STATUS OF WOMEN COMMISSION CONCLUDES DISCUSSION OF WOMEN AND HEALTH, AND FOLLOW-UP TO BEIJING CONFERENCE

3 March 1999

Press Release
WOM/1105

STATUS OF WOMEN COMMISSION CONCLUDES DISCUSSION OF WOMEN AND HEALTH, AND FOLLOW-UP TO BEIJING CONFERENCE

19990303 Maternal mortality was a serious problem which had too often been neglected, Dr. Nafis Sadik, Executive Director of the United Nations Population Fund (UNFPA), told the Commission on the Status of Women as it met this afternoon and evening to hear a presentation on women and health and conclude its general discussion of the follow-up to the Fourth World Conference on Women.

There were many issues which impacted on the reproductive health and rights of women and girls, she said. The first was pre-natal sex selection and poor nutritional status, which resulted in high infant mortality rates, especially among girls. That was exacerbated by a lack of educational and employment opportunities and oppressive traditions that limited them to reproductive rules only -- such as early marriages and early and extended births -- without choices in whom or when to marry.

Dr. Gro Harlem Brundtland, Director-General of the World Health Organization (WHO), said the issue of women's health could not be considered in isolation. Men, fathers, brothers, husbands and sons were important. Women lived in a complex social context, and gender roles and relations were embedded within that context. In order to improve the health of women, there was a need to analyse the determinants of women's health status in the reality of their lives. "This is why I am committed to incorporating a gender perspective in health across WHO's work", she stressed.

The representative of Australia said that many countries were segregating health data based on gender and that was making evaluation of women's health easier. However, data measuring the social, mental and emotional well-being was not segregated on the basis of sex. Therefore, it was difficult to monitor the mental well-being of women. There was a need to create gender sensitive indicators of women's mental health. Quality of life indicators should be incorporated, along with morbidity indicators in evaluating the health of women, she added.

Christine Bergmann, the Federal Minister for Family Affairs, Senior Citizens, Women and Youth of Germany, speaking on behalf of the European Union and associated States, said that a holistic approach was needed to overcome

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overall discrimination and empower women. In that context, campaigns needed to be taken to combat violence against women and increase governmental efforts to ensure that health-care services, research centres and non-governmental organizations (NGOs) addressed those issues in a gender sensitive manner. The Union urged governments to take measures to address the specific needs of women with disabilities so as to empower them to lead independent lives in full self-determination.

Statements were also made by the Deputy Minister for Health of the Russian Federation, Minister for Labour and Social Affairs of Spain, and the Director, Women's Affairs Department, Ministry of Labour and Home Affairs of Botswana. Also speaking were the representatives of Israel, Turkey, India, Dominican Republic, Italy, Chile, China, United States, Cuba, Mexico, Sudan, Norway, France, Republic of Korea, Iran, Canada, Egypt, Bolivia, Costa Rica, Iraq, Cyprus, Viet Nam, Croatia, Mongolia and Yemen.

The Chief, Gender Partnerships of Participation Section, Programme Division, United Nations Children's Fund (UNICEF), and a representative of the World Bank also made statements, as did the observers for the Holy See and for Palestine.

The representatives of the following NGOs made statements to the Commission as well: NGO Committee on the Status of Women, NGO Committee on UNICEF, International Task Force on Women and Environment, and Medical Women's International Association.

The Commission will meet again at 11 a.m. tomorrow, Thursday, 4 March, to continue its deliberations.

Commission Work Programme

The Commission on the Status of Women met this afternoon to continue its dialogue on women and health. It was scheduled to hear presentations by Dr. Gro Harlem Brundtland, Director-General of the World Health Organization (WHO), and Dr. Nafis Sadik, Executive Director of the United Nations Population Fund (UNFPA). It will also continue to hear comments on the presentations of the panel of experts from this morning's meeting. (For background information, see Press Release WOM/1104 issued today.)

Following that, the Commission will resume its general discussion on the follow-up to the Fourth World Conference on Women. (For background information on that item, see Press Release WOM/1098 of 26 February.)

Statement by WHO Director-General

Dr. GRO HARLEM BRUNDTLAND, Director-General of the World Health Organization (WHO), said the health of women was a fundamental pillar that underpinned sustainable development. However, taking on the challenges related to women's health meant acknowledging several realities. The first of those was that for a long time, the focus had always been on the reproductive period. The time had come, however, to focus beyond the sexual and reproductive health of women and view the different needs in the entire life-span. The second reality was that the women's health agenda challenged "our institutions" to incorporate a multitude of partners. "I am committed to making WHO a partnership organization, one which draws upon, and is nurtured by, the comparative advantages of many interest groups."

The third reality, she continued, was that while there was discussion about equity in health, there was a tendency to forget that such equity included the way in which responsibilities were distributed in the health sector. Women's health was not just about their health, but also about the women who worked in health at all levels. Most importantly, she stressed, "we must make sure that women have the access and control of the resources needed to assume community responsibilities in health". The fourth reality was that the focus on women's health had yet to be extended to include a life-span approach. "We tend to compartmentalize women's lives and their health into neat little boxes that make our organizational lives easier. We have yet to work in a way that fully acknowledges that there is a connection between the female foetus, the girl child, a young girl's development, her navigation through adolescence and adulthood, and the way in which she will enjoy her later years."

She said the issue of women's health could not be considered in isolation. Men, fathers, brothers, husbands and sons were important. Women lived in complex social contexts, and gender roles and relations were embedded within that

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context. In order to improve the health of women, there was a need to analyse the determinants of women's health status in the reality of their lives. "This is why I am committed to incorporating a gender perspective in health across WHO's work." Work was, therefore, under way to establish a gender policy for her organization. A gender perspective focused on the roles and relations between women and men and how those affected their health and development. It was also important to remember that gender referred not only to the relations between the sexes at an individual and personal level. It also took into account the values and norms that permeated societies and institutions, organizational systems, including the health and legal systems.

She said that a gender lens could help WHO to better address issues such as malaria, sexually transmitted diseases including HIV/AIDS, health systems and services, violence and mental disorders, environmental health, development policies and tobacco addiction. However, she stressed, "to be able to look through the gender lens, we need information". The basis for a gender approach was sex disaggregated data. "We cannot know what is going on with men and women if we cannot count on information on which to base a comparative analysis." The data collected by countries must, therefore, be sex differentiated. Providing WHO with such information would enable it to produce information on men and women separately that would allow countries to address health needs more equitably and effectively. However, sex disaggregated data was not enough. "We must learn to analyse what that data means", she concluded.

Statement by UNFPA Executive Director

Dr. NAFIS SADIK, Executive Director of the United Nations Population Fund (UNFPA), said there were many issues which impact on the reproductive health and rights of women and girls. First among them was pre-natal sex selection and poor nutritional status, which resulted in high infant mortality rates, especially for girls. It was exacerbated by a lack of educational and employment opportunities and oppressive traditions that limit them to reproductive roles only -- such as early marriages and early and extended births -- without choices for whom to marry or when to marry.

Maternal mortality was a serious problem which had too often been neglected, she said. Each year, nearly 600,000 or more women die during pregnancy or childbirth, a third of them because of lack of access to reproductive health and family planning methods and oppressive traditions that limit women's role to childbearing -- without a choice or support in that role. One of the most important, yet neglected, areas was adolescent reproductive health. It was estimated that over 100 million young people were in need of reproductive health information and services.

She said that many women and girls were exposed to gender-based violence, such as rape and incest, which jeopardized their lives. Governments should be urged to enact and enforce laws to protect women's rights. Another problem was

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the plight of women and girls in refugee and emergency situations, for whom the risk of sexual violence was multiplied. Other threats to women's health included: the spread of HIV/AIDS, female genital mutilation and the lack of economic independence.

She called on governments to take the actions recommended during the International Conference on Population Development +5 (ICPD+5) review, to be held in June, which would be included in the Beijing +5 review next year. Among those would be the following: ensuring that policies and strategic plans were based on human rights; facilitating policy development processes that were participatory and included all stakeholders; increasing investments designed to improve the quality of reproductive health care; giving high priority to reproductive and sexual health; and promoting men's understanding of their roles and responsibilities for respecting women's rights.

Question-and-Answer Period

Dr. BRUNDTLAND, in response to a question on women and girls in sub- Saharan Africa, said HIV/AIDS, combined with poverty, made the situation for African women difficult. The WHO was working with the Joint United Nations Programme on HIV/AIDS (UNAIDS) in sub-Saharan Africa, and it was also working to develop cooperative programming so that all agencies could play a role in that region. On actions taken after Cairo and Beijing, she said the WHO was part of the follow-up process, and it was implementing the conclusions of those conferences together with other United Nations agencies.

On a question regarding the situation in Iraq, she said there were certainly many problems there. The WHO and other United Nations agencies were trying to help and do their best to improve conditions. The WHO staff and others there were looking at what could be done in the general humanitarian efforts. On the situation in Bangladesh, Dr. Brundtland said she would visit that country in the fall and would be able to discuss a number of issues with government leaders there.

Dr. SADIK, in response to a question on HIV/AIDS, said the UNFPA was setting goals for 2005 to make sure that the transmission of HIV was reduced. On the situation in Iraq, the UNFPA was participating in working groups in that regard and would be providing funds for a programme on reproductive health and family planning. On the situation in Bangladesh, she said the woman prime minister there had made a great difference both in introducing women's issues into discussions and creating new women-friendly policies. That situation showed that women in policy-making positions did make a difference.

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Statements on Women and Health

RACHEL ADDATO-LEVY (Israel) said the most important occurrence in her country with regard to the Beijing Conference was the enactment of the National Health Insurance Law in 1995. Health insurance now provided coverage to 100 per cent of Israel's residents. It also did not discriminate by sex, age, religion or ethnicity. The law entitled the residents of Israel to a comprehensive health basket with good access to medical services. Those services also reached the most remote rural areas. The law had also improved the provision of medical services to minority populations such as Bedouin Arab and other groups that had poor coverage and access to care. Among the care provided under the auspices of the health basket were services ranging from basic maternity and pregnancy care through in vitro fertilizations to highly sophisticated treatments for breast and ovarian cancer.

She said one of the cornerstones of Israel's public health system was a network of family health clinics distributed throughout the country and which provided services to all sectors of the nation. Those stations offered mother and child care, family planning, vaccinations, obstetric and pre- and post-natal care. Those services were provided indiscriminately to every woman and child, including female migrant workers who were in Israel legally or illegally. The basket of health services offered a growing number of medications. Among them were remedies for gender-specific problems, such as osteoporosis. The Ministry of Health had recently launched a public campaign to promote awareness and utilization of mammography screening. Health promotion and education for women was another area in which growing efforts were being invested. Violence in the family was addressed in laws that made it mandatory for members of the medical community to report every such suspected case.

CHRISTINE BERGMANN, Federal Minister for Family Affairs, Senior Citizens, Women and Youth of Germany, spoke on behalf of the European Union and Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Romania, Slovakia, Slovenia, Cyprus and Iceland.

She said the countries of the Union had identified a number of principles and goals that were already or would become inherent parts of their health policies. Women had the right to enjoy the highest standard of physical and mental health throughout their life cycle. Their health was an issue of health and justice and not only a medical issue or a social good. Women's status at large in society, their experiences with discrimination, their lack of opportunities and their lack of equal rights did have an impact on their health -- that merited special attention.

She said health care and health systems must ensure the full enjoyment of health-related human rights by all women, regardless of age and marital status. The human rights of women included their right to have control over and decide freely and responsibly on matters related to their sexuality, free

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from coercion, discrimination and violence. Governments also needed to ensure that legislation protected women from all forms of violation of their rights, including rape and violence and any form of violence on the basis of sexual orientation. In addition, it was felt that an important priority for health development was ensuring reproductive rights of young people to enable them to deal in a positive and responsible way with their sexuality.

She said that the Union felt that a holistic approach was needed to overcome overall discrimination and to empower women. In that context, there was a need for campaigns to be held to combat violence against women and increase governmental efforts to ensure that health-care services, research centres and NGOs addressed those issues in a gender sensitive manner and supported treatment centres for victims. The Union also urged governments to take measures to address the specific needs of women with disabilities of all ages with a view to empowering them to lead independent lives in full self- determination. There was also a need to promote radical steps to control HIV/AIDS and other sexually transmitted diseases. The Union proposed that mental health care be integrated into government's health services because mental health problems were a growing concern to women.

AYSE AKIN (Turkey) said that reproductive health care was offered in primary care centres in her country and that had proven a convenient and cost- effective method of furthering women's health. Turkey had also used education and other methods to motivate people to use reproductive health services. In the past, a significant number of women died due to unsafe abortions. Some years ago, induced abortion was legalized in Turkey, in two years time, maternal death due to induced abortion were reduced significantly. Turkey did not support abortion as a form of family planning, however, and it had managed to reduce the number of induced abortions despite its legalization.

ELIZABETH ECKERMANN (Australia) said that many countries were segregating health data based on gender, and that was making evaluation of women's health easier. However, data measuring social, mental and emotional well-being was not segregated on the basis of sex. Therefore, it was difficult to monitor the mental well-being of women. There was a need to create gender sensitive indicators of women's mental health. Quality of life indicators should be incorporated along with morbidity indicators in evaluating the health of women.

Ms. AGGARWAL (India) said women in poor families were equal partners in earning incomes. Consequently, any impairment of their health seriously affected their ability to perform that function. Improvements in indicators of female well-being had managed to draw attention to the large gaps between men and women in achieving development goals. India had also banned the use of ante-natal diagnostic techniques, which ascertained the sex of children, in an effort to stop the destruction of non-male foetuses. The country had also made considerable progress in reducing maternal and infant mortality rates.

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TATIANA I. STUKOLOVA, Deputy Minister for Health of the Russian Federation, said women's health was one of the key factors for ensuring their well-being. As a result, her country was among those nations where the issue of women's health had always been given great attention. Accordingly, such concerns had been reflected in the country's Constitution. Reduction in budget financing, however, had resulted in a situation where certain medical services could only be given in return for payment. All problems could not be resolved alone and required international cooperation. She cited addressing HIV/AIDS in that respect.

EMILIA GUZMAN (Dominican Republic) said there was a high maternal mortality rate and neo-natal mortality rate in her country. Due to that problem there was a national plan to reduce that type of mortality. Teenage pregnancy and school abandonment were also problems for young girls. There had been efforts to improve the health system in her country. Among efforts in that regard was the formation of health centres for maternal health and adolescence. There were also programmes for family planning and those that address violence against women. The motto for the Ministry of Health was: "Humanized health for the next century".

CHUEH CHANG, NGO Committee on the Status of Women, said that, failing to address the mental health needs of women and girls had a damaging impact on social and economic development of communities. The imposed inferior social and economic status of women in most parts of the world was reflected in higher rates of depression and anxiety. Special attention must be given to the mental health needs of the most oppressed groups of women and girls, including marginalized ethnic and other cultural groups, those with chronic mental illness and refugees. Mental health was achievable and treatable.

GRAZIANA DELPIERRE (Italy) said that in many countries, including Italy, the life expectancy of women and men had increased in recent years. But while women were living longer, their health conditions on the whole were worse than men's as a result of a series of cultural, social and economic disadvantages. Even in cases where there was no formal discrimination, women had a more difficult access to health-care services. In health, as in other fields, gender statistics were extremely important, as were medical training and planning. Progress was possible so long as women had the will and the ability to better understand emerging problems, choose priorities, and build solutions that were appropriate for all.

TERESA RODRIGUEZ (Chile) said her country had dealt with women's health in a global manner -- from adolescence to old age. In an effort to prevent pregnancy in young girls, Chile had established an inter-sectoral approach. The methodology was called "talks on sexuality", and it aimed to encourage dialogue to promote sexual education -- a previously taboo topic in the country. Adolescents could now talk to health professionals and members of the community and make space for sexual education. It was hoped that this would reduce the number of pregnancies in girl children.

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MENG XIAN YING (China) said that if the issue of women's health was not addressed concretely first, then there could be no discussion on other issues such as women's education, training and participation in politics. China believed that women and men had the same rights. Women, however, had special value, and to respect and protect them was a sign of civilization. Her Government had taken a comprehensive approach, including legislations, and had achieved outstanding progress. All laws in place now protected women's rights from a legal and administrative point of view.

ELLEN LUKAS, observer for the Holy See, said that Pope John Paul II had said in a public statement that dignity and rights belonged to every person regardless of their sex, and that the Church denounced discrimination as action contrary to God's plan.

MARY PURCELL, of the NGO Committee on the United Nations Children's Fund (UNICEF), said that, despite the Beijing Platform for Action, adolescent girls were still extremely vulnerable to health problems. Young girls felt a single overriding concern for pregnancy and sexually transmitted diseases. There was continuing discomfort and disregard for the needs and rights of adolescent girls in many societies. Health care for them should be affordable and easily accessible, and it should also show respect for young girls and their abilities to make their own decisions.

DOLORES FLORES, Minister for Labour and Social Affairs of Spain, said that within the national health-care programme there were specific provisions for women's health. They were based on ensuring health for women throughout their full life cycle. There was also the creation of specific services for women that focused on preventing breast and cervical cancers. The public health-care system offered treatment to 100 per cent of women free of charge. Services were also being expanded at family planning centres. On the psychological health of women, she said there were efforts to heighten awareness and change attitudes in society and improve the status of women in the workplace.

MARGARET POLLACK (United States) said the challenge was to make women's lives healthy and productive. Social issues, such as poverty, discrimination and isolation, affected women's health. While the longer lives of women were being celebrated, much work still needed to be done to address shortcomings. There was a need to recognize the escalation of the HIV/AIDS pandemic since Beijing in 1995. In that regard, mother-to-child transmissions also needed to be addressed. Mental health, depression and substance abuse amongst women, particularly pregnant ones, were areas that needed critical attention. She noted that women had different responses to hazards in the work place. Exposure to chemicals, such as ether, lead and radiation, had adverse effects on pregnant women. Measures must be put in place to protect them. Tobacco abuse, violence against women, the health needs of older and disabled women had not been addressed by the Secretary-General in his report.

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RITA PEREIRA (Cuba) said health was not only the absence of disease, but a state of full social well-being. One million women died each year through pregnancy- and abortion-related situations. Ninety-nine per cent of maternal mortality took place in developing countries. Cuba's national health system, however, was decentralized, free of cost and provided services to the entire Cuban population. The issue of women's health was a priority for her Government. The level of Cuba's health service was comparable to levels of services in the developed world. In recent years, however, Cuba had faced a critical economic situation as a result of the inhumane United States imposed blockade. The reduction in imports of medicines and spare parts had seriously affected her country's health service, but had not stopped the provision of free services to all its population.

AIDA GONZALEZ (Mexico) said that special priority had been given by her country to childhood health. Its programme in that regard focused on disease prevention and the diagnosis and control of sicknesses. The reproductive health programme covered contraceptive services and family planning. A teenagers health programme offered information on understanding their sexuality and on avoiding unwanted pregnancy. That programme also urged that the adolescent population postponed early sex and increased the use of contraceptive measures. There was also personalized follow-up by medical staff in the area of pre-natal and neo-natal health.

MARIA ARIAS-ZEBALLOS, International Task Force on Women and Environment, said good health was the most basic element of people's lives and was a human right. The preservation of quality air and soil was essential to health. There was evidence that proper environmental policies were directly related to healthy living, and the absence of such policies was the source of disease and death. Cancer had become the second leading cause of death, and water-born diseases were on the increase. Measures to increase agricultural output focused mainly on more insecticide use. But that was a short-term solution that did not address the long-term health risks involved in using such chemicals.

SIHAM SUKKAR, observer for Palestine, said that, although the lifespan of Palestinian women was longer than men, they still suffered from worsened psychological and mental health. Women in refugee camps and other areas needed special attention. The Palestinian Authority's health plan had made special efforts to address the needs of women. It sought to ensure that pregnancy was incurred by choice and that services were accessible to the entire population. Another goal of the national health plan was to integrate family planning with primary care services. Despite those relentless efforts, Palestinian women were suffering from financial constraints and occupation.

JOAN FRENCH, Chief, Gender Partnerships of Participation Section, Programme Division, UNICEF, said her organization affirmed the importance of the life skills approach to girls and women. Early socialization and the role of the community and parents were important in the prevention of violence

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against women. Early marriage and adolescent pregnancy were special threats to the health of girls. UNICEF's efforts to create a supportive and safe environment where girls could make informed decisions had yielded positive results. Critical to the success of such efforts was the participation of adults. Another lesson learned by UNICEF was that the attitudes of parents and teachers in life skills education was important.

The representative of Sudan said her country had created schools for the education of midwives and other areas of health care. The final goal was to reduce female mortality, particularly in the rural areas. The Government had provided support for maternity clinics in a number of provinces. A number of treatment clinics had also been set up all over the country to improve women's health services. A campaign against unacceptable social attitudes and harmful practices had also been put in place. The war, however, was delaying government efforts in many areas.

INGER JOHANNE WERMER (Norway) said that almost every maternal death should and could have been avoided. There was a need for a health infrastructure that provided adequate services and met the needs of all people. Societies needed to overcome the excuse that too many resources were needed for such a health system -- women's lives were too valuable. Also, education and information were crucial for young people to promote better health, leading to a decrease in unwanted pregnancies and the spread of HIV/AIDS.

FRANÇOISE GASPARD (France) said that women in France had gained greater freedom and control of their lives through the increased use of contraception and medical interruption of pregnancy. Government health programmes understood women of all ages had to deal with special problems. Once virtually unknown in France, the country was now having to deal with female genital mutilation which was carried out among migrant women. The Government was taking steps to suppress such practices by stipulating strict prison sentences. There were also attempts to increase information and education in that regard to heighten awareness of the risks of female genital mutilation. Another health concern was the increase in the number of HIV/AIDS cases among women. That led to a policy of prevention and increased cooperation with United Nations agencies in that regard.

SUM MYUMG-SUM (Republic of Korea) said women's health was closely related to social health and social structures. Cooperation between ministries, governmental and non-governmental organizations was integral to her country's national plan for women. There were now 3,400 health centres, 2,590 doctors and 4,944 nurses. In order to offer services based on women's perspectives, the Ministry of Health was planning to train personnel. It was also planning to increase the number of females in health-related industries. The Republic of Korea was also strengthening health education, especially for pregnant women.

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Ms. HASTAIE (Iran) said women were more vulnerable than men to sexually transmitted diseases, including HIV/AIDS. Women's health was often linked to social factors and should be considered on a multidimensional basis. Iran's health system was universal. Pre- and post-natal care, safe delivery, prevention of sexually transmitted diseases were all offered in an integrated network. Governments could extend social services for women in the area of health insurance coverage. They could also allocate adequate financial services to facilitate women's access to primary health-care services.

DOROTHY WARD, of the Medical Women's International Association, said hers was a worldwide association of women medical doctors, which stressed the importance of promoting and securing health for every woman throughout their lifespan. The following health issues were among those identified by the Association for action by Member States: malnutrition, the most widespread and disabling health problem among women in developing countries, affecting also women in industrialized countries; reproductive health, including access to family planning, safe motherhood and sexually transmitted diseases; the right to choose, based on early education; and the health consequences of violence, including harmful practices such as female genital mutilation.

Continuing, she said the Association had also identified lifestyle- related health problems caused by diet, smoking and lack of exercise. The Association called upon Member States to commit themselves to make the best use of available resources to combat malnutrition, and the underlying factors of poverty and the low status of women. Member States must also provide high quality health care which was accessible, affordable and appropriate for all age groups. Those should also recognize violence as a public health issue, and allocate resources for its prevention, including awareness-raising programmes in the judicial systems and among health providers. Resources must also be allocated for programmes aimed at preventing lifestyle-related diseases, and education for girls and women should be supported.

DIANE PONEE (Canada) thanked all of the speakers who had found it possible to touch on a vast range of topics and proposals. It was presumptuous, as one of the last speakers, to think that she had anything to add. Her country had formally accepted a framework for health that rested on the belief that health services alone did not assure good health. The framework had identified 12 determinants, including biological, social, economic and behaviourial aspects. Gender and cultural issues were two determinants which cross-cut each other and mediated all others.

She said that the shift to community-based work and the need for preventive care were the best way to ensure that those determinants were taken into consideration. She was concerned that globalization had emphasized the need to harmonize the use of many therapeutic products and medications to ensure that the highest standards were both established and maintained. Given

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the huge cohort of people reaching the age of 50 and apt to live a number of more years in many countries, attention must also be paid to older women.

Statements on Follow-up to Beijing Conference

MARINA KORYNOVA (Russian Federation) said the twentieth century was probably the most blood-soaked in the history of mankind. The attention of humanity should focus on ways of finding a secure peace and assert the primacy of human rights. Tackling those goals needed the participation of women. Women also needed to be integrated into the process of development. Since Beijing, much had been achieved, but in all regions of the world women still faced poverty, unemployment and the attrition of their social welfare. They had shown themselves to be the most vulnerable sector of society.

She said that, in her country, reforms had ushered in a new age. Women had learned to take independent decisions. Women's political self-awareness had been strengthened, and they could now play a key part in political life. The Russian Government was trying to mitigate the consequences of the economic crisis on women. It was also trying to lessen the burdens on women who were mothers. United Nations organizations must support women in transition economies.

MAGED A. ABDELAZIZ (Egypt) said the women's issues component was incorporated in his country's overall development plan in accordance with the Beijing Platform for Action. Regarding women's health, Egypt saw the close link between health and development. It also attached importance to the health of women in rural and urban societies. There was improved family planning, including the provision of free services throughout the country.

He said Egypt had criminalized the circumcision of girls and expanded the mobile services of health teams to provide services in rural and very remote areas. Health workers were being trained to identify victims of sexual assault and violence. The country was also providing rehabilitation for female drug addicts and health care for older women. The institutional mechanisms put in place so far were the National Council for Childhood and Maternity and the National Commission for Women.

GARDY COSTAS SANCHEZ (Bolivia) said that, from a gender perspective, sustainable development provided a broad range of possibilities for overcoming poverty and marginalization, which affected women to a larger degree than men. Bolivia had passed from a low level of development to a medium level, and life expectancy had increased. Still, Bolivian women were, in particular, victims of poverty. Regrettably, confronting poverty had gradually fallen to women, and the feminization of poverty as a general phenomenon had emerged.

She said her Government had demonstrated the political will to introduce equity in public policies, in order to achieve equality in sustainable

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development. A dialogue in 1997 had produced a general plan of economic and social development. A Vice-Minister of gender and family affairs was responsible for overcoming discrimination, and its activities were directed towards various State institutions. The Supreme Decree on Equal Opportunity was the legal instrument designed to promote policies and action that led to gender equality, a strengthened democracy and the fight against poverty. That decree represented a historical step forward towards mainstreaming the gender perspective in public policy.

Most women were vulnerable to disease, abortion and maternal mortality because of their unequal access to health services, she said. In that respect, her Government had undertaken various initiatives, such as strengthening the national strategy for sexual and reproductive health. The creation of motherhood and childhood insurance, and the provision to pregnant women of medical attention during pregnancy, childbirth and the post-partum period were further evidence of the Government's commitment. As a result, maternal mortality had been reduced, and women's coverage had risen in the first year. In order to prevent violence against women and the girl child, multisectoral activities against violence had been incorporated into health services. The health strategy for 1997 should bring about the implementation of basic health insurance, with particular attention paid to haemorrhages during early pregnancy, and the prevention and control of cervical and breast diseases.

ALFREDO SFEIR-YOUNIS, of the World Bank, said that mainstreaming gender concerns into the development process was an essential task for the World Bank, although that was far from easy. Mainstreaming meant focusing on a very diverse set of decision-making processes, at the country, regional and global levels. Furthermore, mainstreaming gender issues demanded a major political commitment in many societies around the world, if not a totally new social contract. Otherwise, the whole debate and all of the aims being discussed today would just become yet another add-on to a process that, by definition, was biased against women and minorities.

He said the concerns of the World Bank must not only be focused on existing levels of production and consumption, but also on the actual distribution of physical, financial, natural and cultural assets. Different styles of development and alternative forms of wealth creation would yield very different results. The Bank was extremely concerned with development styles that had major gender biases. Both economic discrimination and marginalization were major forces playing against the mainstreaming of gender concerns. For those reasons, economic and financial concerns could not be disregarded, nor could the need to integrate all the social and political dimensions of such a process.

Besides the Bank's awareness of the sources of those biases, it was also fully aware of the feminization of poverty, he went on. It had now compiled information on more than 90 countries. Those assessments confirmed the

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importance of mainstreaming, but perhaps more important than implementing those activities was to recognize that inadequate macroeconomic polices that led to high levels of inflation, distortions in the labour and food markets, and the like, hurt women and children the most. Macroeconomic policy management, therefore, could not be seen as neutral with regard to their impact on the poor, especially women. It was within that context that the Bank believed some of its efforts should be supported and evaluated.

The representative of Costa Rica said her country was seeking equality between the sexes and the Government had committed itself to raising women's issues to the highest level. That would facilitate fulfilling the obligations of the Beijing Platform for Action. There was now a code on childhood and adolescence and laws against sexual violence and sexual harassment. There was also a permanent committee on the condition of women.

Costa Rica was convinced that the addition of a protocol to the Convention on the Elimination of All Forms of Discrimination against Women would be beneficial, she said. It had worked to mainstream the gender perspective into its health services and policies. Cervical and breast cancers and pregnancy among teenagers were priority areas. In 1998, out of 78,000 births, 15,000 were born to children. The goal now was to develop a healthy and responsible sexuality among teenagers and help them to find their way in society.

ABDUL MUNIM AL-KADHE (Iraq) said women in his country had enjoyed particular attention in the promotion of their roles and protection of their rights. It was difficult to talk about the Convention on the Elimination of All Forms of Discrimination against Women in any country of the world when one looked at particular circumstances. Iraq had been the target of an eight- year-old blockade and continued to be the victim of a most horrendous crime against humanity.

Many Iraqi women died every year from illness and pregnancy-related diseases, he said. He wondered what percentage of those deaths were caused by women being deprived of food as a result of the blockade. Many reports had underscored the severe impact of the blockade. His country, nevertheless, was doing its best to promote women's issues.

VALENCIA K.D. MOGEGEH, Director, Women's Affairs Department, Ministry of Labour and Home Affairs of Botswana, said her country had recognized and implemented an inter-sectoral collaboration related to the improvement of the health status of women. The Ministry of Health collaborated closely with the Ministry of Local Government, Lands and Housing, and NGOs in determining the health service needs of women, and in developing necessary strategies to make those services available. Women were offered free health care in Botswana in the areas of ante-natal care, delivery, post-natal care, family planning, cancer screening and the treatment of sexually transmitted diseases. With regard to girl children, the country's health service was structured in such a

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way that benefited all children between the ages of zero and five. It was also the Government's policy that all children should be immunized to protect them from childhood diseases.

She said the problem of teenage pregnancy and unsafe abortion still persisted. Non-governmental organizations were active in youth-health programmes, especially for youth who were in and out of school. Programmes included information and public education on sexuality, contraception and counselling. Botswana was one of the top five countries that was devastated by the HIV/AIDS epidemic. Control of the problem meant that women and men had to be equally involved. One way of addressing the major problem of HIV/AIDS in her country was the aggressive promotion of male fertility control methods. As a result, the use of condoms had increased from 1.3 per cent in 1988 to 16 per cent in 1996. The Government was also putting in place interventions for the prevention of HIV mother-to-child transmission. With regard to institutional mechanisms, a national policy on women in development was promulgated in 1996. The gender/women's affairs function was also elevated to the status of a fully fledged government department within the Ministry of Labour and Home Affairs.

DEMETRIS HADJIARGYROU (Cyprus) said that, although considerable progress had been made halfway through the time period set at Beijing, an intensification of efforts was becoming more imperative in order to fully realize the full equality of women as envisaged by the World Conference. That equality could only be achieved in an environment where democracy and respect for the inalienable rights of each person truly reigned supreme. In order to achieve that, however, it was essential to pursue policies that would assure social and economic development.

He said that poverty eradication, education and training and the creation of economic opportunities must be pursued in tandem with the development of the institutional mechanisms for the advancement of women, the enforcement of humanitarian law, the promotion of health policies and other aspects as described in the 12 critical areas agreed in Beijing. Only then could the environment for the attainment of gender equality truly be established. The special session of the General Assembly on "Women 2000 -- Gender Equality, Development and Peace for the 21st Century" would provide an opportunity to expand the prospects for full implementation of the Beijing Platform for Action.

For its part, Cyprus was intensely pursuing legislative modernization, which was a central component of the Government's efforts to eliminate gender discrimination, he said. Following the recommendations of the Committee on the Elimination of Discrimination against Women, some very important laws would soon be enacted in the fields of labour and sexual harassment. Laws had already been enacted in the fields of social security and family law. An additional area of concern was violence against women, for which his Government had already taken

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substantial steps to remedy existing weaknesses in legislation. Its efforts to eliminate trafficking in women and girls for the purpose of sexual exploitation had been clarified in relation to the regulation of the employment of foreign artists and entertainers, as well as the prosecution of criminal offences. Provisions affording the victims of such exploitation special legal protection had also been added to current legislation.

TRAN MAI HUONG (Viet Nam) said her country had recently focused its efforts on the national machinery for the advancement of women. Proudly, Viet Nam had pursued a comprehensive approach to following up the Beijing Conference. The establishment of a national committee for the advancement of women had facilitated the development of a national plan of action, which had been signed by the Prime Minister in October 1997. It was a solemn document, which had translated the international Platform for Action into a national context. It had also identified the actions to be undertaken, as well as the government actors responsible for such action. The most unique aspect of implementation of the international Platform for Action had been the additional level of planning and execution by many ministries, which had developed their own provincial plan of action.

She said that in her country, the Government played an important role in social and economic development, aimed at enhancing both the family and the community. Viet Nam had always been committed to the protection and care of women and children, and maternal and children's health care had been given special attention. Maternal mortality, however, was still high due to inappropriate knowledge about nutrition and poor diet. In fact, malnutrition among women and children was also rather high. There was no statistical data on genital infections and sexually transmitted diseases, but Viet Nam was still among the countries with high number of abortions, also causing maternal mortality.

Also in the field of health, she said the National Plan of Action for the Advancement of Women sought to increase the average life expectancy of Vietnamese women to 70 years of age, and to eliminate problems associated with pregnancy. It also strove to reduce maternal mortality, and malnutrition among children under five years of age.

DUBRAVKA SIMONOVIC (Croatia) said that in the wake of the Beijing Declaration and Platform for Action, the Croatian Government had recognized the need to transform political will into action through the establishment of institutional mechanisms for gender equality and the advancement of women. A National Commission for Equality was established in 1996, which drafted a National Policy for the Promotion of Equality by the following year. The National Policy provided for specific measures towards achieving particular goals in the areas of political decision-making and representation of women, their economic position, health care, education, human rights and violence against women in war and peace.

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She said that the Commission for Equality soon recognized the high level of competence among domestic NGOs and their indispensable role in implementing the Beijing Platform for Action. They were, thus, invited to form an advisory NGO council to work together with the Commission. Hopefully, such institutionalized cooperation between the Commission and the NGO community would lead to further progress in the advancement of women and implementation of the Platform for Action. With that in mind, the National Commission recently initiated an open competition providing financial support for projects designed to implement the National Policy's goals.

Undoubtedly, the Beijing Declaration and Platform for Action had provided new impetus for the advancement of women's rights in 1995, she said. Five years later, the General Assembly's special session would build upon that outcome and provide an ideal opportunity for a comprehensive review of the progress made by governments. It would also identify problems, with a view to devising strategies to overcome them. National preparations for the special session, as all as its outcome, would provide further impetus for advancing women in the future. One of the special session's goals of responding to emerging issues and new developments was particularly pertinent in the area of addressing new scientific developments in methods of medically assisted procreation, while balancing them against potential abuses in the field of genetic science and research.

B. SUVD (Mongolia) said that in 1996 her Government launched the National Programme of Action for the Advancement of Women and established a national council responsible for its implementation. In two years since adoption of the Programme, while considerable progress had been achieved in priority areas, the realization process was slow and required further intensification of efforts to improve the functioning of the national mechanism. Coordination of the activities of all the relevant organizations in that respect also needed improvement. In addition, the present socio-economic hardships of the transitional period in Mongolia had also affected the implementation of the Programme.

She said the health sector was a priority area for her Government. The National Reproductive Health and Adolescent Health Programmes were approved, respectively, in 1996 and 1997 with a view to improving access to and the quality of reproductive health services. While the health indicators were generally improving, the maternal mortality rate, increasing number of abortions, and domestic violence were still matters of concern. However, cooperation between her country, the United Nations system, other international organizations, and enhanced involvement of NGOs contributed to the resolving of women-related issues in Mongolia, raised public awareness of problems and allowed for capacity- building between governmental and non-governmental organizations.

Ms. AL-BASHA (Yemen) said institutional mechanisms in her country had established many policies and measures geared at women's issues and provided many opportunities for women to participate in the decision-making processes. There was a new labour law being set up to provide equality of opportunity

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between men and women. There was also a provision for part-time employment for women. The national population strategies were aimed at general health and particularly at women and children. Yemen also had a national strategy for women, which had been put in place in 1996. There was also a national strategy for teaching girls between six and 16, and one to address illiteracy. A system for adult education was also being established. Government expenditure in health was expected to meet 11 per cent of total expenditure.

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