International Agreements on Health (Commitment 6)

Index
Commitment 6 from the Copenhagen Declaration on Social Development
Agenda 21, Rio 1992
Chapter 6. Protection and Promotion of Human Health 
Chapter 24. Global Action for Women Towards Sustainable and Equitable Development
International Conference on Population and Development (ICPD), Cairo 1994
Programme of Action
Chapter 4 : Gender Equality, Equity and Empowerment of Women
Fourth World Conference on Women, Beijing 1995
Platform for Action
IV. Strategic Objectives and Actions
C. Women and Health
Habitat II, Istanbul 1996
Istanbul Declaration on Human Settlements
IV Global Plan of Action
C. Sustainable human settlements development in an urbanizing world
5. Environmentally sustainable, healthy and liveable human settlements
UN Commissions
Commission on Human Rights
Fifty-fourth session, Item 9
Further promotion and encouragement of human rights and fundamental freedoms, including the question of the programme and methods of work of the Commission
The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)
UN Division for the Advancement of Women (Beijing+5 Workshop) 

Documents
Commitment 6: Education and Health
We commit ourselves to promoting and attaining the goals of universal and equitable access to quality education, the highest attainable standard of physical and mental health, and the access of all to primary health care, making particular efforts to rectify inequalities relating to social conditions and without distinction as to race, national origin, gender, age or disability; respecting and promoting our common and particular cultures; striving to strengthen the role of culture in development; preserving the essential bases of people-centred sustainable development; and contributing to the full development of human resources and to social development. The purpose of these activities is to eradicate poverty, promote full and productive employment and foster social integration.
To this end, at the national level, we will:
(a) Formulate and strengthen time-bound national strategies for the eradication of illiteracy and universalization of basic education, which includes early childhood education, primary education and education for the illiterate, in all communities, in particular for the introduction, if possible, of national languages in the educational system and by support of the various means of non-formal education, striving to attain the highest possible standard of learning;
(b) Emphasize lifelong learning by seeking to improve the quality of education to ensure that people of all ages are provided with useful knowledge, reasoning ability, skills, and the ethical and social values required to develop their full capacities in health and dignity and to participate fully in the social, economic and political process of development. In this regard, women and girls should be considered a priority group;
(c) Ensure that children, particularly girls, enjoy their rights and promote the exercise of those rights by making education, adequate nutrition and health care accessible to them, consistent with the Convention on the Rights of the Child, 13/ and recognizing the rights, duties and responsibilities of parents and other persons legally responsible for children;
(d) Take appropriate and affirmative steps to enable all children and adolescents to attend and complete school and to close the gender gap in primary, secondary, vocational and higher education;
(e) Ensure full and equal access to education for girls and women, recognizing that investing in women's education is the key element in achieving social equality, higher productivity and social returns in terms of health, lower infant mortality and the reduced need for high fertility;
(f) Ensure equal educational opportunities at all levels for children, youth and adults with disabilities, in integrated settings, taking full account of individual differences and situations;
(g) Recognize and support the right of indigenous people to education in a manner that is responsive to their specific needs, aspirations and cultures, and ensure their full access to health care;
(h) Develop specific educational policies, with gender perspective, and design appropriate mechanisms at all levels of society in order to accelerate the conversion of general and specific information available world wide into knowledge, and the conversion of that knowledge into creativity, increased productive capacity and active participation in society;
(i) Strengthen the links between labour market and education policies, realizing that education and vocational training are vital elements in job creation and in combating unemployment and social exclusion in our societies, and emphasize the role of higher education and scientific research in all plans of social development;
(j) Develop broad-based education programmes that promote and strengthen respect for all human rights and fundamental freedoms, including the right to development, promote the values of tolerance, responsibility and respect for the diversity and rights of others, and provide training in peaceful conflict resolution, in recognition of the United Nations Decade for Human Rights Education (1995-2005); 14/
(k) Focus on learning acquisition and outcome, broaden the means and scope of basic education, enhance the environment for learning and strengthen partnerships among Governments, non-governmental organizations, the private sector, local communities, religious groups and families to achieve the goal of education for all;
(l) Establish or strengthen both school-based and community-based health education programmes for children, adolescents and adults, with special attention to girls and women, on a whole range of health issues, as one of the prerequisites for social development, recognizing the rights, duties and responsibilities of parents and other persons legally responsible for children consistent with the Convention on the Rights of the Child;
(m) Expedite efforts to achieve the goals of national Health-for-All strategies, based on equality and social justice in line with the Alma-Ata Declaration on Primary Health Care, 15/ by developing or updating country action plans or programmes to ensure universal, non-discriminatory access to basic health services, including sanitation and drinking water, to protect health, and to promote nutrition education and preventive health programmes;
(n) Strive to ensure that persons with disabilities have access to rehabilitation and other independent living services and assistive technology to enable them to maximize their well-being, independence and full participation in society;
(o) Ensure an integrated and intersectoral approach so as to provide for the protection and promotion of health for all in economic and social development, taking cognizance of the health dimensions of policies in all sectors;
(p) Seek to attain the maternal and child health objectives, especially the objectives of reducing child and maternal mortality, of the World Summit for Children, the United Nations Conference on Environment and Development and the International Conference on Population and Development;
(q) Strengthen national efforts to address more effectively the growing HIV/AIDS pandemic by providing necessary education and prevention services, working to ensure that appropriate care and support services are available and accessible to those affected by HIV/AIDS, and taking all necessary steps to eliminate every form of discrimination against and isolation of those living with HIV/AIDS;
(r) Promote, in all educational and health policies and programmes, environmental awareness, including awareness of unsustainable patterns of consumption and production.
At the international level, we will:
(s) Strive to ensure that international organizations, in particular the international financial institutions, support these objectives, integrating them into their policy programmes and operations as appropriate. This should be complemented by renewed bilateral and regional cooperation;
(t) Recognize the importance of the cultural dimension of development to ensure respect for cultural diversity and that of our common human cultural heritage. Creativity should be recognized and promoted;
(u) Request the specialized agencies, notably the United Nations Educational, Scientific and Cultural Organization and the World Health Organization, as well as other international organizations dedicated to the promotion of education, culture and health, to give greater emphasis to the overriding goals of eradicating poverty, promoting full and productive employment and fostering social integration;
(v) Strengthen intergovernmental organizations that utilize various forms of education to promote culture; disseminate information through education and communication media; help spread the use of technologies; and promote technical and professional training and scientific research;
(w) Provide support for stronger, better coordinated global actions against major diseases that take a heavy toll of human lives, such as malaria, tuberculosis, cholera, typhoid fever and HIV/AIDS; in this context, continue to support the joint and co-sponsored United Nations programme on HIV/AIDS; 16/
(x) Share knowledge, experience and expertise and enhance creativity, for example by promoting the transfer of technology, in the design and delivery of effective education, training and health programmes and policies, including substance-abuse awareness, prevention and rehabilitation programmes, which will result, inter alia, in endogenous capacity-building;
(y) Intensify and coordinate international support for education and health programmes based on respect for human dignity and focused on the protection of all women and children, especially against exploitation, trafficking and harmful practices, such as child prostitution, female genital mutilation and child marriages.

Agenda 21; Chapter 6. Protection and Promotion of Human Health
Introduction
6.1. Health and development are intimately interconnected. Both insufficient development leading to poverty and inappropriate development resulting in overconsumption, coupled with an expanding world population, can result in severe environmental health problems in both developing and developed nations. Action items under Agenda 21 must address the primary health needs of the world's population, since they are integral to the achievement of the goals of sustainable development and primary environmental care. The linkage of health, environmental and socio-economic improvements requires intersectoral efforts. Such efforts, involving education, housing, public works and community groups, including businesses, schools and universities and religious, civic and cultural organizations, are aimed at enabling people in their communities to ensure sustainable development. Particularly relevant is the inclusion of prevention programmes rather than relying solely on remediation and treatment. Countries ought to develop plans for priority actions, drawing on the programme areas in this chapter, which are based on cooperative planning by the various levels of government, non-governmental organizations and local communities. An appropriate international organization, such as WHO, should coordinate these activities. 
6.2. The following programme areas are contained in this chapter: 
(a) Meeting primary health care needs, particularly in rural areas; 
(b) Control of communicable diseases; 
(c) Protecting vulnerable groups; 
(d) Meeting the urban health challenge; 
(e) Reducing health risks from environmental pollution and hazards. 
Programme Areas
A. Meeting primary health care needs, particularly in rural areas 
Basis for action 
6.3. Health ultimately depends on the ability to manage successfully the interaction between the physical, spiritual, biological and economic/social environment. Sound development is not possible without a healthy population; yet most developmental activities affect the environment to some degree, which in turn causes or exacerbates many health problems. Conversely, it is the very lack of development that adversely affects the health condition of many people, which can be alleviated only through development. The health sector cannot meet basic needs and objectives on its own; it is dependent on social, economic and spiritual development, while directly contributing to such development. It is also dependent on a healthy environment, including the provision of a safe water supply and sanitation and the promotion of a safe food supply and proper nutrition. Particular attention should be directed towards food safety, with priority placed on the elimination of food contamination; comprehensive and sustainable water policies to ensure safe drinking water and sanitation to preclude both microbial and chemical contamination; and promotion of health education, immunization and provision of essential drugs. Education and appropriate services regarding responsible planning of family size, with respect for cultural, religious and social aspects, in keeping with freedom, dignity and personally held values and taking into account ethical and cultural considerations, also contribute to these intersectoral activities. 
Objectives 
6.4. Within the overall strategy to achieve health for all by the year 2000, the objectives are to meet the basic health needs of rural peri-urban and urban populations; to provide the necessary specialized environmental health services; and to coordinate the involvement of citizens, the health sector, the health-related sectors and relevant non-health sectors (business, social, educational and religious institutions) in solutions to health problems. As a matter of priority, health service coverage should be achieved for population groups in greatest need, particularly those living in rural areas. 
Activities 
6.5. National Governments and local authorities, with the support of relevant non-governmental organizations and international organizations, in the light of countries' specific conditions and needs, should strengthen their health sector programmes, with special attention to rural needs, to: 
(a) Build basic health infrastructures, monitoring and planning systems: 
(i) Develop and strengthen primary health care systems that are practical, community-based, scientifically sound, socially acceptable and appropriate to their needs and that meet basic health needs for clean water, safe food and sanitation; (ii) Support the use and strengthening of mechanisms that improve coordination between health and related sectors at all appropriate levels of government, and in communities and relevant organizations; 
(iii) Develop and implement rational and affordable approaches to the establishment and maintenance of health facilities; 
(iv) Ensure and, where appropriate, increase provision of social services support; 
(v) Develop strategies, including reliable health indicators, to monitor the progress and evaluate the effectiveness of health programmes; 
(vi) Explore ways to finance the health system based on the assessment of the resources needed and identify the various financing alternatives; 
(vii) Promote health education in schools, information exchange, technical support and training; 
(viii) Support initiatives for self-management of services by vulnerable groups; 
(ix) Integrate traditional knowledge and experience into national health systems, as appropriate; 
(x) Promote the provisions for necessary logistics for outreach activities, particularly in rural areas; 
(xi) Promote and strengthen community-based rehabilitation activities for the rural handicapped. 
(b) Support research and methodology development: 
(i) Establish mechanisms for sustained community involvement in environmental health activities, including optimization of the appropriate use of community financial and human resources; 
(ii) Conduct environmental health research, including behaviour research and research on ways to increase coverage and ensure greater utilization of services by peripheral, underserved and vulnerable populations, as appropriate to good prevention services and health care; 
(iii) Conduct research into traditional knowledge of prevention and curative health practices. 
Means of implementation 
(a) Financing and cost evaluation 
6.6. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $40 billion, including about $5 billion from the international community on grant or concessional terms. These are indicative and order-of-magnitude estimates only and have not been reviewed by Governments. Actual costs and financial terms, including any that are non-concessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. 
(b) Scientific and technological means 
6.7. New approaches to planning and managing health care systems and facilities should be tested, and research on ways of integrating appropriate technologies into health infrastructures supported. The development of scientifically sound health technology should enhance adaptability to local needs and maintainability by community resources, including the maintenance and repair of equipment used in health care. Programmes to facilitate the transfer and sharing of information and expertise should be developed, including communication methods and educational materials. 
(c) Human resource development 
6.8. Intersectoral approaches to the reform of health personnel development should be strengthened to ensure its relevance to the "Health for All" strategies. Efforts to enhance managerial skills at the district level should be supported, with the aim of ensuring the systematic development and efficient operation of the basic health system. Intensive, short, practical training programmes with emphasis on skills in effective communication, community organization and facilitation of behaviour change should be developed in order to prepare the local personnel of all sectors involved in social development for carrying out their respective roles. In cooperation with the education sector, special health education programmes should be developed focusing on the role of women in the health-care system. 
(d) Capacity-building 
6.9. Governments should consider adopting enabling and facilitating strategies to promote the participation of communities in meeting their own needs, in addition to providing direct support to the provision of health-care services. A major focus should be the preparation of community-based health and health-related workers to assume an active role in community health education, with emphasis on team work, social mobilization and the support of other development workers. National programmes should cover district health systems in urban, peri-urban and rural areas, the delivery of health programmes at the district level, and the development and support of referral services. 
B. Control of communicable diseases 
Basis for action 6.10. Advances in the development of vaccines and chemotherapeutic agents have brought many communicable diseases under control. However, there remain many important communicable diseases for which environmental control measures are indispensable, especially in the field of water supply and sanitation. Such diseases include cholera, diarrhoeal diseases, leishmaniasis, malaria and schistosomiasis. In all such instances, the environmental measures, either as an integral part of primary health care or undertaken outside the health sector, form an indispensable component of overall disease control strategies, together with health and hygiene education, and in some cases, are the only component. 
6.11. With HIV infection levels estimated to increase to 30-40 million by the year 2000, the socio-economic impact of the pandemic is expected to be devastating for all countries, and increasingly for women and children. While direct health costs will be substantial, they will be dwarfed by the indirect costs of the pandemic - mainly costs associated with the loss of income and decreased productivity of the workforce. The pandemic will inhibit growth of the service and industrial sectors and significantly increase the costs of human capacity-building and retraining. The agricultural sector is particularly affected where production is labour-intensive. 
Objectives 
6.12. A number of goals have been formulated through extensive consultations in various international forums attended by virtually all Governments, relevant United Nations organizations (including WHO, UNICEF, UNFPA, UNESCO, UNDP and the World Bank) and a number of non-governmental organizations. Goals (including but not limited to those listed below) are recommended for implementation by all countries where they are applicable, with appropriate adaptation to the specific situation of each country in terms of phasing, standards, priorities and availability of resources, with respect for cultural, religious and social aspects, in keeping with freedom, dignity and personally held values and taking into account ethical considerations. Additional goals that are particularly relevant to a country's specific situation should be added in the country's national plan of action (Plan of Action for Implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s). 1/ Such national level action plans should be coordinated and monitored from within the public health sector. Some major goals are: 
(a) By the year 2000, to eliminate guinea worm disease (dracunculiasis); 
(b) By the year 2000, eradicate polio; 
(c) By the year 2000, to effectively control onchocerciasis (river blindness) and leprosy; 
(d) By 1995, to reduce measles deaths by 95 per cent and reduce measles cases by 90 per cent compared with pre-immunization levels; (e) By continued efforts, to provide health and hygiene education and to ensure universal access to safe drinking water and universal access to sanitary measures of excreta disposal, thereby markedly reducing waterborne diseases such as cholera and schistosomiasis and reducing: 
(i) By the year 2000, the number of deaths from childhood diarrhoea in developing countries by 50 to 70 per cent; 
(ii) By the year 2000, the incidence of childhood diarrhoea in developing countries by at least 25 to 50 per cent; 
(f) By the year 2000, to initiate comprehensive programmes to reduce mortality from acute respiratory infections in children under five years by at least one third, particularly in countries with high infant mortality; 
(g) By the year 2000, to provide 95 per cent of the world's child population with access to appropriate care for acute respiratory infections within the community and at first referral level; 
(h) By the year 2000, to institute anti-malaria programmes in all countries where malaria presents a significant health problem and maintain the transmission-free status of areas freed from endemic malaria; 
(i) By the year 2000, to implement control programmes in countries where major human parasitic infections are endemic and achieve an overall reduction in the prevalence of schistosomiasis and of other trematode infections by 40 per cent and 25 per cent, respectively, from a 1984 baseline, as well as a marked reduction in incidence, prevalence and intensity of filarial infections; 
(j) To mobilize and unify national and international efforts against AIDS to prevent infection and to reduce the personal and social impact of HIV infection; 
(k) To contain the resurgence of tuberculosis, with particular emphasis on multiple antibiotic resistant forms; 
(l) To accelerate research on improved vaccines and implement to the fullest extent possible the use of vaccines in the prevention of disease. 
Activities 
6.13. Each national Government, in accordance with national plans for public health, priorities and objectives, should consider developing a national health action plan with appropriate international assistance and support, including, at a minimum, the following components: 
(a) National public health systems: 
(i) Programmes to identify environmental hazards in the causation of communicable diseases; 
(ii) Monitoring systems of epidemiological data to ensure adequate forecasting of the introduction, spread or aggravation of communicable diseases; 
(iii) Intervention programmes, including measures consistent with the principles of the global AIDS strategy; 
(iv) Vaccines for the prevention of communicable diseases; 
(b) Public information and health education: 
Provide education and disseminate information on the risks of endemic communicable diseases and build awareness on environmental methods for control of communicable diseases to enable communities to play a role in the control of communicable diseases; 
(c) Intersectoral cooperation and coordination: 
(i) Second experienced health professionals to relevant sectors, such as planning, housing and agriculture; 
(ii) Develop guidelines for effective coordination in the areas of professional training, assessment of risks and development of control technology; 
(d) Control of environmental factors that influence the spread of communicable diseases: 
Apply methods for the prevention and control of communicable diseases, including water supply and sanitation control, water pollution control, food quality control, integrated vector control, garbage collection and disposal and environmentally sound irrigation practices; 
(e) Primary health care system: 
(i) Strengthen prevention programmes, with particular emphasis on adequate and balanced nutrition; 
(ii) Strengthen early diagnostic programmes and improve capacities for early preventative/treatment action; 
(iii) Reduce the vulnerability to HIV infection of women and their offspring; 
(f) Support for research and methodology development: 
(i) Intensify and expand multidisciplinary research, including focused efforts on the mitigation and environmental control of tropical diseases; 
(ii) Carry out intervention studies to provide a solid epidemiological basis for control policies and to evaluate the efficiency of alternative approaches; 
(iii) Undertake studies in the population and among health workers to determine the influence of cultural, behavioural and social factors on control policies; 
(g) Development and dissemination of technology: 
(i) Develop new technologies for the effective control of communicable diseases; 
(ii) Promote studies to determine how to optimally disseminate results from research; 
(iii) Ensure technical assistance, including the sharing of knowledge and know-how. 
Means of implementation 
(a) Financing and cost evaluation 
6.14. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $4 billion, including about $900 million from the international community on grant or concessional terms. These are indicative and order-of-magnitude estimates only and have not been reviewed by Governments. Actual costs and financial terms, including any that are non-concessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. 
(b) Scientific and technological means 
6.15. Efforts to prevent and control diseases should include investigations of the epidemiological, social and economic bases for the development of more effective national strategies for the integrated control of communicable diseases. Cost-effective methods of environmental control should be adapted to local developmental conditions. 
(c) Human resource development 
6.16. National and regional training institutions should promote broad intersectoral approaches to prevention and control of communicable diseases, including training in epidemiology and community prevention and control, immunology, molecular biology and the application of new vaccines. Health education materials should be developed for use by community workers and for the education of mothers for the prevention and treatment of diarrhoeal diseases in the home. (d) Capacity-building 
6.17. The health sector should develop adequate data on the distribution of communicable diseases, as well as the institutional capacity to respond and collaborate with other sectors for prevention, mitigation and correction of communicable disease hazards through environmental protection. The advocacy at policy- and decision-making levels should be gained, professional and societal support mobilized, and communities organized in developing self-reliance. 
C. Protecting vulnerable groups 
Basis for action 
6.18. In addition to meeting basic health needs, specific emphasis has to be given to protecting and educating vulnerable groups, particularly infants, youth, women, indigenous people and the very poor as a prerequisite for sustainable development. Special attention should also be paid to the health needs of the elderly and disabled population. 
6.19. Infants and children. Approximately one third of the world's population are children under 15 years old. At least 15 million of these children die annually from such preventable causes as birth trauma, birth asphyxia, acute respiratory infections, malnutrition, communicable diseases and diarrhoea. The health of children is affected more severely than other population groups by malnutrition and adverse environmental factors, and many children risk exploitation as cheap labour or in prostitution. 
6.20. Youth. As has been the historical experience of all countries, youth are particularly vulnerable to the problems associated with economic development, which often weakens traditional forms of social support essential for the healthy development, of young people. Urbanization and changes in social mores have increased substance abuse, unwanted pregnancy and sexually transmitted diseases, including AIDS. Currently more than half of all people alive are under the age of 25, and four of every five live in developing countries. Therefore it is important to ensure that historical experience is not replicated. 
6.21. Women. In developing countries, the health status of women remains relatively low, and during the 1980s poverty, malnutrition and general ill-health in women were even rising. Most women in developing countries still do not have adequate basic educational opportunities and they lack the means of promoting their health, responsibly controlling their reproductive life and improving their socio-economic status. Particular attention should be given to the provision of pre-natal care to ensure healthy babies. 
6.22. Indigenous people and their communities. Indigenous people had their communities make up a significant percentage of global population. The outcomes of their experience have tended to be very similar in that the basis of their relationship with traditional lands has been fundamentally changed. They tend to feature disproportionately in unemployment, lack of housing, poverty and poor health. In many countries the number of indigenous people is growing faster than the general population. Therefore it is important to target health initiatives for indigenous people. 
Objectives 
6.23. The general objectives of protecting vulnerable groups are to ensure that all such individuals should be allowed to develop to their full potential (including healthy physical, mental and spiritual development); to ensure that young people can develop, establish and maintain healthy lives; to allow women to perform their key role in society; and to support indigenous people through educational, economic and technical opportunities. 
6.24. Specific major goals for child survival, development and protection were agreed upon at the World Summit for Children and remain valid also for Agenda 21. Supporting and sectoral goals cover women's health and education, nutrition, child health, water and sanitation, basic education and children in difficult circumstances. 
6.25. Governments should take active steps to implement, as a matter of urgency, in accordance with country specific conditions and legal systems, measures to ensure that women and men have the same right to decide freely and responsibly on the number and spacing of their children, to have access to the information, education and means, as appropriate, to enable them to exercise this right in keeping with their freedom, dignity and personally held values, taking into account ethical and cultural considerations. 
6.26. Governments should take active steps to implement programmes to establish and strengthen preventive and curative health facilities which include women-centred, women-managed, safe and effective reproductive health care and affordable, accessible services, as appropriate, for the responsible planning of family size, in keeping with freedom, dignity and personally held values and taking into account ethical and cultural considerations. Programmes should focus on providing comprehensive health care, including pre-natal care, education and information on health and responsible parenthood and should provide the opportunity for all women to breast-feed fully, at least during the first four months post-partum. Programmes should fully support women's productive and reproductive roles and well being, with special attention to the need for providing equal and improved health care for all children and the need to reduce the risk of maternal and child mortality and sickness. 
Activities 
6.27. National Governments, in cooperation with local and non-governmental organizations, should initiate or enhance programmes in the following areas: 
(a) Infants and children: 
(i) Strengthen basic health-care services for children in the context of primary health-care delivery, including prenatal care, breast-feeding, immunization and nutrition programmes; 
(ii) Undertake widespread adult education on the use of oral rehydration therapy for diarrhoea, treatment of respiratory infections and prevention of communicable diseases; 
(iii) Promote the creation, amendment and enforcement of a legal framework protecting children from sexual and workplace exploitation; 
(iv) Protect children from the effects of environmental and occupational toxic compounds; 
(b) Youth: 
Strengthen services for youth in health, education and social sectors in order to provide better information, education, counselling and treatment for specific health problems, including drug abuse; 
(c) Women: 
(i) Involve women's groups in decision-making at the national and community levels to identify health risks and incorporate health issues in national action programmes on women and development; 
(ii) Provide concrete incentives to encourage and maintain attendance of women of all ages at school and adult education courses, including health education and training in primary, home and maternal health care; 
(iii) Carry out baseline surveys and knowledge, attitude and practice studies on the health and nutrition of women throughout their life cycle, especially as related to the impact of environmental degradation and adequate resources; 
(d) Indigenous people and their communities: 
(i) Strengthen, through resources and self-management, preventative and curative health services; 
(ii) Integrate traditional knowledge and experience into health systems. 
Means of implementation 
(a) Financing and cost evaluation 
6.28. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $3.7 billion, including about $400 billion from the international community on grant or concessional terms. These are indicative and order-of-magnitude estimates only and have not been reviewed by Governments. Actual costs and financial terms, including any that are non-concessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. 
(b) Scientific and technological means 
6.29. Educational, health and research institutions should be strengthened to provide support to improve the health of vulnerable groups. Social research on the specific problems of these groups should be expanded and methods for implementing flexible pragmatic solutions explored, with emphasis on preventive measures. Technical support should be provided to Governments, institutions and non-governmental organizations for youth, women and indigenous people in the health sector. 
(c) Human resources development 
6.30. The development of human resources for the health of children, youth and women should include reinforcement of educational institutions, promotion of interactive methods of education for health and increased use of mass media in disseminating information to the target groups. This requires the training of more community health workers, nurses, midwives, physicians, social scientists and educators, the education of mothers, families and communities and the strengthening of ministries of education, health, population etc. 
(d) Capacity-building 
6.31. Governments should promote, where necessary: (i) the organization of national, intercountry and interregional symposia and other meetings for the exchange of information among agencies and groups concerned with the health of children, youth, women and indigenous people, and (ii) women's organizations, youth groups and indigenous people's organizations to facilitate health and consult them on the creation, amendment and enforcement of legal frameworks to ensure a healthy environment for children, youth, women and indigenous peoples. 
D. Meeting the urban health challenge 
Basis for action 
6.32. For hundreds of millions of people, the poor living conditions in urban and peri-urban areas are destroying lives, health, and social and moral values. Urban growth has outstripped society's capacity to meet human needs, leaving hundreds of millions of people with inadequate incomes, diets, housing and services. Urban growth exposes populations to serious environmental hazards and has outstripped the capacity of municipal and local governments to provide the environmental health services that the people need. All too often, urban development is associated with destructive effects on the physical environment and the resource base needed for sustainable development. Environmental pollution in urban areas is associated with excess morbidity and mortality. Overcrowding and inadequate housing contribute to respiratory diseases, tuberculosis, meningitis and other diseases. In urban environments, many factors that affect human health are outside the health sector. Improvements in urban health therefore will depend on coordinated action by all levels of government, health care providers, businesses, religious groups, social and educational institutions and citizens. 
Objectives 
6.33. The health and well-being of all urban dwellers must be improved so that they can contribute to economic and social development. The global objective is to achieve a 10 to 40 per cent improvement in health indicators by the year 2000. The same rate of improvement should be achieved for environmental, housing and health service indicators. These include the development of quantitative objectives for infant mortality, maternal mortality, percentage of low birth weight newborns and specific indicators (e.g. tuberculosis as an indicator of crowded housing, diarrhoeal diseases as indicators of inadequate water and sanitation, rates of industrial and transportation accidents that indicate possible opportunities for prevention of injury, and social problems such as drug abuse, violence and crime that indicate underlying social disorders). 
Activities 
6.34. Local authorities, with the appropriate support of national Governments and international organizations should be encouraged to take effective measures to initiate or strengthen the following activities: 
(a) Develop and implement municipal and local health plans: 
(i) Establish or strengthen intersectoral committees at both the political and technical level, including active collaboration on linkages with scientific, cultural, religious, medical, business, social and other city institutions, using networking arrangements; 
(ii) Adopt or strengthen municipal or local "enabling strategies" that emphasize "doing with" rather than "doing for" and create supportive environments for health; 
(iii) Ensure that public health education in schools, workplace, mass media etc. is provided or strengthened; 
(iv) Encourage communities to develop personal skills and awareness of primary health care; 
(v) Promote and strengthen community-based rehabilitation activities for the urban and peri-urban disabled and the elderly; 
(b) Survey, where necessary, the existing health, social and environmental conditions in cities, including documentation of intra-urban differences; 
(c) Strengthen environmental health services: 
(i) Adopt health impact and environmental impact assessment procedures; 
(ii) Provide basic and in-service training for new and existing personnel; 
(d) Establish and maintain city networks for collaboration and exchange of models of good practice. 
Means of implementation 
(a) Financing and cost evaluation 
6.35. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $222 million, including about $22 million from the international community on grant or concessional terms. These are indicative and order-of-magnitude estimates only and have not been reviewed by Governments. Actual costs and financial terms, including any that are non-concessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. 
(b) Scientific and technological means 
6.36. Decision-making models should be further developed and more widely used to assess the costs and the health and environment impacts of alternative technologies and strategies. Improvement in urban development and management requires better national and municipal statistics based on practical, standardized indicators. Development of methods is a priority for the measurement of intra-urban and intra-district variations in health status and environmental conditions, and for the application of this information in planning and management. 
(c) Human resources development 
6.37. Programmes must supply the orientation and basic training of municipal staff required for the healthy city processes. Basic and in-service training of environmental health personnel will also be needed. 
(d) Capacity-building 
6.38. The programme is aimed towards improved planning and management capabilities in the municipal and local government and its partners in central Government, the private sector and universities. Capacity development should be focused on obtaining sufficient information, improving coordination mechanisms linking all the key actors, and making better use of available instruments and resources for implementation. 
E. Reducing health risks from environmental pollution and hazards 
Basis for action 
6.39. In many locations around the world the general environment (air, water and land), workplaces and even individual dwellings are so badly polluted that the health of hundreds of millions of people is adversely affected. This is, inter alia, due to past and present developments in consumption and production patterns and lifestyles, in energy production and use, in industry, in transportation etc., with little or no regard for environmental protection. There have been notable improvements in some countries, but deterioration of the environment continues. The ability of countries to tackle pollution and health problems is greatly restrained because of lack of resources. Pollution control and health protection measures have often not kept pace with economic development. Considerable development-related environmental health hazards exist in the newly industrializing countries. Furthermore, the recent analysis of WHO has clearly established the interdependence among the factors of health, environment and development and has revealed that most countries are lacking such integration as would lead to an effective pollution control mechanism. 2/ Without prejudice to such criteria as may be agreed upon by the international community, or to standards which will have to be determined nationally, it will be essential in all cases to consider the systems of values prevailing in each country and the extent of the applicability of standards that are valid for the most advanced countries but may be inappropriate and of unwarranted social cost for the developing countries. 
Objectives 
6.40. The overall objective is to minimize hazards and maintain the environment to a degree that human health and safety is not impaired or endangered and yet encourage development to proceed. Specific programme objectives are: 
(a) By the year 2000, to incorporate appropriate environmental and health safeguards as part of national development programmes in all countries; 
(b) By the year 2000, to establish, as appropriate, adequate national infrastructure and programmes for providing environmental injury, hazard surveillance and the basis for abatement in all countries; 
(c) By the year 2000, to establish, as appropriate, integrated programmes for tackling pollution at the source and at the disposal site, with a focus on abatement actions in all countries; 
(d) To identify and compile, as appropriate, the necessary statistical information on health effects to support cost/benefit analysis, including environmental health impact assessment for pollution control, prevention and abatement measures. Activities 
6.41. Nationally determined action programmes, with international assistance, support and coordination, where necessary, in this area should include: 
(a) Urban air pollution: 
(i) Develop appropriate pollution control technology on the basis of risk assessment and epidemiological research for the introduction of environmentally sound production processes and suitable safe mass transport; 
(ii) Develop air pollution control capacities in large cities, emphasizing enforcement programmes and using monitoring networks, as appropriate; 
(b) Indoor air pollution: 
(i) Support research and develop programmes for applying prevention and control methods to reducing indoor air pollution, including the provision of economic incentives for the installation of appropriate technology; 
(ii) Develop and implement health education campaigns, particularly in developing countries, to reduce the health impact of domestic use of biomass and coal; 
(c) Water pollution: 
(i) Develop appropriate water pollution control technologies on the basis of health risk assessment; 
(ii) Develop water pollution control capacities in large cities; 
(d) Pesticides: 
Develop mechanisms to control the distribution and use of pesticides in order to minimize the risks to human health by transportation, storage, application and residual effects of pesticides used in agriculture and preservation of wood; 
(e) Solid waste: 
(i) Develop appropriate solid waste disposal technologies on the basis of health risk assessment; 
(ii) Develop appropriate solid waste disposal capacities in large cities; 
(f) Human settlements: Develop programmes for improving health conditions in human settlements, in particular within slums and non-tenured settlements, on the basis of health risk assessment; 
(g) Noise: 
Develop criteria for maximum permitted safe noise exposure levels and promote noise assessment and control as part of environmental health programmes; 
(h) Ionizing and non-ionizing radiation: 
Develop and implement appropriate national legislation, standards and enforcement procedures on the basis of existing international guidelines; 
(i) Effects of ultraviolet radiation: 
Undertake, as a matter of urgency, research on the effects on human health of the increasing ultraviolet radiation reaching the earth's surface as a consequence of depletion of the stratospheric ozone layer; 
(ii) On the basis of the outcome of this research, consider taking appropriate remedial measures to mitigate the above-mentioned effects on human beings; 
(j) Industry and energy production: 
(i) Establish environmental health impact assessment procedures for the planning and development of new industries and energy facilities; 
(ii) Incorporate appropriate health risk analysis in all national programmes for pollution control and management, with particular emphasis on toxic compounds such as lead; 
(iii) Establish industrial hygiene programmes in all major industries for the surveillance of workers' exposure to health hazards; 
(iv) Promote the introduction of environmentally sound technologies within the industry and energy sectors; 
(k) Monitoring and assessment: 
Establish, as appropriate, adequate environmental monitoring capacities for the surveillance of environmental quality and the health status of populations; 
(l) Injury monitoring and reduction: 
(i) Support, as appropriate, the development of systems to monitor the incidence and cause of injury to allow well-targeted intervention/prevention strategies; 
(ii) Develop, in accordance with national plans, strategies in all sectors (industry, traffic and others) consistent with the WHO safe cities and safe communities programmes, to reduce the frequency and severity of injury; 
(iii) Emphasize preventive strategies to reduce occupationally derived diseases and diseases caused by environmental and occupational toxins to enhance worker safety; 
(m) Research promotion and methodology development: 
(i) Support the development of new methods for the quantitative assessment of health benefits and cost associated with different pollution control strategies; 
(ii) Develop and carry out interdisciplinary research on the combined health effects of exposure to multiple environmental hazards, including epidemiological investigations of long-term exposures to low levels of pollutants and the use of biological markers capable of estimating human exposures, adverse effects and susceptibility to environmental agents. 
Means of implementation 
(a) Financing and cost evaluation 
6.42. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme to be about $3 billion, including about $115 million from the international community on grant or concessional terms. These are indicative and order-of-magnitude estimates only and have not been reviewed by Governments. Actual costs and financial terms, including any that are non-concessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. 
(b) Scientific and technological means 
6.43. Although technology to prevent or abate pollution is readily available for a large number of problems, for programme and policy development countries should undertake research within an intersectoral framework. Such efforts should include collaboration with the business sector. Cost/effect analysis and environmental impact assessment methods should be developed through cooperative international programmes and applied to the setting of priorities and strategies in relation to health and development. 
6.44. In the activities listed in paragraph 6.41 (a) to (m) above, developing country efforts should be facilitated by access to and transfer of technology, know-how and information, from the repositories of such knowledge and technologies, in conformity with chapter 34. 
(c) Human resource development 
6.45. Comprehensive national strategies should be designed to overcome the lack of qualified human resources, which is a major impediment to progress in dealing with environmental health hazards. Training should include environmental and health officials at all levels from managers to inspectors. More emphasis needs to be placed on including the subject of environmental health in the curricula of secondary schools and universities and on educating the public. 
(d) Capacity-building 
6.46. Each country should develop the knowledge and practical skills to foresee and identify environmental health hazards, and the capacity to reduce the risks. Basic capacity requirements must include knowledge about environmental health problems and awareness on the part of leaders, citizens and specialists; operational mechanisms for intersectoral and intergovernmental cooperation in development planning and management and in combating pollution; arrangements for involving private and community interests in dealing with social issues; delegation of authority and distribution of resources to intermediate and local levels of government to provide front-line capabilities to meet environmental health needs. 
Notes 
1/ A/45/625, annex. 
2/ Report of the WHO Commission on Health and Environment (Geneva, forthcoming). 

AGENDA 21; Chapter 24. Global Action for Women Towards Sustainable and Equitable Development
Programme Area
Basis for action 
24.1. The international community has endorsed several plans of action and conventions for the full, equal and beneficial integration of women in all development activities, in particular the Nairobi Forward-looking Strategies for the Advancement of Women, 1/ which emphasize women's participation in national and international ecosystem management and control of environment degradation. Several conventions, including the Convention on the Elimination of All Forms of Discrimination against Women (General Assembly resolution 34/180, annex) and conventions of ILO and UNESCO have also been adopted to end gender-based discrimination and ensure women access to land and other resources, education and safe and equal employment. Also relevant are the 1990 World Declaration on the Survival, Protection and Development of Children and the Plan of Action for implementing the Declaration (A/45/625, annex). Effective implementation of these programmes will depend on the active involvement of women in economic and political decision-making and will be critical to the successful implementation of Agenda 21. 
Objectives 
24.2. The following objectives are proposed for national Governments: 
(a) To implement the Nairobi Forward-looking Strategies for the Advancement of Women, particularly with regard to women's participation in national ecosystem management and control of environment degradation; 
(b) To increase the proportion of women decision makers, planners, technical advisers, managers and extension workers in environment and development fields; 
(c) To consider developing and issuing by the year 2000 a strategy of changes necessary to eliminate constitutional, legal, administrative, cultural, behavioural, social and economic obstacles to women's full participation in sustainable development and in public life; 
(d) To establish by the year 1995 mechanisms at the national, regional and international levels to assess the implementation and impact of development and environment policies and programmes on women and to ensure their contributions and benefits; 
(e) To assess, review, revise and implement, where appropriate, curricula and other educational material, with a view to promoting the dissemination to both men and women of gender-relevant knowledge and valuation of women's roles through formal and non-formal education, as well as through training institutions, in collaboration with non-governmental organizations; 
(f) To formulate and implement clear governmental policies and national guidelines, strategies and plans for the achievement of equality in all aspects of society, including the promotion of women's literacy, education, training, nutrition and health and their participation in key decision-making positions and in management of the environment, particularly as it pertains to their access to resources, by facilitating better access to all forms of credit, particularly in the informal sector, taking measures towards ensuring women's access to property rights as well as agricultural inputs and implements; 
(g) To implement, as a matter of urgency, in accordance with country-specific conditions, measures to ensure that women and men have the same right to decide freely and responsibly the number and spacing of their children and have access to information, education and means, as appropriate, to enable them to exercise this right in keeping with their freedom, dignity and personally held values; 
(h) To consider adopting, strengthening and enforcing legislation prohibiting violence against women and to take all necessary administrative, social and educational measures to eliminate violence against women in all its forms. 
Activities 
24.3. Governments should take active steps to implement the following: 
(a) Measures to review policies and establish plans to increase the proportion of women involved as decision makers, planners, managers, scientists and technical advisers in the design, development and implementation of policies and programmes for sustainable development; 
(b) Measures to strengthen and empower women's bureaux, women's non-governmental organizations and women's groups in enhancing capacity-building for sustainable development; 
(c) Measures to eliminate illiteracy among females and to expand the enrolment of women and girls in educational institutions, to promote the goal of universal access to primary and secondary education for girl children and for women, and to increase educational and training opportunities for women and girls in sciences and technology, particularly at the post-secondary level; (d) Programmes to promote the reduction of the heavy workload of women and girl children at home and outside through the establishment of more and affordable nurseries and kindergartens by Governments, local authorities, employers and other relevant organizations and the sharing of household tasks by men and women on an equal basis, and to promote the provision of environmentally sound technologies which have been designed, developed and improved in consultation with women, accessible and clean water, an efficient fuel supply and adequate sanitation facilities; 
(e) Programmes to establish and strengthen preventive and curative health facilities, which include women-centred, women-managed, safe and effective reproductive health care and affordable, accessible, responsible planning of family size and services, as appropriate, in keeping with freedom, dignity and personally held values. Programmes should focus on providing comprehensive health care, including pre-natal care, education and information on health and responsible parenthood, and should provide the opportunity for all women to fully breastfeed at least during the first four months post-partum. Programmes should fully support women's productive and reproductive roles and well-being and should pay special attention to the need to provide equal and improved health care for all children and to reduce the risk of maternal and child mortality and sickness; 
(f) Programmes to support and strengthen equal employment opportunities and equitable remuneration for women in the formal and informal sectors with adequate economic, political and social support systems and services, including child care, particularly day-care facilities and parental leave, and equal access to credit, land and other natural resources; 
(g) Programmes to establish rural banking systems with a view to facilitating and increasing rural women's access to credit and to agricultural inputs and implements; 
(h) Programmes to develop consumer awareness and the active participation of women, emphasizing their crucial role in achieving changes necessary to reduce or eliminate unsustainable patterns of consumption and production, particularly in industrialized countries, in order to encourage investment in environmentally sound productive activities and induce environmentally and socially friendly industrial development; 
(i) Programmes to eliminate persistent negative images, stereotypes, attitudes and prejudices against women through changes in socialization patterns, the media, advertising, and formal and non-formal education; 
(j) Measures to review progress made in these areas, including the preparation of a review and appraisal report which includes recommendations to be submitted to the 1995 world conference on women. 
24.4. Governments are urged to ratify all relevant conventions pertaining to women if they have not already done so. Those that have ratified conventions should enforce and establish legal, constitutional and administrative procedures to transform agreed rights into domestic legislation and should adopt measures to implement them in order to strengthen the legal capacity of women for full and equal participation in issues and decisions on sustainable development. 
24.5. States parties to the Convention on the Elimination of All Forms of Discrimination against Women should review and suggest amendments to it by the year 2000, with a view to strengthening those elements of the Convention related to environment and development, giving special attention to the issue of access and entitlements to natural resources, technology, creative banking facilities and low-cost housing, and the control of pollution and toxicity in the home and workplace. States parties should also clarify the extent of the Convention's scope with respect to the issues of environment and development and request the Committee on the Elimination of Discrimination against Women to develop guidelines regarding the nature of reporting such issues, required under particular articles of the Convention. 
(a) Areas requiring urgent action 
24.6. Countries should take urgent measures to avert the ongoing rapid environmental and economic degradation in developing countries that generally affects the lives of women and children in rural areas suffering drought, desertification and deforestation, armed hostilities, natural disasters, toxic waste and the aftermath of the use of unsuitable agro-chemical products. 
24.7. In order to reach these goals, women should be fully involved in decision-making and in the implementation of sustainable development activities. 
(b) Research, data collection and dissemination of information 
24.8. Countries should develop gender-sensitive databases, information systems and participatory action-oriented research and policy analyses with the collaboration of academic institutions and local women researchers on the following: 
(a) Knowledge and experience on the part of women of the management and conservation of natural resources for incorporation in the databases and information systems for sustainable development; 
(b) The impact of structural adjustment programmes on women. In research done on structural adjustment programmes, special attention should be given to the differential impact of those programmes on women, especially in terms of cut-backs in social services, education and health and in the removal of subsidies on food and fuel; 
(c) The impact on women of environmental degradation, particularly drought, desertification, toxic chemicals and armed hostilities; 
(d) Analysis of the structural linkages between gender relations, environment and development; 
(e) The integration of the value of unpaid work, including work that is currently designated "domestic", in resource accounting mechanisms in order better to represent the true value of the contribution of women to the economy, using revised guidelines for the United Nations System of National Accounts, to be issued in 1993; 
(f) Measures to develop and include environmental, social and gender impact analyses as an essential step in the development and monitoring of programmes and policies; 
(g) Programmes to create rural and urban training, research and resource centres in developing and developed countries that will serve to disseminate environmentally sound technologies to women. 
(c) International and regional cooperation and coordination 
24.9. The Secretary-General of the United Nations should review the adequacy of all United Nations institutions, including those with a special focus on the role of women, in meeting development and environment objectives, and make recommendations for strengthening their capacities. Institutions that require special attention in this area include the Division for the Advancement of Women (Centre for Social Development and Humanitarian Affairs, United Nations Office at Vienna), the United Nations Development Fund for Women (UNIFEM), the International Research and Training Institute for the Advancement of Women (INSTRAW) and the women's programmes of regional commissions. The review should consider how the environment and development programmes of each body of the United Nations system could be strengthened to implement Agenda 21 and how to incorporate the role of women in programmes and decisions related to sustainable development. 
24.10. Each body of the United Nations system should review the number of women in senior policy-level and decision-making posts and, where appropriate, adopt programmes to increase that number, in accordance with Economic and Social Council resolution 1991/17 on the improvement of the status of women in the Secretariat. 
24.11. UNIFEM should establish regular consultations with donors in collaboration with UNICEF, with a view to promoting operational programmes and projects on sustainable development that will strengthen the participation of women, especially low-income women, in sustainable development and in decision-making. UNDP should establish a women's focal point on development and environment in each of its resident representative offices to provide information and promote exchange of experience and information in these fields. Bodies of the United Nations system, governments and non-governmental organizations involved in the follow-up to the Conference and the implementation of Agenda 21 should ensure that gender considerations are fully integrated into all the policies, programmes and activities. 
Means of implementation 
Financing and cost evaluation 
24.12. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this chapter to be about $40 million from the international community on grant or concessional terms. These are indicative and order-of-magnitude estimates only and have not been reviewed by Governments. Actual costs and financial terms, including any that are non-concessional, will depend upon, inter alia, the specific strategies and programmes Governments decide upon for implementation. 
Notes 
1/ Report of the World Conference to Review and Appraise the Achievements of the United Nations Decade for Women: Equality, Development and Peace, Nairobi, 15-26 July 1985 (United Nations publication, Sales No. E.85.IV.10), chap. I, sect. A.

International Conference on Population and Development (ICPD)
Programme of Action of the International Conference on Population and Development 
Chapter 4 : Gender Equality, Equity and Empowerment of Women
A. Empowerment and status of women 
B. The girl child 
C. Male responsibilities and participation 
A. Empowerment and status of women 
Basis for action 
4.1. The empowerment and autonomy of women and the improvement of their political, social, economic and health status is a highly important end in itself. In addition, it is essential for the achievement of sustainable development. The full participation and partnership of both women and men is required in productive and reproductive life, including shared responsibilities for the care and nurturing of children and maintenance of the household. In all parts of the world, women are facing threats to their lives, health and well- being as a result of being overburdened with work and of their lack of power and influence. In most regions of the world, women receive less formal education than men, and at the same time, women's own knowledge, abilities and coping mechanisms often go unrecognized. The power relations that impede women's attainment of healthy and fulfilling lives operate at many levels of society, from the most personal to the highly public. Achieving change requires policy and programme actions that will improve women's access to secure livelihoods and economic resources, alleviate their extreme responsibilities with regard to housework, remove legal impediments to their participation in public life, and raise social awareness through effective programmes of education and mass communication. In addition, improving the status of women also enhances their decision-making capacity at all levels in all spheres of life, especially in the area of sexuality and reproduction. This, in turn, is essential for the long- term success of population programmes. Experience shows that population and development programmes are most effective when steps have simultaneously been taken to improve the status of women. 
4.2. Education is one of the most important means of empowering women with the knowledge, skills and self-confidence necessary to participate fully in the development process. More than 40 years ago, the Universal Declaration of Human Rights asserted that "everyone has the right to education". In 1990, Governments meeting at the World Conference on Education for All in Jomtien, Thailand, committed themselves to the goal of universal access to basic education. But despite notable efforts by countries around the globe that have appreciably expanded access to basic education, there are approximately 960 million illiterate adults in the world, of whom two thirds are women. More than one third of the world's adults, most of them women, have no access to printed knowledge, to new skills or to technologies that would improve the quality of their lives and help them shape and adapt to social and economic change. There are 130 million children who are not enrolled in primary school and 70 per cent of them are girls. 
Objectives 
4.3. The objectives are: 
(a) To achieve equality and equity based on harmonious partnership between men and women and enable women to realize their full potential; 
(b) To ensure the enhancement of women's contributions to sustainable development through their full involvement in policy- and decision-making processes at all stages and participation in all aspects of production, employment, income-generating activities, education, health, science and technology, sports, culture and population-related activities and other areas, as active decision makers, participants and beneficiaries; 
(c) To ensure that all women, as well as men, are provided with the education necessary for them to meet their basic human needs and to exercise their human rights. 
Actions 
4.4. Countries should act to empower women and should take steps to eliminate inequalities between men and women as soon as possible by: 
(a) Establishing mechanisms for women's equal participation and equitable representation at all levels of the political process and public life in each community and society and enabling women to articulate their concerns and needs; 
(b) Promoting the fulfilment of women's potential through education, skill development and employment, giving paramount importance to the elimination of poverty, illiteracy and ill health among women; 
(c) Eliminating all practices that discriminate against women; assisting women to establish and realize their rights, including those that relate to reproductive and sexual health; 
(d) Adopting appropriate measures to improve women's ability to earn income beyond traditional occupations, achieve economic self-reliance, and ensure women's equal access to the labour market and social security systems; 
(e) Eliminating violence against women; 
(f) Eliminating discriminatory practices by employers against women, such as those based on proof of contraceptive use or pregnancy status; 
(g) Making it possible, through laws, regulations and other appropriate measures, for women to combine the roles of child-bearing, breast-feeding and child-rearing with participation in the workforce. 
4.5. All countries should make greater efforts to promulgate, implement and enforce national laws and international conventions to which they are party, such as the Convention on the Elimination of All Forms of Discrimination against Women, that protect women from all types of economic discrimination and from sexual harassment, and to implement fully the Declaration on the Elimination of Violence against Women and the Vienna Declaration and Programme of Action adopted at the World Conference on Human Rights in 1993. Countries are urged to sign, ratify and implement all existing agreements that promote women's rights. 
4.6. Governments at all levels should ensure that women can buy, hold and sell property and land equally with men, obtain credit and negotiate contracts in their own name and on their own behalf and exercise their legal rights to inheritance. 
4.7. Governments and employers are urged to eliminate gender discrimination in hiring, wages, benefits, training and job security with a view to eliminating gender-based disparities in income. 
4.8. Governments, international organizations and non-governmental organizations should ensure that their personnel policies and practices comply with the principle of equitable representation of both sexes, especially at the managerial and policy-making levels, in all programmes, including population and development programmes. 
Specific procedures and indicators should be devised for gender-based analysis of development programmes and for assessing the impact of those programmes on women's social, economic and health status and access to resources. 
4.9. Countries should take full measures to eliminate all forms of exploitation, abuse, harassment and violence against women, adolescents and children. This implies both preventive actions and rehabilitation of victims. Countries should prohibit degrading practices, such as trafficking in women, adolescents and children and exploitation through prostitution, and pay special attention to protecting the rights and safety of those who suffer from these crimes and those in potentially exploitable situations, such as migrant women, women in domestic service and schoolgirls. In this regard, international safeguards and mechanisms for cooperation should be put in place to ensure that these measures are implemented. 
4.10. Countries are urged to identify and condemn the systematic practice of rape and other forms of inhuman and degrading treatment of women as a deliberate instrument of war and ethnic cleansing and take steps to assure that full assistance is provided to the victims of such abuse for their physical and mental rehabilitation. 
4.11. The design of family health and other development interventions should take better account of the demands on women's time from the responsibilities of child-rearing, household work and income-generating activities. Male responsibilities should be emphasized with respect to child-rearing and housework. Greater investments should be made in appropriate measures to lessen the daily burden of domestic responsibilities, the greatest share of which falls on women. Greater attention should be paid to the ways in which environmental degradation and changes in land use adversely affect the allocation of women's time. Women's domestic working environments should not adversely affect their health. 
4.12. Every effort should be made to encourage the expansion and strengthening of grass-roots, community-based and activist groups for women. Such groups should be the focus of national campaigns to foster women's awareness of the full range of their legal rights, including their rights within the family, and to help women organize to achieve those rights. 
4.13. Countries are strongly urged to enact laws and to implement programmes and policies which will enable employees of both sexes to organize their family and work responsibilities through flexible work-hours, parental leave, day-care facilities, maternity leave, policies that enable working mothers to breast-feed their children, health insurance and other such measures. Similar rights should be ensured to those working in the informal sector. 
4.14. Programmes to meet the needs of growing numbers of elderly people should fully take into account that women represent the larger proportion of the elderly and that elderly women generally have a lower socio-economic status than elderly men. 
B. The girl child 
Basis for action 
4.15. Since in all societies discrimination on the basis of sex often starts at the earliest stages of life, greater equality for the girl child is a necessary first step in ensuring that women realize their full potential and become equal partners in development. In a number of countries, the practice of prenatal sex selection, higher rates of mortality among very young girls, and lower rates of school enrolment for girls as compared with boys, suggest that "son preference" is curtailing the access of girl children to food, education and health care. This is often compounded by the increasing use of technologies to determine foetal sex, resulting in abortion of female foetuses. Investments made in the girl child's health, nutrition and education, from infancy through adolescence, are critical. 
Objectives 
4.16. The objectives are: 
(a) To eliminate all forms of discrimination against the girl child and the root causes of son preference, which results in harmful and unethical practices regarding female infanticide and prenatal sex selection; 
(b) To increase public awareness of the value of the girl child, and concurrently, to strengthen the girl child's self-image, self-esteem and status; 
(c) To improve the welfare of the girl child, especially in regard to health, nutrition and education. 
Actions 
4.17. Overall, the value of girl children to both their family and society must be expanded beyond their definition as potential child-bearers and caretakers and reinforced through the adoption and implementation of educational and social policies that encourage their full participation in the development of the societies in which they live. Leaders at all levels of the society must speak out and act forcefully against patterns of gender discrimination within the family, based on preference for sons. One of the aims should be to eliminate excess mortality of girls, wherever such a pattern exists. Special education and public information efforts are needed to promote equal treatment of girls and boys with respect to nutrition, health care, education and social, economic and political activity, as well as equitable inheritance rights. 
4.18. Beyond the achievement of the goal of universal primary education in all countries before the year 2015, all countries are urged to ensure the widest and earliest possible access by girls and women to secondary and higher levels of education, as well as to vocational education and technical training, bearing in mind the need to improve the quality and relevance of that education. 
4.19. Schools, the media and other social institutions should seek to eliminate stereotypes in all types of communication and educational materials that reinforce existing inequities between males and females and undermine girls' self-esteem. Countries must recognize that, in addition to expanding education for girls, teachers' attitudes and practices, school curricula and facilities must also change to reflect a commitment to eliminate all gender bias, while recognizing the specific needs of the girl child. 
4.20. Countries should develop an integrated approach to the special nutritional, general and reproductive health, education and social needs of girls and young women, as such additional investments in adolescent girls can often compensate for earlier inadequacies in their nutrition and health care. 
4.21. Governments should strictly enforce laws to ensure that marriage is entered into only with the free and full consent of the intending spouses. In addition, Governments should strictly enforce laws concerning the minimum legal age of consent and the minimum age at marriage and should raise the minimum age at marriage where necessary. Governments and non-governmental organizations should generate social support for the enforcement of laws on the minimum legal age at marriage, in particular by providing educational and employment opportunities. 
4.22. Governments are urged to prohibit female genital mutilation wherever it exists and to give vigorous support to efforts among non-governmental and community organizations and religious institutions to eliminate such practices. 
4.23. Governments are urged to take the necessary measures to prevent infanticide, prenatal sex selection, trafficking in girl children and use of girls in prostitution and pornography. 
C. Male responsibilities and participation 
Basis for action 
4.24. Changes in both men's and women's knowledge, attitudes and behaviour are necessary conditions for achieving the harmonious partnership of men and women. Men play a key role in bringing about gender equality since, in most societies, men exercise preponderant power in nearly every sphere of life, ranging from personal decisions regarding the size of families to the policy and programme decisions taken at all levels of Government. It is essential to improve communication between men and women on issues of sexuality and reproductive health, and the understanding of their joint responsibilities, so that men and women are equal partners in public and private life. 
Objective 
4.25. The objective is to promote gender equality in all spheres of life, including family and community life, and to encourage and enable men to take responsibility for their sexual and reproductive behaviour and their social and family roles. 
Actions 
4.26. The equal participation of women and men in all areas of family and household responsibilities, including family planning, child-rearing and housework, should be promoted and encouraged by Governments. This should be pursued by means of information, education, communication, employment legislation and by fostering an economically enabling environment, such as family leave for men and women so that they may have more choice regarding the balance of their domestic and public responsibilities. 
4.27. Special efforts should be made to emphasize men's shared responsibility and promote their active involvement in responsible parenthood, sexual and reproductive behaviour, including family planning; prenatal, maternal and child health; prevention of sexually transmitted diseases, including HIV; prevention of unwanted and high-risk pregnancies; shared control and contribution to family income, children's education, health and nutrition; and recognition and promotion of the equal value of children of both sexes. Male responsibilities in family life must be included in the education of children from the earliest ages. Special emphasis should be placed on the prevention of violence against women and children. 
4.28. Governments should take steps to ensure that children receive appropriate financial support from their parents by, among other measures, enforcing child- support laws. Governments should consider changes in law and policy to ensure men's responsibility to and financial support for their children and families. Such laws and policies should also encourage maintenance or reconstitution of the family unit. The safety of women in abusive relationships should be protected. 
4.29. National and community leaders should promote the full involvement of men in family life and the full integration of women in community life. Parents and schools should ensure that attitudes that are respectful of women and girls as equals are instilled in boys from the earliest possible age, along with an understanding of their shared responsibilities in all aspects of a safe, secure and harmonious family life. Relevant programmes to reach boys before they become sexually active are urgently needed. 
Also look at:REPORT OF THE COMMISSION ON THE STATUS OF WOMEN ON ITS 41ST SESSION (1997)

FWCW Platform for Action
Women and Health

C. Women and Health
89. Women have the right to the enjoyment of the highest attainable standardof physical and mental health. The enjoyment of this right is vital to their life and well-being and their ability to participate in all areas of public and private life. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology. However, health and well-being elude the majority of women. A major barrier for women to the achievement of the highest attainable standard of health is inequality, both between men and women and among women in different geographical regions, social classes and indigenous and ethnic groups. In national and international forums, women have emphasized that to attain optimal health throughout the life cycle, equality, including the sharing of family responsibilities, development and peace are necessary conditions. 
90. Women have different and unequal access to and use of basic health resources, including primary health services for the prevention and treatment of childhood diseases, malnutrition, anaemia, diarrhoeal diseases, communicable diseases, malaria and other tropical diseases and tuberculosis, among others. Women also have different and unequal opportunities for the protection, promotion and maintenance of their health. In many developing countries, the lack of emergency obstetric services is also of particular concern. Health policies and programmes often perpetuate gender stereotypes and fail to consider socio-economic disparities and other differences among women and may not fully take account of the lack of autonomy of women regarding their health. Women's health is also affected by gender bias in the health system and by the provision of inadequate and inappropriate medical services to women. 
91. In many countries, especially developing countries, in particular the least developed countries, a decrease in public health spending and, in some cases, structural adjustment, contribute to the deterioration of public health systems. In addition, privatization of health-care systems without appropriate guarantees of universal access to affordable health care further reduces health-care availability. This situation not only directly affects the health of girls and women, but also places disproportionate responsibilities on women, whose multiple roles, including their roles within the family and the community, are often not acknowledged; hence they do not receive the necessary social, psychological and economic support. 
92. Women's right to the enjoyment of the highest standard of health must be secured throughout the whole life cycle in equality with men. Women are affected by many of the same health conditions as men, but women experience them differently. The prevalence among women of poverty and economic dependence, their experience of violence, negative attitudes towards women and girls, racial and other forms of discrimination, the limited power many women have over their sexual and reproductive lives and lack of influence in decision-making are social realities which have an adverse impact on their health. Lack of food and inequitable distribution of food for girls and women in the household, inadequate access to safe water, sanitation facilities and fuel supplies, particularly in rural and poor urban areas, and deficient housing conditions, all overburden women and their families and have a negative effect on their health. Good health is essential to leading a productive and fulfilling life, and the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment. 
93. Discrimination against girls, often resulting from son preference, in access to nutrition and health-care services endangers their current and future health and well-being. Conditions that force girls into early marriage, pregnancy and child-bearing and subject them to harmful practices, such as female genital mutilation, pose grave health risks. Adolescent girls need, but too often do not have, access to necessary health and nutrition services as they mature. Counselling and access to sexual and reproductive health information and services for adolescents are still inadequate or lacking completely, and a young woman's right to privacy, confidentiality, respect and informed consent is often not considered. Adolescent girls are both biologically and psychosocially more vulnerable than boys to sexual abuse, violence and prostitution, and to the consequences of unprotected and premature sexual relations. The trend towards early sexual experience, combined with a lack of information and services, increases the risk of unwanted and too early pregnancy, HIV infection and other sexually transmitted diseases, as well as unsafe abortions. Early child-bearing continues to be an impediment to improvements in the educational, economic and social status of women in all parts of the world. Overall, for young women early marriage and early motherhood can severely curtail educational and employment opportunities and are likely to have a long-term, adverse impact on the quality of their lives and the lives of their children. Young men are often not educated to respect women's self-determination and to share responsibility with women in matters of sexuality and reproduction. 
94. Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. In line with the above definition of reproductive health, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases. 
95. Bearing in mind the above definition, reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents. In the exercise of this right, they should take into account the needs of their living and future children and their responsibilities towards the community. The promotion of the responsible exercise of these rights for all people should be the fundamental basis for government- and community-supported policies and programmes in the area of reproductive health, including family planning. As part of their commitment, full attention should be given to the promotion of mutually respectful and equitable gender relations and particularly to meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality. Reproductive health eludes many of the world's people because of such factors as: inadequate levels of knowledge about human sexuality and inappropriate or poor-quality reproductive health information and services; the prevalence of high-risk sexual behaviour; discriminatory social practices; negative attitudes towards women and girls; and the limited power many women and girls have over their sexual and reproductive lives. Adolescents are particularly vulnerable because of their lack of information and access to relevant services in most countries. Older women and men have distinct reproductive and sexual health issues which are often inadequately addressed. 
96. The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences. 
97. Further, women are subject to particular health risks due to inadequate responsiveness and lack of services to meet health needs related to sexuality and reproduction. Complications related to pregnancy and childbirth are among the leading causes of mortality and morbidity of women of reproductive age in many parts of the developing world. Similar problems exist to a certain degree in some countries with economies in transition. Unsafe abortions threaten the lives of a large number of women, representing a grave public health problem as it is primarily the poorest and youngest who take the highest risk. Most of these deaths, health problems and injuries are preventable through improved access to adequate health-care services, including safe and effective family planning methods and emergency obstetric care, recognizing the right of women and men to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. These problems and means should be addressed on the basis of the report of the International Conference on Population and Development, with particular reference to relevant paragraphs of the Programme of Action of the Conference. In most countries, the neglect of women's reproductive rights severely limits their opportunities in public and private life, including opportunities for education and economic and political empowerment. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights. Shared responsibility between women and men in matters related to sexual and reproductive behaviour is also essential to improving women's health. 
98. HIV/AIDS and other sexually transmitted diseases, the transmission of which is sometimes a consequence of sexual violence, are having a devastating effect on women's health, particularly the health of adolescent girls and young women. They often do not have the power to insist on safe and responsible sex practices and have little access to information and services for prevention and treatment. Women, who represent half of all adults newly infected with HIV/AIDS and other sexually transmitted diseases, have emphasized that social vulnerability and the unequal power relationships between women and men are obstacles to safe sex, in their efforts to control the spread of sexually transmitted diseases. The consequences of HIV/AIDS reach beyond women's health to their role as mothers and caregivers and their contribution to the economic support of their families. The social, developmental and health consequences of HIV/AIDS and other sexually transmitted diseases need to be seen from a gender perspective. 
99. Sexual and gender-based violence, including physical and psychological abuse, trafficking in women and girls, and other forms of abuse and sexual exploitation place girls and women at high risk of physical and mental trauma, disease and unwanted pregnancy. Such situations often deter women from using health and other services. 
100. Mental disorders related to marginalization, powerlessness and poverty, along with overwork and stress and the growing incidence of domestic violence as well as substance abuse, are among other health issues of growing concern to women. Women throughout the world, especially young women, are increasing their use of tobacco with serious effects on their health and that of their children. Occupational health issues are also growing in importance, as a large number of women work in low-paid jobs in either the formal or the informal labour market under tedious and unhealthy conditions, and the number is rising. Cancers of the breast and cervix and other cancers of the reproductive system, as well as infertility affect growing numbers of women and may be preventable, or curable, if detected early. 
101. With the increase in life expectancy and the growing number of older women, their health concerns require particular attention. The long-term health prospects of women are influenced by changes at menopause, which, in combination with life-long conditions and other factors, such as poor nutrition and lack of physical activity, may increase the risk of cardiovascular disease and osteoporosis. Other diseases of ageing and the interrelationships of ageing and disability among women also need particular attention. 
102. Women, like men, particularly in rural areas and poor urban areas, are increasingly exposed to environmental health hazards owing to environmental catastrophes and degradation. Women have a different susceptibility to various environmental hazards, contaminants and substances and they suffer different consequences from exposure to them. 
103. The quality of women's health care is often deficient in various ways, depending on local circumstances. Women are frequently not treated with respect, nor are they guaranteed privacy and confidentiality, nor do they always receive full information about the options and services available. Furthermore, in some countries, over-medicating of women's life events is common, leading to unnecessary surgical intervention and inappropriate medication. 
104. Statistical data on health are often not systematically collected, disaggregated and analysed by age, sex and socio-economic status and by established demographic criteria used to serve the interests and solve the problems of subgroups, with particular emphasis on the vulnerable and marginalized and other relevant variables. Recent and reliable data on the mortality and morbidity of women and conditions and diseases particularly affecting women are not available in many countries. Relatively little is known about how social and economic factors affect the health of girls and women of all ages, about the provision of health services to girls and women and the patterns of their use of such services, and about the value of disease prevention and health promotion programmes for women. Subjects of importance to women's health have not been adequately researched and women's health research often lacks funding. Medical research, on heart disease, for example, and epidemiological studies in many countries are often based solely on men; they are not gender specific. Clinical trials involving women to establish basic information about dosage, side-effects and effectiveness of drugs, including contraceptives, are noticeably absent and do not always conform to ethical standards for research and testing. Many drug therapy protocols and other medical treatments and interventions administered to women are based on research on men without any investigation and adjustment for gender differences. 
105. In addressing inequalities in health status and unequal access to and inadequate health-care services between women and men, Governments and other actors should promote an active and visible policy of mainstreaming a gender perspective in all policies and programmes, so that, before decisions are taken, an analysis is made of the effects for women and men, respectively. 
 

Strategic objective C.1.
Increase women's access throughout the life cycle to appropriate, affordable and quality health care, information and related services 
Actions to be taken 
106. By Governments, in collaboration with non-governmental organizations and employers' and workers' organizations and with the support of international institutions: 
a. Support and implement the commitments made in the Programme of Action of the International Conference on Population and Development, as established in the report of that Conference and the Copenhagen Declaration on Social Development and Programme of Action of the World Summit for Social Development and the obligations of States parties under the Convention on the Elimination of All Forms of Discrimination against Women and other relevant international agreements, to meet the health needs of girls and women of all ages; 
b. Reaffirm the right to the enjoyment of the highest attainable standards of physical and mental health, protect and promote the attainment of this right for women and girls and incorporate it in national legislation, for example; review existing legislation, including health legislation, as well as policies, where necessary, to reflect a commitment to women's health and to ensure that they meet the changing roles and responsibilities of women wherever they reside; 
c. Design and implement, in cooperation with women and community-based organizations, gender-sensitive health programmes, including decentralized health services, that address the needs of women throughout their lives and take into account their multiple roles and responsibilities, the demands on their time, the special needs of rural women and women with disabilities and the diversity of women's needs arising from age and socio-economic and cultural differences, among others; include women, especially local and indigenous women, in the identification and planning of health-care priorities and programmes; remove all barriers to women's health services and provide a broad range of health-care services; 
d. Allow women access to social security systems in equality with men throughout the whole life cycle; 
e. Provide more accessible, available and affordable primary health- care services of high quality, including sexual and reproductive health care, which includes family planning information and services, and giving particular attention to maternal and emergency obstetric care, as agreed to in the Programme of Action of the International Conference on Population and Development; 
f. Redesign health information, services and training for health workers so that they are gender-sensitive and reflect the user's perspectives with regard to interpersonal and communications skills and the user's right to privacy and confidentiality; these services, information and training should be based on a holistic approach; 
g. Ensure that all health services and workers conform to human rights and to ethical, professional and gender-sensitive standards in the delivery of women's health services aimed at ensuring responsible, voluntary and informed consent; encourage the development, implementation and dissemination of codes of ethics guided by existing international codes of medical ethics as well as ethical principles that govern other health professionals; 
h. Take all appropriate measures to eliminate harmful, medically unnecessary or coercive medical interventions, as well as inappropriate medication and over-medication of women, and ensure that all women are fully informed of their options, including likely benefits and potential side-effects, by properly trained personnel; 
i. Strengthen and reorient health services, particularly primary health care, in order to ensure universal access to quality health services for women and girls; reduce ill health and maternal morbidity and achieve world wide the agreed-upon goal of reducing maternal mortality by at least 50 per cent of the 1990 levels by the year 2000 and a further one half by the year 2015; ensure that the necessary services are available at each level of the health system and make reproductive health care accessible, through the primary health-care system, to all individuals of appropriate ages as soon as possible and no later than the year 2015; 
j. Recognize and deal with the health impact of unsafe abortion as a major public health concern, as agreed in paragraph 8.25 of the Programme of Action of the International Conference on Population and Development
k. In the light of paragraph 8.25 of the Programme of Action of the International Conference on Population and Development, which states: "In no case should abortion be promoted as a method of family planning. All Governments and relevant intergovernmental and non-governmental organizations are urged to strengthen their commitment to women's health, to deal with the health impact of unsafe abortion  as a major public health concern and to reduce the recourse to abortion through expanded and improved family-planning services. Prevention of unwanted pregnancies must always be given the highest priority and every attempt should be made to eliminate the need for abortion. Women who have unwanted pregnancies should have ready access to reliable information and compassionate counselling. Any measures or changes related to abortion within the health system can only be determined at the national or local level according to the national legislative process. In circumstances where abortion is not against the law, such abortion should be safe. In all cases, women should have access to quality services for the management of complications arising from abortion. Post-abortion counselling, education and family-planning services should be offered promptly, which will also help to avoid repeat abortions", consider reviewing laws containing punitive measures against women who have undergone illegal abortions; 
l. Give particular attention to the needs of girls, especially the promotion of healthy behaviour, including physical activities; take specific measures for closing the gender gaps in morbidity and mortality where girls are disadvantaged, while achieving internationally approved goals for the reduction of infant and child mortality - specifically, by the year 2000, the reduction of mortality rates of infants and children under five years of age by one third of the 1990 level, or 50 to 70 per 1,000 live births, whichever is less; by the year 2015 an infant mortality rate below 35 per 1,000 live births and an under-five mortality rate below 45 per 1,000; 
m. Ensure that girls have continuing access to necessary health and nutrition information and services as they mature, to facilitate a healthful transition from childhood to adulthood; 
n. Develop information, programmes and services to assist women to understand and adapt to changes associated with ageing and to address and treat the health needs of older women, paying particular attention to those who are physically or psychologically dependent; 
o. Ensure that girls and women of all ages with any form of disability receive supportive services; 
p. Formulate special policies, design programmes and enact the legislation necessary to alleviate and eliminate environmental and occupational health hazards associated with work in the home, in the workplace and elsewhere with attention to pregnant and lactating women; 
q. Integrate mental health services into primary health-care systems or other appropriate levels, develop supportive programmes and train primary health workers to recognize and care for girls and women of all ages who have experienced any form of violence especially domestic violence, sexual abuse or other abuse resulting from armed and non-armed conflict; 
r. Promote public information on the benefits of breast-feeding; examine ways and means of implementing fully the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes, and enable mothers to breast-feed their infants by providing legal, economic, practical and emotional support; 
s. Establish mechanisms to support and involve non-governmental organizations, particularly women's organizations, professional groups and other bodies working to improve the health of girls and women, in government policy-making, programme design, as appropriate, and implementation within the health sector and related sectors at all levels; 
t. Support non-governmental organizations working on women's health and help develop networks aimed at improving coordination and collaboration between all sectors that affect health; 
u. Rationalize drug procurement and ensure a reliable, continuous supply of high-quality pharmaceutical, contraceptive and other supplies and equipment, using the WHO Model List of Essential Drugs as a guide, and ensure the safety of drugs and devices through national regulatory drug approval processes; 
v. Provide improved access to appropriate treatment and rehabilitation services for women substance abusers and their families; 
w. Promote and ensure household and national food security, as appropriate, and implement programmes aimed at improving the nutritional status of all girls and women by implementing the commitments made in the Plan of Action on Nutrition of the International Conference on Nutrition, including a reduction world wide of severe and moderate malnutrition among children under the age of five by one half of 1990 levels by the year 2000, giving special attention to the gender gap in nutrition, and a reduction in iron deficiency anaemia in girls and women by one third of the 1990 levels by the year 2000; 
x. Ensure the availability of and universal access to safe drinking water and sanitation and put in place effective public distribution systems as soon as possible; 
y. Ensure full and equal access to health-care infrastructure and services for indigenous women. 
 

Strategic objective C.2.
Strengthen preventive programmes that promote women's health 
Actions to be taken 
107. By Governments, in cooperation with non-governmental organizations, the mass media, the private sector and relevant international organizations, including United Nations bodies, as appropriate: 
a. Give priority to both formal and informal educational programmes that support and enable women to develop self-esteem, acquire knowledge, make decisions on and take responsibility for their own health, achieve mutual respect in matters concerning sexuality and fertility and educate men regarding the importance of women's health and well-being, placing special focus on programmes for both men and women that emphasize the elimination of harmful attitudes and practices, including female genital mutilation, son preference (which results in female infanticide and prenatal sex selection), early marriage, including child marriage, violence against women, sexual exploitation, sexual abuse, which at times is conducive to infection with HIV/AIDS and other sexually transmitted diseases, drug abuse, discrimination against girls and women in food allocation and other harmful attitudes and practices related to the life, health and well-being of women, and recognizing that some of these practices can be violations of human rights and ethical medical principles; 
b. Pursue social, human development, education and employment policies to eliminate poverty among women in order to reduce their susceptibility to ill health and to improve their health; 
c. Encourage men to share equally in child care and household work and to provide their share of financial support for their families, even if they do not live with them; 
d. Reinforce laws, reform institutions and promote norms and practices that eliminate discrimination against women and encourage both women and men to take responsibility for their sexual and reproductive behaviour; ensure full respect for the integrity of the person, take action to ensure the conditions necessary for women to exercise their reproductive rights and eliminate coercive laws and practices; 
e. Prepare and disseminate accessible information, through public health campaigns, the media, reliable counselling and the education system, designed to ensure that women and men, particularly young people, can acquire knowledge about their health, especially information on sexuality and reproduction, taking into account the rights of the child to access to information, privacy, confidentiality, respect and informed consent, as well as the responsibilities, rights and duties of parents and legal guardians to provide, in a manner consistent with the evolving capacities of the child, appropriate direction and guidance in the exercise by the child of the rights recognized in the Convention on the Rights of the Child, and in conformity with the Convention on the Elimination of All Forms of Discrimination against Women; ensure that in all actions concerning children, the best interests of the child are a primary consideration; 
f. Create and support programmes in the educational system, in the workplace and in the community to make opportunities to participate in sport, physical activity and recreation available to girls and women of all ages on the same basis as they are made available to men and boys; 
g. Recognize the specific needs of adolescents and implement specific appropriate programmes, such as education and information on sexual and reproductive health issues and on sexually transmitted diseases, including HIV/AIDS, taking into account the rights of the child and the responsibilities, rights and duties of parents as stated in paragraph 107 (e) above; 
h. Develop policies that reduce the disproportionate and increasing burden on women who have multiple roles within the family and the community by providing them with adequate support and programmes from health and social services; 
i. Adopt regulations to ensure that the working conditions, including remuneration and promotion of women at all levels of the health system, are non-discriminatory and meet fair and professional standards to enable them to work effectively; 
j. Ensure that health and nutritional information and training form an integral part of all adult literacy programmes and school curricula from the primary level; 
k. Develop and undertake media campaigns and information and educational programmes that inform women and girls of the health and related risks of substance abuse and addiction and pursue strategies and programmes that discourage substance abuse and addiction and promote rehabilitation and recovery; 
l. Devise and implement comprehensive and coherent programmes for the prevention, diagnosis and treatment of osteoporosis, a condition that predominantly affects women; 
m. Establish and/or strengthen programmes and services, including media campaigns, that address the prevention, early detection and treatment of breast, cervical and other cancers of the reproductive system; 
n. Reduce environmental hazards that pose a growing threat to health, especially in poor regions and communities; apply a precautionary approach, as agreed to in the Rio Declaration on Environment and Development, adopted by the United Nations Conference on Environment and Development, and include reporting on women's health risks related to the environment in monitoring the implementation of Agenda 21; 
o. Create awareness among women, health professionals, policy makers and the general public about the serious but preventable health hazards stemming from tobacco consumption and the need for regulatory and education measures to reduce smoking as important health promotion and disease prevention activities; 
p. Ensure that medical school curricula and other health-care training include gender-sensitive, comprehensive and mandatory courses on women's health; 
q. Adopt specific preventive measures to protect women, youth and children from any abuse - sexual abuse, exploitation, trafficking and violence, for example - including the formulation and enforcement of laws, and provide legal protection and medical and other assistance. 
 

Strategic objective C.3.
Undertake gender-sensitive initiatives that address sexually transmitted diseases, HIV/AIDS, and sexual and reproductive health issues 
Actions to be taken 
108. By Governments, international bodies including relevant United Nations organizations, bilateral and multilateral donors and non-governmental organizations: 
a. Ensure the involvement of women, especially those infected with HIV/AIDS or other sexually transmitted diseases or affected by the HIV/AIDS pandemic, in all decision-making relating to the development, implementation, monitoring and evaluation of policies and programmes on HIV/AIDS and other sexually transmitted diseases; 
b. Review and amend laws and combat practices, as appropriate, that may contribute to women's susceptibility to HIV infection and other sexually transmitted diseases, including enacting legislation against those socio-cultural practices that contribute to it, and implement legislation, policies and practices to protect women, adolescents and young girls from discrimination related to HIV/AIDS; 
c. Encourage all sectors of society, including the public sector, as well as international organizations, to develop compassionate and supportive, non-discriminatory HIV/AIDS-related policies and practices that protect the rights of infected individuals; 
d. Recognize the extent of the HIV/AIDS pandemic in their countries, taking particularly into account its impact on women, with a view to ensuring that infected women do not suffer stigmatization and discrimination, including during travel; 
e. Develop gender-sensitive multisectoral programmes and strategies to end social subordination of women and girls and to ensure their social and economic empowerment and equality; facilitate promotion of programmes to educate and enable men to assume their responsibilities to prevent HIV/AIDS and other sexually transmitted diseases; 
f. Facilitate the development of community strategies that will protect women of all ages from HIV and other sexually transmitted diseases; provide care and support to infected girls, women and their families and mobilize all parts of the community in response to the HIV/AIDS pandemic to exert pressure on all responsible authorities to respond in a timely, effective, sustainable and gender-sensitive manner; 
g. Support and strengthen national capacity to create and improve gender-sensitive policies and programmes on HIV/AIDS and other sexually transmitted diseases, including the provision of resources and facilities to women who find themselves the principal caregivers or economic support for those infected with HIV/AIDS or affected by the pandemic, and the survivors, particularly children and older persons; 
h. Provide workshops and specialized education and training to parents, decision makers and opinion leaders at all levels of the community, including religious and traditional authorities, on prevention of HIV/AIDS and other sexually transmitted diseases and on their repercussions on both women and men of all ages; 
i. Give all women and health workers all relevant information and education about sexually transmitted diseases including HIV/AIDS and pregnancy and the implications for the baby, including breast- feeding; 
j. Assist women and their formal and informal organizations to establish and expand effective peer education and outreach programmes and to participate in the design, implementation and monitoring of these programmes; 
k. Give full attention to the promotion of mutually respectful and equitable gender relations and, in particular, to meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality; 
l. Design specific programmes for men of all ages and male adolescents, recognizing the parental roles referred to in paragraph 107 (e) above, aimed at providing complete and accurate information on safe and responsible sexual and reproductive behaviour, including voluntary, appropriate and effective male methods for the prevention of HIV/AIDS and other sexually transmitted diseases through, inter alia, abstinence and condom use; 
m. Ensure the provision, through the primary health-care system, of universal access of couples and individuals to appropriate and affordable preventive services with respect to sexually transmitted diseases, including HIV/AIDS, and expand the provision of counselling and voluntary and confidential diagnostic and treatment services for women; ensure that high-quality condoms as well as drugs for the treatment of sexually transmitted diseases are, where possible, supplied and distributed to health services; 
n. Support programmes which acknowledge that the higher risk among women of contracting HIV is linked to high-risk behaviour, including intravenous substance use and substance-influenced unprotected and irresponsible sexual behaviour, and take appropriate preventive measures; 
o. Support and expedite action-oriented research on affordable methods, controlled by women, to prevent HIV and other sexually transmitted diseases, on strategies empowering women to protect themselves from sexually transmitted diseases, including HIV/AIDS, and on methods of care, support and treatment of women, ensuring their involvement in all aspects of such research; 
p. Support and initiate research which addresses women's needs and situations, including research on HIV infection and other sexually transmitted diseases in women, on women-controlled methods of protection, such as non-spermicidal microbicides, and on male and female risk-taking attitudes and practices. 
 

Strategic objective C.4.
Promote research and disseminate information on women's health 
Actions to be taken 
109. By Governments, the United Nations system, health professions, research institutions, non-governmental organizations, donors, pharmaceutical industries and the mass media, as appropriate: 
a. Train researchers and introduce systems that allow for the use of data collected, analysed and disaggregated by, among other factors, sex and age, other established demographic criteria and socio-economic variables, in policy-making, as appropriate, planning, monitoring and evaluation; 
b. Promote gender-sensitive and women-centred health research, treatment and technology and link traditional and indigenous knowledge with modern medicine, making information available to women to enable them to make informed and responsible decisions; 
c. Increase the number of women in leadership positions in the health professions, including researchers and scientists, to achieve equality at the earliest possible date; 
d. Increase financial and other support from all sources for preventive, appropriate biomedical, behavioural, epidemiological and health service research on women's health issues and for research on the social, economic and political causes of women's health problems, and their consequences, including the impact of gender and age inequalities, especially with respect to chronic and non-communicable diseases, particularly cardiovascular diseases and conditions, cancers, reproductive tract infections and injuries, HIV/AIDS and other sexually transmitted diseases, domestic violence, occupational health, disabilities, environmentally related health problems, tropical diseases and health aspects of ageing; 
e. Inform women about the factors which increase the risks of developing cancers and infections of the reproductive tract, so that they can make informed decisions about their health; 
f. Support and fund social, economic, political and cultural research on how gender-based inequalities affect women's health, including etiology, epidemiology, provision and utilization of services and eventual outcome of treatment; 
g. Support health service systems and operations research to strengthen access and improve the quality of service delivery, to ensure appropriate support for women as health-care providers and to examine patterns with respect to the provision of health services to women and use of such services by women; 
h. Provide financial and institutional support for research on safe, effective, affordable and acceptable methods and technologies for the reproductive and sexual health of women and men, including more safe, effective, affordable and acceptable methods for the regulation of fertility, including natural family planning for both sexes, methods to protect against HIV/AIDS and other sexually transmitted diseases and simple and inexpensive methods of diagnosing such diseases, among others; this research needs to be guided at all stages by users and from the perspective of gender, particularly the perspective of women, and should be carried out in strict conformity with internationally accepted legal, ethical, medical and scientific standards for biomedical research; 
i. Since unsafe abortion is a major threat to the health and life of women, research to understand and better address the determinants and consequences of induced abortion, including its effects on subsequent fertility, reproductive and mental health and contraceptive practice, should be promoted, as well as research on treatment of complications of abortions and post-abortion care; 
j. Acknowledge and encourage beneficial traditional health care, especially that practised by indigenous women, with a view to preserving and incorporating the value of traditional health care in the provision of health services, and support research directed towards achieving this aim; 
k. Develop mechanisms to evaluate and disseminate available data and research findings to researchers, policy makers, health professionals and women's groups, among others; 
l. Monitor human genome and related genetic research from the perspective of women's health and disseminate information and results of studies conducted in accordance with accepted ethical standards. 
 

Strategic objective C.5.
Increase resources and monitor follow-up for women's health 
Actions to be taken 
110. By Governments at all levels and, where appropriate, in cooperation with non-governmental organizations, especially women's and youth organizations: 
a. Increase budgetary allocations for primary health care and social services, with adequate support for secondary and tertiary levels, and give special attention to the reproductive and sexual health of girls and women and give priority to health programmes in rural and poor urban areas; 
b. Develop innovative approaches to funding health services through promoting community participation and local financing; increase, where necessary, budgetary allocations for community health centres and community-based programmes and services that address women's specific health needs; 
c. Develop local health services, promoting the incorporation of gender-sensitive community-based participation and self-care and specially designed preventive health programmes; 
d. Develop goals and time-frames, where appropriate, for improving women's health and for planning, implementing, monitoring and evaluating programmes, based on gender-impact assessments using qualitative and quantitative data disaggregated by sex, age, other established demographic criteria and socio-economic variables; 
e. Establish, as appropriate, ministerial and inter-ministerial mechanisms for monitoring the implementation of women's health policy and programme reforms and establish, as appropriate, high- level focal points in national planning authorities responsible for monitoring to ensure that women's health concerns are mainstreamed in all relevant government agencies and programmes. 
111. By Governments, the United Nations and its specialized agencies, international financial institutions, bilateral donors and the private sector, as appropriate: 
a. Formulate policies favourable to investment in women's health and, where appropriate, increase allocations for such investment; 
b. Provide appropriate material, financial and logistical assistance to youth non-governmental organizations in order to strengthen them to address youth concerns in the area of health, including sexual and reproductive health; 
c. Give higher priority to women's health and develop mechanisms for coordinating and implementing the health objectives of the Platform for Action and relevant
international agreements to en