Committee on the elimination of all forms of discrimination against women

 Distr. GENERAL
12 October 1993
ORIGINAL: ENGLISH

COMMITTEE ON THE ELIMINATION OF

  DISCRIMINATION AGAINST WOMEN

Thirteenth session

New York, 17 January-4 February 1994

Item 4 of the provisional agenda*



     *    CEDAW/C/1994/1.





     IMPLEMENTATION OF ARTICLE 21 OF THE CONVENTION ON THE

    ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST WOMEN



Reports provided by specialized agencies of the United Nations

on the implementation of the Convention in areas falling within

the scope of their activities



                 Note by the Secretary-General



                            Addendum





     In accordance with the Convention on the Elimination of All

Forms of Discrimination against Women (General Assembly

resolution 34/180, annex), article 22, the World Health

Organization has submitted to the Committee on the Elimination of

Discrimination against Women, for consideration at its thirteenth

session, the report attached to the present document.





                    WORLD HEALTH ORGANIZATION



                        Introductory note



     On behalf of the Committee, the Secretariat invited the

World Health Organization on 22 June 1993 to submit to the

Committee by 1 September 1993 a report on information provided by

States to the World Health Organization on the implementation of

article 12 and related articles of the Convention which would

supplement the information contained in the reports of those

States parties to the Convention on the Elimination of All Forms

of Discrimination against Women which will be considered at the

thirteenth session.  These are the latest reports of Barbados,

Colombia, Ecuador, Guatemala, Guyana, Japan, Libyan Arab

Jamahiriya, Madagascar, the Netherlands, New Zealand, Norway,

Senegal and Zambia.



     Other information sought by the Committee refers to the

activities, programmes and policy decisions undertaken by WHO to

promote the implementation of article 12 and related articles of

the Convention on the Elimination of All Forms of Discrimination

against Women.



     The report annexed hereto has been submitted in compliance

with the Committee's request.







                            Annex



        Report on the work of the World Health Organization in

the area of women, health and development*



*  This report has been reproduced in the form in which it was

received.

                                                        

[Original:  English]



1.   Within the World Health Organization (WHO), as well as

outside it, interest continues to grow in the links between

women's health, the health of families and communities and social

and economic development of societies.  There is increasing

awareness that neglect of women's health concerns stems from a

failure to recognize and take account of their unique health

needs which are determined by both the physiological differences

between men and women and also by culturally determined

attributes which lead to social and economic inequalities between

the sexes.  Women's health status around the world and throughout

their entire lifespan was the focus of the 1992 Technical

Discussions on "Women, health and development".  A WHO

publication and background document entitled "Women's health: 

across age and frontier" underscored the physiological

differences between men and women and illustrated the diverse

socio-economic factors that determine the health status of women. 

The gender differences in nutritional status, disease prevalence,

availability of health services and quality of health care for

women exemplify the persistent and pervasive effects of

discrimination on women's health status.



2.   Global Commission on Women's Health.  These discussions

built upon WHO's substantial experience in the area of women's

health and led to resolution WHA45.25 Rev.1 which calls, inter

alia, for the creation of a Global Commission on Women's Health,

the terms of reference of which include:  producing an agenda for

action on women's health; making policy-makers aware of women's

health issues by using sex-specific, disaggregated data on

women's socio-economic and health conditions; advocating the

promotion of women's health issues within all development plans,

using all forms of mass media; providing a forum for consultation

and dialogue with women's organizations, women's health advocacy

groups and others who represent the mobilization of women, from

the grass-roots to the highest political levels.



     A Working Group was established in July 1992 to coordinate

follow-up on this resolution.  A notable objective of this Group

has been to capitalize first on existing knowledge and expertise

by ensuring cooperation within technical programmes at all

levels, and between WHO and other appropriate agencies of the

United Nations system and pertinent non-governmental

organizations (NGOs).



     An inter-agency/interregional meeting was thus held in March

1993 which agreed on the importance of approaching women's health

issues within an overall framework of human rights.  Priority

issues in women's health, immediate areas for action and

indicators to monitor changes were agreed upon.  Activities to

address the issues suggested will be selected by each region

according to regional priorities.  Participants advocated the

immediate implementation of such a grass-roots strategy at the

country level so that the Global Commission on Women's Health

itself may be formed before the end of 1993.



3.   Women's health and human rights.  In response to the request

by Member States that the Global Commission on Women's Health

provide input to all major international forums, including the

World Conference on Human Rights, the International Conference on

Population and Development and the Fourth World Conference on

Women, the above-mentioned Working Group commissioned a WHO

document entitled "Human rights in relation to women's health"

which was presented at the World Conference on Human Rights, held

at Vienna in June 1993.  The paper highlights ways in which

existing international human rights laws may be better used to

protect and promote women's health.  The most dynamic feature of

using the human rights framework is its pro-active approach in

which the promotion of a culture of equal worth and dignity of

all human beings is fostered and the principle of

non-discrimination, whether concerning access to existing goods

and services or allowing for participation and freedom of choice,

is respected.



4.   WHO, as the technical agency responsible for global public

health, seeks to bring women and health care providers, needs and

services together into a harmonious and functional relationship. 

In defining women's priority health needs, the objective is to

break the cycle of neglect which afflicts women across the

generations.  The organization is developing interventions which

will lead to rapid and sustained improvement in women's health

status.  Three indicators which reflect the unequal health status

of women and which are amenable to substantial and short-term

improvement have been selected for priority action in a first

phase:  nutrition, fertility and maternal mortality.



5.   Nutrition.  Dealing with the nutritional needs of girls and

women throughout their lives implies developing strategies to end

discrimination in terms of food allocation and nutritional

status.  An enormous burden of ill-health is associated with

malnutrition which causes wasting, blindness from vitamin A

deficiency, mental retardation from iodine deficiency and the

widespread iron deficiency anaemia.  Malnutrition affects women

and girls more than boys, both because of discrimination in

feeding and health care and because of the extra demands for

energy and iron imposed by menstruation, childbearing and

lactation.  Malnutrition also contributes to increased morbidity

and death from a variety of infectious and chronic diseases. 

Anaemia, which affects some 450 million women aged between 15 and

49 years, is the most widespread and neglected nutritional

deficiency disease in the world today, and is largely a problem

for women, particularly during pregnancy and lactation.  The WHO

Nutrition Programme is working to implement a range of

interventions targeting anaemia, including modification of

dietary patterns, alternative treatment schedules, delivery

systems for ferrous sulphate prophylaxis that have fewer side

effects and food fortification.



6.   Improving women's nutritional status, in particular,

removing the burden of chronic fatigue which accompanies anaemia,

will be a vital first step in breaking the cycle of neglect and

ill-health and demonstrating to women that ill-health is not an

immutable state and that simple interventions exist which result

in real changes to their everyday lives.



7.   Fertility.  Changing the realities of women's daily lives is

also at the heart of fertility control.  Access to family

planning information and services would lead to a vast

improvement in women's health.  Giving women power to take free

and informed decisions about when to start and stop childbearing,

and how many children to have, frees them to take better care of

themselves and their families.  The benefits of family planning

to the health of women and children are well established. 

Empowering women to take decisions about their fertility also

empowers them in other domains such as household decision-making

and participation in educational and economic life.



8.   During their reproductive lives women require a range of

contraceptive methods, from the temporary and transient to the

more or less permanent, from barrier to hormonal methods. 

Providing an appropriate range of methods is the challenge WHO is

seeking to address through the preparation of guidelines for

programme managers and planners.  The Family Planning and

Population Unit has sought to promote the integration of family

planning programmes into the broader context of primary health

care services.  In the past, population policies and programmes

have been driven by demographic imperatives rather than health or

quality-of-life goals.  Increasingly, however, voluntary,

individually decided fertility control is seen to be a critical

element in protecting the health of families and communities. 

Success and sustainability will depend on integrating the

perspectives of women and men into the development and

implementation of population policies and programmes.



9.   Maternal health.  Poor nutritional status and high-risk

fertility patterns both contribute to chronic ill-health suffered

by millions of women who experience complications during

pregnancy and delivery, half a million of whom die as a result. 

Women die from infection, high blood pressure, obstructed labour,

unsafe abortion and a range of diseases which are aggravated by

pregnancy such as malaria, hepatitis, rheumatic heart disease and

diabetes.  All can be either prevented or treated through the

application of cost-effective technologies at the community or

health centre.



10.  High-quality services for pregnant women should be available

as close to where women live and work as possible.  The Maternal

Health and Safe Motherhood Programme seeks to encourage

health-care providers to ensure that services are welcoming,

flexible and low-cost.  Accessibility, appropriateness,

affordability and quality are the prime considerations in the

provision of maternal health care.  The Maternal Health and Safe

Motherhood Programme has developed guidelines for the

decentralization of essential obstetric care in order to

facilitate access to care for all women, especially those

disadvantaged by poverty, distance or socio-cultural and economic

barriers.



11.  To make health care accessible to all, WHO is developing

strategies to redress the balance between the health centre and

the hospital.  The Maternal Health and Safe Motherhood Programme

has defined the minimal set of interventions for the care of

mother and baby that should be provided at the health centre. 

Many life-saving procedures can and should be performed by

midwives and other non-physician health workers in the health

centre which has a community-oriented role and is the best

facility to inform, educate and take care of women's and

children's health needs.  The health centre is the place where

the most cost-effective interventions can be provided.



12.  Women's perspectives in health care.  Because removing

inequalities in health status and ensuring equitable access to

care will depend critically on greater collaboration between

health-care systems and families, medical professionals and their

clients, health-care providers and women themselves, the

organization is seeking to stimulate a process whereby programmes

for women's reproductive health are placed in the broader context

of primary health-care services and reproductive choice is

defined as a health issue.  The work of the organization will

increasingly depend on the mobilization of NGOs and women's

groups to ensure that women's perspectives are at the centre of

all maternal health and family-planning strategies.



13.  To this end, the Special Programme for Research, Development

and Research Training in Human Reproduction and the Maternal

Health and Safe Motherhood Programme collaborated to establish

and foster the integration of women's perspectives into research

on human reproduction and into the provision of services for

reproductive health.  In the context of the Meeting of the

Medical Women's International Association for Africa and the Near

East, the two programmes have jointly organized a workshop to

discuss ways and means for ensuring women's input and

participation and to establish a network of interested parties.



14.  Gender-based indicators.  WHO's activities in Women, Health

and Development (WHD) aim to address the question of interactive

relationships between the health of women and their social,

political, cultural and economic status and their contribution to

health and overall development.  Over the years WHD has advocated

integrating gender considerations into health systems.  Among the

important outcomes are:  the promotion, collection and

dissemination of sex-specific health data; gender analysis of the

impact of disease and health-related conditions; promotion of

women's perspectives; participation and leadership in health and

development; and promotion of women's role and status in health

and health-related matters from family to national

decision-making levels.



15.  In accordance with resolution WHA45.25, the Interdivisional

Steering Committee on Women, Health and Development continues its

task of ensuring that the organization's programmes, as well as

the Ninth General Programme of Work, give proper attention to

matters affecting women's health in all areas.



16.  To facilitate the process of incorporating women's

perspectives in WHO's General Programme of Work the Steering

Committee on Women, Health and Development has prepared a

check-list of indicators for programme managers.  It includes a

series of questions, including consideration of the following: 

indicators of gender differentials in health, and access to and

use of health services; the impact of the programme's activities

on the health of women in countries; the provision of services

and the participation of women and/or women's organizations in

health promotion and disease prevention and control; and research

needs as related to women's concerns in the context of primary

health care.



17.  Leadership.  The fourth United Nations Population Fund

(UNFPA)-supported interregional workshop on leadership and

participation of women in maternal and child health and family

planning, held in Washington, D.C., November 1992, resulted in

the further strengthening of the network of multisectoral teams

on women's leadership and participation, which now includes 42

countries throughout all WHO regions.  Efforts are under way to

mobilize resources and support for grass-roots women's

organizations.



18.  WHO has long sought to ensure sex-specific data collection

on mortality and morbidity, focusing particular attention on

collecting data to fill information gaps on issues that affect

only women and that have been neglected in many official

data-collection efforts.  The Division of Family Health continues

to maintain several bibliographic and/or indicator databases on

women's health and has close links with other programme areas

with sex-disaggregated data sets.  It is planned that eventually

these databases will form the starting-point of a comprehensive

bibliographic and indicator database on women's health across the

lifespan, bringing together all available information from

different programme areas.



19.  Stimulated by the activities of the Steering Committee on

Women, Health and Development and by linkages with the Global

Commission on Women's Health, various programme areas are

increasingly becoming aware of the invisibility of women's health

problems.  This has led to efforts to quantify the extent of

under-reporting and to develop research and data-collection

methods to fill the information gap.  An informal working group

on gender and health research has come together, under the

coordination of the Special Programme for Research and Training

in Tropical Diseases (TDR), to discuss gender research issues of

common concern.  One of its activities is the development of a

multi-country intervention study on the development of a "healthy

women counselling guide".  This would focus on women's health

problems and would be used at the community level, for example,

when women take children for immunization or during attendance at

meetings of women's groups and NGOs.



20.  Several programme areas have worked to develop strategies to

reveal the gender aspects of diseases and health conditions.  The

issue of women and drugs was the subject of a consultation held

in August 1993.  The discussions will serve as a basis for a

United Nations system-wide position paper on women, drug abuse

and human immunodeficiency virus (HIV)/acquired immune deficiency

syndrome (AIDS) and will provide an essential contribution to the

1995 conference in Beijing.  The WHD Steering Committee was

convened to coordinate input to the Conference and to ensure a

high profile for women's health on the proposed Platform for

Action.



21.  Women and violence.  In devoting World Health Day 1993 to

the prevention of accidents and injuries, special attention was

drawn to the issue of violence affecting girls and women. 

Violence against women has to be seen in its broadest context,

referring not only to the physical and mental abuse to which

women are subjected but also to the hidden violence that women

face when they suffer from discrimination or are denied the basic

human rights of food, medical care, education and a safe

environment.  A round-table discussion held on the day brought

together a panel composed of health-care providers, women's

groups and women who have themselves suffered abuse to examine

ways of helping both victims and perpetrators.



22.  Another form of violence against women is certain

traditional practices, in particular, female genital mutilation,

which affects over 80 million girls and women in over 30

countries.  The Forty- sixth World Health Assembly adopted a

resolution on Maternal and Child Health and Family Planning

(WHA46.18) that highlighted the importance of eliminating such

harmful traditional practices and other social and behavioural

obstacles affecting the health of women, children and

adolescents.  The Assembly requested that the Director-General

provide additional information on the scope and health

implications of such practices.  WHO continues to provide

technical and financial support for national surveys, for

training of traditional birth attendants, midwives and other

health workers, and for grass-roots initiatives to put a stop to

the perpetration of such practices.



23.  Women at decision-making levels.  With regard to articles 7

and 8 of the Convention, on women at the decision-making level in

WHO, in order to achieve the organization's objectives of

increasing the number of women in all Professional and

higher-graded posts as well as the participation of women in WHO

programmes, technical meetings and meetings of WHO's governing

bodies, Dr. Tomris Trmen, Director of the Division of Family

Health, has been appointed Adviser to the Director-General on the

Employment and Participation of Women in WHO.  The Adviser will

work in close collaboration with the WHO Ad Hoc Group on the

Employment of Women, which is composed of representatives of

Personnel, the WHO Staff Committee and the Fifty-Fifty Group.



24.  The terms of reference of the Adviser include identifying

women both inside and outside the organization with potential for

appointment to decision-making and policy-making positions in WHO

and stimulating a search for qualified women candidates for posts

throughout WHO, through contacts with colleagues, member States,

other agencies, universities, research centres and NGOs.  The

Adviser will be part of the Ad Hoc and Senior Staff Selection

Committees in order to contribute to the equitable consideration

of women candidates for vacant posts in the Professional and

higher categories.  It is thus hoped that a mechanism will be set

up to monitor progress towards the achievement of the

organization's objectives for increasing the participation of

women at all levels in WHO.  The Adviser will advise on

innovative measures, drawing on the experience of private and

public bodies, aimed at the equitable recruitment and promotion

of women in WHO and report regularly to the Director-General on

current trends and on further action needed to achieve increased

participation of women in WHO'S programmes.



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