crucially important considering she is the only source of earnings. According to the UNICEF research, early parenthood reduces the likelihood of women's employment most strongly in France, Belgium, Ireland, the Netherlands and the UK.

29.       A country-by-country analysis showed that lone mothers in Austria and Spain are more likely to have a job than mothers with partners. In the UK however, lone parents' probability of employment is significantly less than of mothers in couples. In the remaining ten countries in the EU, lone mothers and other mothers have similar employment rates.

30.       The triangular relationship of family dependence between mothers, fathers and the state had different outcomes, depending on the traditions and policy regimes of particular countries. One interpretation, according to the UNICEF research, may be that teenage motherhood is especially problematic in such countries as Belgium, Denmark, Finland, France, Germany, the Netherlands and the United Kingdom, where most young women leave home early, adopt an independent lifestyle in their twenties, and then start a family some years later. Thus women who have children much younger than that are exceptional; and find that the family and neighbourhood networks which might otherwise have supported them are no longer available. In countries such as Austria, Greece, Ireland, Italy, Portugal and Spain, where young people are closely tied to their families of origin, and where women quite often have children at a relatively young age, teenage mothers are less isolated. Thus early parenting is more disadvantaging in those countries where the gap between leaving home and starting a family life is widest. The gap has currently been widening however in most countries across Europe, so the problems associated with teenage motherhood may become severe.

31.       Apart from early age parenting, we can see a range of key factors which might make the difference between prosperity and disadvantage: woman's educational attainment; the family structure within which she raises children (i.e. marriage as opposed to lone parenthood); the qualifications of her partner; her own employment prospects, the chances of anyone in the family having a job; the family's level of income... All these factors are associated with each other, so that disadvantage in one dimension tends to coincide with disadvantage in others. Thus we can talk in terms of causal links. For example, a low level of education might increase the probability of lone motherhood, lone parenthood might mean the absence of family employment, which would lead to poverty. All these potential links are visible in all European countries. The age at which a woman gives birth to her first child proves to be associated with all of these factors, with teenage motherhood always representing the disadvantaged end of the spectrum. 40% of teenage mothers across Western Europe are estimated to have been in poverty, compared with only 11% of the twenty-eight year old mothers. Thus teenage motherhood can be seen as equivalent to poverty.

32.       In every Western European country, young mothers are less likely to have upper secondary educational qualifications than older mothers. In most Western European countries, young mothers are less likely to be in formal marriages - the exception is Greece (a high-marriage country). In the majority of Western European countries, young mothers were less likely to have a job, and less likely to have a partner at work.

33.       In every Western European country, early motherhood was associated with an increased risk of poverty. Poverty is the most general measure of disadvantage for young mothers. The Netherlands was clearly the country where young mothers were most disadvantaged, followed by France and Finland, where apparent consequences of young motherhood remained severe. Consequences in Portugal and Spain were less strong.

34.       According to the UNICEF research, Ireland and the Netherlands were the worst places to have babies while a teenager. The relative disadvantage was substantially lower in Greece and Germany than elsewhere in Western Europe, but lowest of all in Austria. (Austria is a special case which has a long history of marriage following on from a first birth - this may help to explain why Austria was among the Western European countries where teenage motherhood was least associated with disadvantage).

35.       Teenage motherhood is not only a problem from the point of the State, it is also a problem of education! I suggest that teachers and all employees in the education sector start focusing their educational influence on especially vulnerable groups: girls, the homeless and children on the streets. Member States of the Council of Europe should target children who are under the care of the State. The problem of teenage mothers is not so much a health problem since Council of Europe member states have medical standards which can ensure the teenage mother a safe birth. The fundamental problem lies in the State's responsibility for marginal children such as homeless, orphaned and street children. Apart from health and social care, this is where the State's full responsibility in encouraging education and prevention comes into play.

TABLE I

Rank Country Statutory Maternity Paid Leave in some Council of Europe member States, Canada and the United States (weeks)

Sweden	691	Austria	16
Norway	51	Portugal	16
Denmark	28	Romania	16
Czech Republic	28	Latvia	16
Slovakia	28	Spain	16
France	16-46	Netherlands	16
Hungary	24	Luxembourg	16
Iceland	24	Finland	15
Poland	22	Belgium	15
Italy	20	United-Kingdom	14-18
Liechtenstein	20	Germany	14
Russia	20	Ireland	14
Lithuania	18	Switzerland	8
Canada	17	USA	0

4.       Reforms in family and maternity protection policies

36.       Current social and economic policies towards the family unit in the 21^st century are being questioned. Traditional values are in retreat across Europe and new and varied family structures are changing the way we live: divorce does not carry the social stigma it once did; as we have seen, there is a rising trend in numbers of single mothers, some of whom have never married and have no plans to marry; couples decide to have smaller families, or no children at all; some European countries give homosexual relations some of the same legal rights as their heterosexual counterparts - it is a far different portrait of a typical European family than existed just a generation ago. Family policies should therefore be oriented towards what exists.

37.       The ways in which European countries provide rights and financial help to families and working parents vary enormously. Differences do not just come from detailed calculations of cost or labour market structures. They reflect different cultural attitudes to the family, to the roles of men and women, to childcare and to how far the state should be involved. France has a long history of trying to encourage more childbirth so it pays generous benefits for women with subsequent children. Germany has traditionally aimed to support the male-breadwinner family and so it makes it easier for women not to work. The Scandinavian countries have had a long-lasting commitment to sex equality and helping both parents to work.

38.       The need for reforms in family policies has not gone unnoticed by European governments. Austria has introduced childcare benefits for everybody designed mainly to provide incentives to increase the birth rate and offer financial support and acknowledgement of the care work for all and not just for employed women, which should reduce risks for families. Germany has introduced changes in parental leave and benefit policy, aiming to increase the percentage of families receiving complete child-rearing benefit over the maximum period of two years, to improve the possibilities for two working parents to combine work and family life by increasing the attractiveness of part-time work while on parental leave, and to increase the percentage of fathers going on parental leave. The United Kingdom has introduced working families tax credit aiming to tackle poverty and social exclusion in all regions of the United Kingdom. Parties in the Parliament in Denmark have proposed an extension of maternity/paternity leave which will target mainly young families with children. The Netherlands has initiated reform aiming to improve child-care by doubling the number of places in child care. The Parliament in Italy has initiated reform on parental leave and benefits which will introduce more flexibility in family organisation after child birth and recognise the father’s role and his right to paternity leave, but also aiming to protect maternity for most categories of workers so as to favour the presence of women in the labour market and to increase their fertility rate.

39.       Spain has initiated reforms with a view to zero cost replacement for maternity leave promoting equality at work for women and guaranteeing the right to maternity without involving added costs for companies and employers. The Spanish Parliament passed a new act to promote reconciliation of work and family life of employed persons, as well as revision of child benefits in the social insurance system which updates the amounts of the means-tested child allowances targeting parents that have a multiple birth and households with lower income. Sweden has initiated reforms such as: maximum fees in publicly subsidised childcare which will lower childcare expenses for all families with children in publicly subsidised childcare; reform of housing allowances attempting to protect single-parent low income families from the effects of incremental cutbacks; and parental insurance reform aiming to expand social entitlements and individualise social rights and insurance.

40.       As a society we must be able to organise life to make childbearing a realistic option, in other words make sure that the problems of the reconciliation of work and family will, if not completely disappear, at least diminish. Finland is proposing to raise its paid paternity leave from 18 to 42 days, within a week of a British proposal to raise it from nothing to two weeks. This is not because the Finns can afford it more than the British. It is a priority for them, so they choose collectively to spend their money that way.

41.       We shall now examine maternity protection policies in more detail in Italy, Slovakia, Sweden and the United-Kingdom.

4.1.       Italy

42.       Family policies in the conservative welfare state model exemplified by Italy are based on male providers, where the family and employee insurance are of central importance. Basic security is directly tied in with employment performance covering only those in paid labour, not the whole population. Minimum sustenance security based on citizenship is not typical. Finally, the public sector is involved in the production of welfare only through its role in income transfers; it produces much more limited welfare services. The ideology of subsidiary lies behind this phenomenon. It may be interpreted as government having the right to intervene only in exceptional cases in which the family is demonstrably inadequate or unfit to care for its dependent members. Alternatively, it may be seen as indicating an obligation on government to provide support for families to enable them to fulfil their obligations.

4.1.1.       Policies for supporting mothers' employment

43.       In Italy, compulsory maternity leave is 5 months long and it is compensated at 80 per cent of the salary. Then the mother has the right to 6 months’ leave until the child is one year old, at 30 per cent of salary. In addition, maternity leave provisions include: i) two one-hour breaks per day at full pay to breast feed babies till their first birthday; and ii) occasional unpaid leave (allowed to either mothers or fathers) to care for the sick child (till his or her third birthday). However, though maternal leave policies appear very generous on the statutory level, many mothers have no entitlements. As maternity leave is paid at the same compensation rate as for sickness, only employed mothers are entitled. Mothers who are employed in the informal labour market or self-employed have no leave entitlement and some full-time employees such as housekeepers and domestic servants have very reduced compensation.

44.       Pre-school services, although "to be provided upon individual demand", are not compulsory and user fees are applied, particularly in nursery schools. For under-3-year-olds, nursery school attendance is particularly low in the South (2%). In contrast, as many as 30 per cent of all children may be enrolled in some cities in the Centre-North. Fees are determined according to family incomes. Nevertheless, poor families, mothers who work odd hours, and disadvantaged groups are often excluded. Kindergartens, on the other hand, have long been free of charge for all, though recently some local governments have introduced an income-based fee. In addition, the number of public kindergartens increased and a more balanced national distribution was achieved, thanks to state intervention, particularly in the South. As a result, the enrolment rate rose to almost 93 per cent in the early 1990s. However, some qualitative differences remain in terms of such items as duration and availability of hot meals.

4.1.2.       Policies for supporting lone-parent families

45.       Italy retains a family structure typical of what demographers have called "the Mediterranean model", with low levels of divorce, cohabitation and births outside marriage. However, it seems likely to experience, within the next 5 to 10 years, the same dramatic rise that most western countries have already seen. Nonetheless, social policy has not considered specific risks that lone-parent families are likely to experience. One-parent families do not receive any supplement. Only income thresholds, according to which family allowance is determined, are slightly higher.

46.       Moreover, the state does not enforce or advance child support, leaving the arrangements and actual payment to the private sphere (family and courts). Still in the late 1980s, two years after separation, 18 per cent of non-custodial fathers did not pay child support and 25 per cent did so only partially or irregularly.

4.2.       Slovakia

47.       Slovakia exemplifies developments taking place in the post–communist countries. These countries have sufficiently developed maternity care systems, but these systems are not adequately financed.

48.       Slovakia is characterised by the following trends:

• Long-term decline in birth rate and fertility

• The decline in the birth rate did not stop in the nineties, in spite of the fact that more young adults were reaching usual parenting age

• Decrease in the share of children in the total population

• The number of children born out of wedlock is gradually increasing

• Decrease in marriage rate

• Long-term moderate growth of divorce rate

• A significant decrease in the abortion rate

• Increase in the use of contraception instead of terminations

• Moderate rise in (traditionally very young) age at time of first marriage and birth of first child

• The most frequent causes of death are cardio-vascular diseases and cancer

• Growth of addiction (to drugs, alcohol)

• Female-dominated old age.

4.2.1.       State social support as one of the pillars of social security in Slovakia

49.       State social support is one of three component parts of the social security system in Slovakia. The remaining two are social insurance and social assistance. State social support covers those events in life which represent a natural part of the individual's or family's life cycle. The State support is to prevent an undesirable drop in the standard of living of families with dependent children in their care. These events include the birth of a child in a family, the dependency of a child and his or her continued preparation for a profession, the presence of a severely disabled child in the family, dependent child in foster family care, temporary or long-term absence of one breadwinner and bereavement in the family.

4.2.2.       State social benefits

50.       The system of state social benefits is made up of several benefits. The most elementary classification is according to the frequency of payment as either one-off or repeated benefits.

a) One-off financial benefits:

- birth grant

- allowance for parents to whom three or more children were born at the same time, or who have had twins twice in the course of two years

- one-off contribution to pay for the needs of the child at the time of start and end of foster care

- funeral grant

b) Repeated financial benefits:

- family allowances and family allowances increment/supplement

- parental benefit

- care benefit

- repeated benefit to cover the needs of a child entrusted to foster care

- housing benefit

In 1998, a total of 14,682,522,000 Slovak crowns were used to pay state social support benefits, approximately 1 percent less than in 1999.

4.2.3.       Maternity leave

51.       Maternity leave is regulated by Labour Code No. 65/1965 Coll., according to which a woman is entitled to maternity leave entering childbirth and care for the new-born child during 28 weeks. If a woman gives birth to two or more children, or if she is a lone mother, she has a right to maternity leave for 37 weeks. In order to intensify maternal care for the child, the employer is obliged to provide the woman who applies for it with further maternity leave until her child is three years old. As a rule, the woman starts maternity leave from the beginning of the 6^th week before the expected day of birth, however, not earlier than the beginning of the 8^th week before that day. Maternity leave for childbirth can never be shorter than 14 weeks, and in no case can be ended or interrupted before six weeks have elapsed from the day of delivery.

52.       During maternity leave or further maternity leave the employee is not entitled to salary. The financial provision is regulated by Act No. 88/68 Coll., as amended, and Act No. 381/1990 Coll. on parental benefit. The mother of the child receives financial help in motherhood from sickness insurance benefit, which is regulated by Act. No. 88/1968 Coll., as amended. A condition for providing this benefit is participation in sickness insurance for 270 days during the previous two years or a protective period, or being registered as unemployed and decided on keeping the pregnancy until childbirth.

53.       The amount of benefit is derived from previous income and represents 90 percent of the net salary, maximum SKK 350 per working day, for self-employed persons maximum SKK 250 per calendar day.

4.2.4.       Parental benefit

54.       Within the state social support system, parental benefit (which is regulated by Act No. 382/1990 Coll. on parental benefit, as amended) is provided. Through this benefit the State contributes to covering living needs of a parent (mother or father) who in person takes proper daily care of a child under the age of three, or the age of seven in the case of a long-term severely disabled child requiring extraordinary care or specially demanding extraordinary care. On the basis of a total of seven legislative changes, which regulated the amount of the benefit, the amount of SKK 900 (enacted in 1990) was increased to the present SKK 3,790 (Act No. 280/2002 Coll). Since 1993, when Act No. 239/1993 Coll. came into effect, the amount of parental benefit has been expressed in relative terms based on the amount of the subsistence level or, since 1998, from ASSB (0,1913 multiple).

55.       A new bill on parental benefit would provide half the parental benefit to a parent who looks after a child aged under three and is, at the same time, engaged in gainful activity. What will have to be verified is if good care is being taken of the child and if the child attends regular preventive medical check-ups, as well as fulfilling the vaccination programme. This measure would help to partly reduce the career handicap caused by a three-year absence from work, and/or lack of continued professional training, and so on.

4.2.5.       Integration into the EU

56.       The most serious question in terms of EU integration seems to be the problem of having a single centralised entity providing family allowances or other family benefits. The fragmented nature of the payment of family allowances by four entities (local state administration, sickness insurance, National Labour Office and Social Insurance Agency) makes them administratively demanding, non-uniform in terms of applying legislation in practice, and increases the risk of abuse by beneficiaries. Additionally, it complicates the flow of financial resources between the Ministry of Finance, Ministry of Labour, Social Insurance Agency and the payers of family benefits. Due to this, there is an effort to minimise these shortcomings by providing state social support benefits within the scope of the activity of one entity, namely the bodies of local state administration and their departments of social affairs.

57.       In terms of EU integration, this need is related to the free movement of persons and members of their families, linked to the obligation to export the determined family benefits abroad. These are, above all, family allowances, funeral grants, parental benefits or some other benefit. The rationale following from concentrating the provision of state social benefits in one entity - the district authority - is the possibility for the mutual exchange of information decisive to the entitlement to state social benefits and social assistance. It is one of the ways of preventing unjustified payment in cases where the entitled person does not use the state social benefit for the purposes for which they were intended. This also makes it possible to prevent overpayment of social assistance benefits.

4.3.       Sweden

58.       The goal of family policy in the Nordic welfare state model typified by Sweden is social integration, sought by maintaining benefit levels and social services standards that are uniformly high, affordably priced and available to all who need them. Basic security is typically at a reasonable level; the state is in a central role as a provider; conditions of eligibility are exceptionally liberal and coverage is in most instances universal. A reasonable level of benefits is determined by minimal security on the one hand and income-relatedness on the other. The state plays a multi-faceted regulating role in society; it is used as an instrument that rules the relationships between genders and between work and family responsibilities, that gives priority to women's integration in the labour market, and makes the cost of having children equal within social groups.

4.3.1.       Policies for supporting mothers' employment

59.       The ability of Swedish women to combine work and parenthood rests on two important programmes: paid parental leave and a nation-wide system of public childcare. Replacing maternity benefits in 1974, parental insurance aimed to give mothers and fathers equal standing in child rearing. Parents could thus share a total of 12 months of work leave at almost full pay - in most cases 90 per cent of current earnings - to care for a new-born. A further three months ´ leave, with a lower flat rate of pay, could be taken at any time until the child entered school. Parents with no prior earnings receive the low flat rate during the whole leave period. Overall leave could also be extended (without pay, but with a guarantee of being able to return to the same job) to care for a child until the age of 18 months. In the case of multiple births, parents receive six months’ extra benefits for each additional child. Furthermore, parents have the right to work only 75 per cent of the full work-week while their children are under 8 years old. In addition, the parental insurance system includes: i) since 1980, ten-days’paid leave for fathers at the birth of a child; ii) occasional leave at nearly full pay to care for a child, extended to sixty days in 1990; iii) since 1980, pay for women unable to continue to work due to health problems related to pregnancy or childbirth; and iv) since 1986, two days' leave (at nearly full pay) per year per child aged 4-12 to participate in day care or school activities. These provisions are financed out of general revenue with no direct cost to the parent's employer.

60.       Day care in Sweden is available in two forms: "day care centres" and "family day care". The latter are women who take children into their own homes and are paid by the local government, which then collect fees from parents. Fees from parents cover, on average, only 10 percent of total day care costs. The majority of working parents in Sweden have a child in the public childcare system: 64.4 percent of pre-schoolers who live with two parents who are both working and studying and 84.2 percent of children of single parents who work or study are in public childcare.

4.3.2.       Policies for supporting lone parent families

61.       All single parents with children under 18 years (or 20 if secondary school students), regardless of income, are entitled to a tax-free advanced maintenance payment, which is about 40 percent of the "base amount" of support on which most of the Swedish Social Security System is based (National Social Insurance Board Sweden, 1992). Hence, in the event of default in payment by the absent parent, the state rather than the child bears the burden. Irrespective of whether the father pays any support or not, the government "fills in" up to 1,123 Swedish crowns. The government then tries to locate the father and retrieve the child support advanced from him. The custodial parent receives the payment even if he or she lives in a new consensual union. In addition, solo parents receive preferential treatment in the allocation of scarce spaces in the public day care system and pay a lower parental fee than do two-parent families.

4.4.       United Kingdom

62.       All women employees can claim 18 weeks’ Ordinary Maternity Leave with the right to return to exactly the same job, no matter whether they are full-time, part-time, the length of time they have worked for their current boss or whether they were pregnant when they started work. They can choose when their maternity leave begins, but the earliest it can start is 11 weeks before expected week of childbirth. By law, Ordinary Maternity Leave must include at least two weeks (or four weeks for factory workers) after the birth to protect the health and safety of mother and baby. From April 2003, Ordinary Maternity Leave will go up to 26 weeks.

63.       Women who have been continuously employed by the same employer for at least one year by the 11^th week before the expected week of childbirth qualify for Additional Maternity Leave, which starts at the end of Ordinary Maternity Leave and lasts for 29 weeks from the birth. From April 2003, women with 26 weeks service by the fifteenth week before the expected week of childbirth will be entitled to Additional Maternity Leave which will last for 26 weeks from the end of Ordinary Maternity Leave giving a maximum leave entitlement of one year.

64.       Statutory Maternity Pay is 18 weeks pay at 90% of average pay for six weeks followed by the “basic rate” of Statutory Maternity Pay, currently GBP 62.20 per week, for 12 weeks. Women will get Statutory Maternity Pay, whether or not they are going back to work, if they meet all the following conditions:

i. They have worked for the same employer for at least 26 weeks by the end of the “qualifying week” of their pregnancy (the 15^th week before the expected week of childbirth);

ii. They actually receive at least GBP 72 per week before tax on average in the eight weeks (if paid weekly) or two months (if paid monthly) up to the last pay day before the end of their qualifying week;

iii. They stop work because of pregnancy.

From April 2002, the Statutory Maternity Pay basic rate will go up to GBP75 a week. Statutory Maternity Pay will last for 26 weeks. The calculation period for Statutory Maternity Pay will also change, from eight to 26 weeks before the 15^th week before the expected week of childbirth. Adoptive parents will also be paid for adoption leave for the same period and at the same flat rate as Statutory Maternity Pay.

65.       Women who are not entitled to Statutory Maternity Pay may be entitled to Maternity Allowance, a benefit for women who have changed jobs during pregnancy and/or are self employed or have had periods of low earnings or unemployment during their pregnancy. This is payable for 18 weeks (also going up to 26 weeks from April 2003) at two rates, depending on average earnings during a test period. The standard rate is currently GBP 62.20 per week (this is also going up to GBP 100 a week from April 2003).

66.       Even with the forthcoming changes, parents in the United Kingdom will still not receive as much help and protection at work as those in almost every other country in Europe. When it comes to maternity rights, parental leave and pay while taking time off to look after children, the United Kingdom remains behind its neighbours in Continental Europe.

67.       However, rights appear to be flouted in practice. According to a report by the National Association of Citizens Advice Bureaux in the United Kingdom, tens of thousands of women each year are illegally sacked or threatened with dismissal when they tell their employer they are pregnant.

After analysing employment problems handled by the Bureaux last year, the Association found widespread flouting of employees’ maternity and paternity rights. Cases included a mother-to-be who was dismissed from her job in a shop on the grounds that a pregnant woman was not an attractive sight to customers. Another woman was contacted while on maternity leave and told not to return to work because regardless of her rights, there was no job for her. A sales assistant with seven years’ service returned to her full time job after maternity leave to be told she was being put on a three day week and her pay cut by 35p an hour. The Association commented that even when employers stopped short of dismissal, women were often asked to resign or reduce their hours, and were denied time off to attend pre-natal appointments and the right to the same job after maternity leave. Additional rights would be worthless to many unless the problem of enforcement was tackled and there was real, practical assistance for small employers. The Association proposed that the government should set up a fair employment commission to enforce employees' rights at work and support firms having difficulties in meeting their statutory duties. The agency should also have powers to investigate complaints, carry out random checks and impose fines.

5.       Mothers’ rights: international standards

5.1       Council of Europe

68.       Employed women have the right to maternity protection under the European Social Charter (ESC) and Revised European Social Charter (RESC), and the European Code of Social Security (Articles 46-52) and its Protocol.

69.       Under ESC Article 8 (“The right of employed women to protection of maternity”), the Parties undertake

1.       to provide either by paid leave, by adequate social security benefits or by benefits from public funds for employed women to take leave before and after childbirth up to a total at least fourteen weeks;

2.       to consider it as unlawful for an employer to give a woman notice of dismissal during the period from the time she notifies her employer that she is pregnant until the end of her maternity leave...

3.       to provide that mothers who are nursing their infants shall be entitled to sufficient time off for this purpose;

      4.       to regulate the employment in night work of pregnant women, women who have recently given birth and women nursing their infants;

5. to prohibit the employment of pregnant women, women who have recently given birth or who are nursing their infants in underground mining and all other work which is unsuitable by reason of its dangerous, unhealthy or arduous nature and to take appropriate measures to protect the employment rights of these women."

70.       ESC Article 16 - (“The right of the family to social, legal and economic protection”) stipulates that:

"with a view to ensuring the necessary conditions for the full development of the family, which is a fundamental unit of society, the Parties undertake to promote the economic, legal and social protection of family life by such means as social and family benefits, fiscal arrangements, provision of family housing, benefits for the newly married and other appropriate means."

71.       Under Article 27 (RESC), all persons with family responsibilities and who are engaged or wish to engage in employment have a right to do so without being subject to discrimination and as far as possible without conflict between their employment and family responsibilities.

72.       Under Article 30 (RESC), everyone has the right to protection against poverty and social exclusion.

5.2.       International Labour Organisation

73.       The ILO´s Maternity Protection Recommendation R191, 2000, which supplements the Maternity Protection Convention, 2000, which entered into force on 7 February 2002, proposes that:

- countries should extend the period of maternity leave to at least 18 weeks

- provision should be made for an extension of maternity leave in the event of multiple births

- measures should be taken to ensure that the woman is entitled to choose freely the time at which she takes any non-compulsory portion of her maternity leave, before or after birth

- the cash benefits during maternity leave should be raised to the full amount of the woman's previous earnings or of such of those earnings as are taken into account for the purpose of computing benefits

- medical benefits should include care given in a doctor's office, at home or other medical establishment by a general practitioner or a specialist; maternity care given by a qualified midwife or by another maternity service at home or in hospital or other medical establishment; maintenance in a hospital or other medical establishment; any necessary pharmaceutical and medical supplies, examinations and tests prescribed by a medical practitioner or other qualified person; and dental and surgical care

- as regards the financing of benefits, any contribution due under compulsory social insurance providing maternity benefits should be paid in respect of the total number of men and women employed, without discrimination of sex

- employment protection and non-discrimination - a woman should be entitled to return to her former position or an equivalent position paid at the same rate at the end of her leave

- health protection - to ensure assessment of any workplace risks related to the safety and health of the pregnant or nursing woman and her child; in any of the situations where a significant risk has been identified measures should be taken to provide, on the basis of a medical certificate as appropriate, an alternative to such work in the form of: elimination of risk (arduous work involving the manual lifting, carrying, pushing or pulling of loads; work involving exposure to biological, chemical or physical agents which represent a reproductive hazard; work requiring special equilibrium); an adaptation of her conditions of work; a transfer to another post, without loss of pay, when such an adaptation is not feasible or paid leave, in accordance with national laws, regulations or practice, when such transfer is not feasible; work involving physical strain due to prolonged periods of sitting or standing, to extreme temperatures, or to vibration; a pregnant or nursing woman should not be obliged to do night work if a medical certificate declares such work to be incompatible with her pregnancy or nursing; the woman should retain the right to return to her job or an equivalent job as soon as it is safe for her to do so; a woman should be allowed to leave her workplace, if necessary, after notifying her employer, for the purpose of undergoing medical examinations relating to her pregnancy

- breastfeeding mothers - the frequency and length of nursing breaks should be adapted to particular needs; it should be possible to combine the time allotted for daily nursing breaks to allow a reduction of hours of work at the beginning or at the end of the working day; provision should be made for the establishment of facilities for nursing under adequate hygienic conditions at or near the workplace

-       related types of leave - in case of the death of the mother before the expiry of postnatal leave, the employed father of the child should be entitled to take leave of a duration equal to the unexpired portion of the postnatal maternity leave; in the case of sickness or hospitalisation of the mother after childbirth and before the expiry of postnatal leave, and where the mother cannot look after the child, the employed father of the child should be entitled to leave of a duration equal to the unexpired portion of the postnatal maternity leave, to look after the child; the employed mother or the employed father of the child should be entitled to parental leave during a period following the expiry of maternity leave; distribution of parental leave, (length, payment and other modalities) between the employed parents should be determined by national laws and regulations; adoptive parents should have access to the system of maternity protection especially regarding leave, benefits and employment protection.

5.3.       World Health Organisation

74.       WHO considers that safe motherhood depends not only on high quality reproductive health care (see below, section 6) but also on strategies to empower women and to implement their human rights. Accordingly, WHO seeks to promote safe motherhood through the application of human rights law. ²

a.       Rights relating to life, survival and security

i. The right to life and survival

"Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life."

The right to life is the most obvious right that could be applied to protect a woman at risk of dying in childbirth due to lack of obstetric care.

ii. The right to liberty and security of the person

"Everyone has the right to liberty and security of the person... No one shall be deprived of his liberty except on such grounds and in accordance with such procedure as are established by law."

The right to liberty and security of the person is one of the strongest defences of individual integrity and the right of women to free choice of maternity (safe abortion).

iii. The right to be free from inhuman and degrading treatment

"No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment…"

A state might be held bound to ensure provision of emergency obstetric care and treatment for maternal morbidities, because lack of such provision could constitute inhuman treatment and denial of respect for the inherent dignity of women. Care could provide for a woman's access to medically indicated treatment, which may include services to treat a high risk pregnancy, and to terminate pregnancy safely where her life or continuing health, including mental health and social well-being, are at risk. A state is responsible to require its health care providers and facilities to ensure women's reasonable access to safe abortion and related health services, as its law permits.

b. Rights relating to maternity and health

i. The right to maternity protection

"Special protection should be accorded to mothers during a reasonable period before and after childbirth..."

Legal research is needed to show if and how these provisions have been or could be applied to ensure women are adequately protected.

ii.       The right to maternity protection during employment

"Working mothers should be accorded paid leave or leave with adequate social security benefits"

iii.       the right to marry and to found a family

iv. The right to free choice of maternity/the right to private and family life

v. The right to the highest attainable standard of health

Women-friendly health services should:

- be available, accessible, affordable and acceptable;

-        respect technical standards of care by providing a continuum of services in the context of integrated and strengthened systems;

-        be implemented by staff motivated and backed up by supervisory, team-based training, and incentive-linked evaluation of performance; and

-        empower users as individuals and as a group by respecting their rights to information, choice and participation.

vi. The right to the benefits of scientific progress

c. Rights to non-discrimination and due respect for difference

"Ensure to all individuals within its territory and subject to its jurisdiction the right to non-discrimination, without discrimination of any kind, such as race, colour, sex, language, religion, political or other opinion, natural or social origin, property, birth or other status / such as age, rural residence or poverty"

d. Rights relating to information and education

6.       Maternal and infant mortality

75.       Although there has been an overall improvement in the rates of maternal and infant mortality (see Tables II-IV), largely as a result of advances in modern obstetric practice, infant and maternal mortality are still too high and subject to wide variation between member states.

76.       According to the Council of Europe’s demographic statistics, the infant mortality rate in member states ranged in 2000 from 35.3 ‰ in Turkey to 3 ‰ in Iceland, with the Central and Eastern European countries varying between 18.6 ‰ in Romania and 4.1 ‰ in the Czech Republic. It is in Eastern Europe that rates are generally above the European average of 9 ‰.

77.       Unintended pregnancies, socio-economic variables, and inequalities in access to reproductive and general health care contribute to unacceptably high maternal mortality rates in some countries - notably in Eastern European countries. Mortality of mothers evidently correlates mostly with economic prosperity as can be seen from the country-specific maternal mortality rates in Table II (weaker economy = higher maternal mortality). Maternal mortality also raises the question of obligatory registration for pre-natal care which was the instrument used in the past by Eastern European countries with currently high maternal mortality rates, but the outcomes seem to suggest that the obligatory registration was conducted only on formal level.

78.       Maternal mortality depends not only on the health care system, but also to a great extent on the social, financial and emotional well-being and the state of health and nutrition of mothers. Nevertheless, it would also be important to encourage the improvement of medical doctors’ training, collaboration between doctors and health care organisations, doctors' participation in educational conferences on women's reproductive health issues and on obstetric complications. Emphasis must be also laid on pre-natal care, counselling and providing the appropriate interventions.

79.       Improvements must be made in the documentation of maternal deaths. Death certificates should be revised to include information on any recent pregnancy prior to the time of death, as well as details concerning reproductive health.

80.       Maternal mortality remains an important indicator of the status of health care in the modern world. Many factors interact in complex ways to increase the risk of death for pregnant women. Attempting to minimise the risk is not enough. The focus must be on prevention, pre-natal care, counselling, encouraging planned pregnancies, addressing cultural disparities in medical and pre-natal care and creating conditions for healthier and happier life styles in European countries.

81.       The Council of Europe member States should continue to support and implement the commitments associated with the Safe Motherhood Initiative, launched in 1987 by WHO, UNICEF, the United Nations Population Fund (UNFPA), the World Bank and other organisations. They should also support the related WHO “Making Pregnancy Safer Initiative”, which, as far as Europe is concerned, is focused initially on Albania, Armenia, Moldova and Russia. The essential aims are to reduce maternal and newborn morbidity and mortality by promoting specific health interventions known to reduce the incidence and severity of major complications associated with pregnancy, childbirth and the postpartum period for mothers and their newborns. These health interventions include:

• prevention and management of unwanted pregnancy and unsafe abortion, as well as good medical and surgical practices for induced abortion, where it is not illegal;

• basic and comprehensive, essential obstetric care provided by a skilled attendant during pregnancy, delivery and the postpartum period in order to prevent or detect and handle complications for the mother and her newborn;

• access to a functioning health referral system, especially if and when complications arise.

82.       Moreover, the member States should fully support the WHO Regional Office for Europe in its programme for the “Promotion of Effective Perinatal Care” (PEPC), especially designed for countries with high maternal and infant mortality, and focusing on the crucial perinatal period from 22 weeks of gestation to seven days after birth, and on the role that primary health care can play.

83.       Improving the performance of health systems in delivering maternal healthcare must be given high priority and greater resources, not least in the areas of information and training.

TABLE II

Maternal mortality ratio (maternal deaths per 100,000 live births) in the Council of Europe member States

Countries	1997	1998	1999	2000
Albania	8,1	13,3	...	...
Andorra	0	0	0	0
Armenia	38,7	25,4	32,87	72,94
Austria	2,38	4,92	1,28	2,56
Azerbaijan	31,05	41,13	43,39	37,61
Belgium	...	...	...	...
Bosnia & Herzegovina	...	...	...	...
Bulgaria	18,71	15,3	22,13	17,64
Croatia	10,81	6,37	11,07	6,86
Cyprus	...	...	...	...
Czech Republic	5,52	6,63	10,06	5,5
Denmark	7,39	3,02	...	...
Estonia	15,84	16,3	15,94	38,2
Finland	5,06	5,25	3,47	...
France	9,63	10,16	...	...
Georgia	26,49	30,25	51,25	49,18
Germany	6,03	5,6	4,8	...
Greece	0	6,94	5,96	...
Hungary	20,93	6,17	4,23	10,25
Iceland	0	0	48,783	0
Ireland	5,68	3,71	1,87	1,84
Italy	4,37	3,38	...	...
Latvia	42,49	48,89	41,25	24,69
Liechtenstein	...	...	...	...
Lithuania	23,8	18,91	16,48	11,71
Luxembourg	0	18,57	...	17,47
Malta	...	22,28	23,21	0
Moldova	50,47	36,29	28,57	27,07
Netherlands	7,79	11,53	9,48	...
Norway	1,67	6,85	...	...
Poland	...	...	5,24	...
Portugal	5,31	7,93	5,17	2,5
Romania	41,37	40,46	41,77	31,98
Russia	50,24	44,03	44,21	39,71
San Marino	...	...	...	...
Slovakia	3,38	8,68	10,67	1,81
Slovenia	11,09	11,25	11,54	...
Spain	2,17	2,74	...	...
Sweden	3,32	7,86	1,13	...
Switzerland	3,72	...	...	...
“The former Yugoslav Republic of Macedonia”	3,39	3,42	7,32	13,65
Turkey	...	130	...	...
Ukraine	25,8	27,19	25,18	24,67
United Kingdom	5,37	6,83	5,28	...

... data not provided by the country

Source:        WHO/Europe, HFA Database, January 2002

TABLE III

Maternal mortality ratio (maternal deaths per 100,000 live births) in Europe (1995)

EUROPE	28
Eastern Europe	50
Northern Europe	12
Southern Europe	12
Western Europe	14

TABLE IV

Infant mortality rate: deaths during first year per 1000 live births

Source: Council of Europe, Recent demographic developments in Europe, 2001, p. 87

7.       Conclusions

84.       The changes that Europe is undergoing in relation to demography, globalisation, new forms of work, family life, the labour market and the transition to a knowledge-based society have raised the profile of the social dimension in the search for economic efficiency and social equity.

85.       One of the main challenges Europe faces today is to generate economic growth and competitiveness whilst preserving its social model within a caring society. The employment situation in Europe is some way behind that of the United States, mainly due to an under-developed services sector. Job creation in this area is a key policy concern in contributing to economic growth.

86.       In developing an appropriate policy framework for the development of employment, maternal rights and health, Europe should seize the opportunity to respond to growing social needs while promoting both economic growth and social cohesion. Since women make up an ever-growing proportion of the work force, not least in the services sector, it is vital that their employment conditions should offer the very highest possible standards of maternity protection with regard to social benefits and health. This is all the more important at a time of falling fertility in Europe. These standards have been set by the Council of Europe through such instruments as the European Social Charter and the European Code of Social Security, by the International Labour Organisation in its Conventions and Recommendations on Maternity Protection, and the World Health Organisation through its guidelines on safe motherhood, pregnancy and perinatal care. The Rapporteur urges the member States to review their maternity protection policies in the light of these instruments and guidelines and urges the Committee and the Assembly to support the preliminary draft resolution contained in this report.

Sources:

1 EUROSTAT: Annual Report - The social situation in the European Union, 2000

2 Richard Berthend and Karen Robson, UNICEF: The outcomes of teenage motherhood in Europe, United Nations Children's Fund Innocenti Research Centre, July 2001

3 Marta Feletto: Market's and Family's Failures. The answers to new social risks in three welfare systems, Department of sociology and social research, 1999

4 MISSOC: Comparative tables of social protection systems in the European Union member states, 2001

5 International Centre for Family Studies: Reflections of recent demographic conditions on family and social policies in CEE Countries, Bratislava, 2001

6 Guardian Unlimited, citing from articles regarding maternity debate in Britain, www.guardian.co.uk

Reporting committee: Social, Health and Family Affairs Committee

Reference to committee: Doc. 8801 and Reference No. 2534 of 25 September 2000

Draft resolution unanimously adopted on 2 September 2002.

Members of the committee: Mrs Ragnarsdóttir (Chairman), Mr Hegyi, Mrs Gatterer, Mr Christodoulides (Vice-Chairmen), MM. Alís Font, Arnau, Mrs Belohorská, Mr Berzinš, Mrs Biga-Friganović, Mrs Björnemalm, Mrs Bolognesi, MM. Brînzan, Brunhart, Cerrahoğlu, Cox, Dees, Dhaille, Dos Santos, Evin, Floros, Flynn, Ms Gamzatova, MM. Giertych, Glesener, Goldberg, Gönül, Gregory, Gusenbauer, Güstafsson, Haack, Herrera, Hladiy, Høie, Hörster, Ms Jäger, Mrs Jirousová, Mr Klympush, Baroness Knight (alternate: Mr Hancock), MM. Kontogiannopoulos, Lomakin-Rumiantsev, Ms Lotz, Ms Luhtanen, MM. Makhachev, Małachowski, Manukyan, Mrs Markovska, MM. Marty (alternate: Mr Schmied), Mattei, Mrs Milotinova, MM. Mladenov, Monfils (alternate: Mr Timmermans), Ms Nowiak (alternate: Mr Wikinski), MM. Olekas, Ouzký, Padilla, Podobnik, Popa, Poty, Provera, Pysarenko, Rigoni (alternate: Mr Piscitello), Rizzi (alternate: Mr Tirelli), Mrs Roseira, MM. Seyidov, Mrs Shakhtakhtinskaya, MM. Slutsky, Surján, Telek, Ms Tevdoradze, MM. Truu, Tudor, Turjačanin, Vella, Mrs Vermot-Mangold, MM. Vesselbo, Vis, Vos, Mrs Zafferani, Mr Zidu.

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

Secretaries to the committee: Mr. Newman, Ms Meunier and Ms Karanjac

¹ “Parental benefit in connection with childbirth”, the Swedish equivalent of maternity paid leave, is payable for a period of 480 days.

² R.J. Cook et al. Advancing safe motherhood through human rights, WHO, Geneva, 2001.

³ According to Icelandic expert Professor Reynir T. Geirsson, “Two women died that year, one in a car accident and this was therefore not a true maternal death. Therefore the correct figure, comparable to other countries, would be 24/10000, but since we are a small population, we are usually careful not to give a rate for a single year but to use larger time periods to get a realistic figure”.